Schools In Melbourne Research Articles

Indicators of a health-promoting local food environment: a conceptual framework to inform urban planning policy and practice.

Global obesity prevalence has risen dramatically over the past 30 years in both adults and children.1 This presents a major public health challenge because of its contribution to chronic disease and inequities in the distribution of obesity within populations.1 Obesity arises from the energy imbalance associated with dietary intake, physical activity and sedentary behaviours.1 Builtenvironment attributes (land use, density, transport) appear to influence these behaviours.2 While associations between builtenvironment attributes and physical activity are well established,2 the relationship between the built environment and dietary behaviour is less well understood and evidence is inconsistent.

Rethinking Encounter: intercultural interactions between parents in Australia’s culturally diverse primary schools

ABSTRACTThis paper critically engages with the idea that everyday spaces of association can be seen as key sites in the development of intercultural understanding for diverse individuals. Drawing on research undertaken in two culturally diverse primary schools in metropolitan Melbourne, it explores the primary school as a key site for intercultural encounters between parents in Australia’s culturally diverse suburbs. This paper identifies a number of barriers limiting productive intercultural encounters between parents within the primary school setting. Specifically, it shows that such encounters are limited by national narratives of diversity, the complex demands of urban life, and the social and emotional benefits of avoiding uncertain interactions with difference. The paper builds on understandings of encounter as a contingent achievement and underscores the complexity of the ‘everyday’ as a space of political possibility.

Health-related impairments in young children with ADHD: a community-based study.

We aimed to examine health-related impairments in young children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls and explore differences in children with ADHD by gender, ADHD subtype and mental health co-morbidity status. Children with ADHD (n = 177) and controls (n = 212) aged 6-8 years were recruited across 43 schools in Melbourne, Australia following a screening (Conners 3 ADHD Index) and case confirmation procedure (Diagnostic Interview Schedule for Children IV). Direct and blinded assessments of height and weight were used to calculate body mass index z-score and to identify overweight/obesity. Parents reported on child global health, sleep problems and physical injuries. Unadjusted and adjusted (socio-demographic factors and co-morbidities) logistic and linear regression were conducted to compare health-related impairments between (1) children with and without ADHD; (2) boys and girls with ADHD; (3) children with ADHD-inattentive and ADHD-combined types; and (4) children with ADHD by internalizing and externalizing disorder status. Children with ADHD had poorer global health than controls when adjusted for socio-demographic characteristics (OR: 2.0; 95% CI 1.1, 3.9); however, this attenuated after adjusting for co-morbidities. In adjusted analyses, children with ADHD had increased odds of moderate/large sleep problems (OR: 3.1; 95% CI 1.4, 6.8), compared with controls. There were no differences between children with and without ADHD in terms of physical injuries or overweight/obesity. Findings were similar when excluding children taking ADHD medication, and health-related impairments did not differ between boys and girls with ADHD. Children with ADHD-combined type had higher BMI z-scores than controls in adjusted analyses (P = 0.04). Children with ADHD and co-occurring internalizing and externalizing co-morbidities were particularly vulnerable to health-related impairments. Young children with ADHD experience a number of health-related impairments, which are exacerbated by the presence of internalizing and externalizing co-morbidities. Clinicians should consider the broader health of children with ADHD in clinical consultations.

Strengthening Support to Families: Basing a Family Support Worker at a Primary School in Melbourne, Australia

This mixed methods study examines the benefits of basing a family support worker (FSW) at a primary school in Melbourne, Australia. The school has a number of high needs families requiring extensive support from school staff. Pre and post intervention data was collected on the time spent on social problems in the school community. These included managing students with behavioural and emotional issues, providing support and practical assistance to parents with problems and liaising with agencies to access support for students and families. Pre and post intervention Strengths and Difficulties Questionnaires were completed by teachers whose students and families were clients of the FSW (n = 8) and compared with non clients (n = 10). Semi-structured interviews were held with FSW clients (n = 6), class teachers (n = 3) the assistant principal, principal and the FSW. Employing a FSW showed a reduction in the amount of time spent on welfare cases for teachers, and therefore a monetary saving for the school. Qualitative data collected from school staff and FSW clients was overwhelmingly positive. Having a FSW based at a primary school provides savings in teacher time, and expenses to the school. Teachers are freed to concentrate on education and the parents valued the relationship provided by the FSW.

Academic Outcomes 2 Years After Working Memory Training for Children With Low Working Memory: A Randomized Clinical Trial.

Working memory training may help children with attention and learning difficulties, but robust evidence from population-level randomized controlled clinical trials is lacking. To test whether a computerized adaptive working memory intervention program improves long-term academic outcomes of children 6 to 7 years of age with low working memory compared with usual classroom teaching. Population-based randomized controlled clinical trial of first graders from 44 schools in Melbourne, Australia, who underwent a verbal and visuospatial working memory screening. Children were classified as having low working memory if their scores were below the 15th percentile on either the Backward Digit Recall or Mister X subtest from the Automated Working Memory Assessment, or if their scores were below the 25th percentile on both. These children were randomly assigned by an independent statistician to either an intervention or a control arm using a concealed computerized random number sequence. Researchers were blinded to group assignment at time of screening. We conducted our trial from March 1, 2012, to February 1, 2015; our final analysis was on October 30, 2015. We used intention-to-treat analyses. Cogmed working memory training, comprising 20 to 25 training sessions of 45 minutes' duration at school. Directly assessed (at 12 and 24 months) academic outcomes (reading, math, and spelling scores as primary outcomes) and working memory (also assessed at 6 months); parent-, teacher-, and child-reported behavioral and social-emotional functioning and quality of life; and intervention costs. Of 1723 children screened (mean [SD] age, 6.9 [0.4] years), 226 were randomized to each arm (452 total), with 90% retention at 1 year and 88% retention at 2 years; 90.3% of children in the intervention arm completed at least 20 sessions. Of the 4 short-term and working memory outcomes, 1 outcome (visuospatial short-term memory) benefited the children at 6 months (effect size, 0.43 [95% CI, 0.25-0.62]) and 12 months (effect size, 0.49 [95% CI, 0.28-0.70]), but not at 24 months. There were no benefits to any other outcomes; in fact, the math scores of the children in the intervention arm were worse at 2 years (mean difference, -3.0 [95% CI, -5.4 to -0.7]; P = .01). Intervention costs were A$1035 per child. Working memory screening of children 6 to 7 years of age is feasible, and an adaptive working memory training program may temporarily improve visuospatial short-term memory. Given the loss of classroom time, cost, and lack of lasting benefit, we cannot recommend population-based delivery of Cogmed within a screening paradigm. anzctr.org.au Identifier: ACTRN12610000486022.

Corporations Taking Deadly Aim

Corporations Taking Deadly Aim Affiliation A. Rob Moodie MBBS, MPHA. Rob Moodie is with the School of Public Health and Family Medicine, College Of Medicine, University of Malawi and the Melbourne School of Population and Global Health, University of Melbourne.CopyRightCorrespondence should be sent to A. Rob Moodie, Professor of Public Health, College of Medicine, Private Bag 360, Blantyre Malawi (e-mail: [email protected]mw). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. https://doi.org/10.2105/AJPH.2016.303164 Accepted: February 25, 2016 Published Online: April 06, 2016

Transforming Health Professionals into Population Health Change Agents.

BackgroundWith the recognition that professional education has not kept pace with the challenges facing the health and human service system, there has been a move to transformative education and learning professional development designed to expand the number of enlightened and empowered change agents with the competence to implement changes at an individual, organisation and systems level.Design and MethodsSince 2010, the Department of Health and Human Services in Victoria, Australia, in collaboration with The University of Melbourne’s School of Population and Global Health, has delivered seven population health short courses aimed to catalyse participants’ transformation into population health change agents. This paper presents key learnings from a combination of evaluation data from six population health short courses using a transformative learning framework from a 2010 independent international commission for health professionals that was designed to support the goals of transformative and interdependent health professionals. Participatory realist evaluation approaches and qualitative methods were used.ResultsEvaluation findings reveal that there were mixed outcomes in facilitating participants’ implementation of population health approaches, and their transformation into population health agents upon their return to their workplaces. Core enablers, barriers and requirements, at individual, organisational and system levels influence the capability of participants to implement population health approaches. The iterative and systemic evolution of the population health short courses, from a one off event to a program of inter-dependent modules, demonstrates sustained commitment by the short course developers and organisers to the promotion of transformative population health learning outcomes.ConclusionsTo leverage this commitment, recognising that professional development is not an event but part of an ongoing transformative process, suggestions to further align recognition of population health professional development programs are presented.Significance for public healthWith decreasing health and wellbeing of whole populations, increasing inequities among specific population groups, health professional educators are increasingly turning their attention to population health. This has implications for implementing evidence into practice. Professional development short courses are being conducted to equip participants (health service managers, health promotion managers and coordinators, health planners, population health planners and senior executives) with knowledge, skills and tools to implement population health approaches and transform them into population health change agents. The findings of this study indicate there were mixed outcomes in facilitating participants’ implementation of population health approaches and their transformation into population health agents upon their return to their workplaces. The study findings informed the evolution of the short courses, from a one off event to a program of interdependent modules, and further reveal that professional development is not an event but part of an on-going transformative process,suggestions to further align recognition of population health professional development programs are presented.

An evaluation of a body image intervention in adolescent girls delivered in single-sex versus co-educational classroom settings

Body dissatisfaction is now recognized as having considerable negative impact on social, psychological, and physical health, particularly in adolescent girls. Consequently, we have developed a six-session co-educational body image intervention (Happy Being Me Co-educational) designed to reduce body dissatisfaction and its risk factors in Grade 7 girls. In addition to evaluating the program's efficacy, we aimed to identify whether girls would benefit equally when it was delivered as a universal intervention to a whole class including both boys and girls (co-educational delivery), or delivered as a selective intervention to girls only (single-sex delivery). Participants were 200 Grade 7 girls from five schools in Melbourne, Australia. Schools were randomly allocated to receive the intervention in single-sex classes (n=74), co-educational classes (n=73), or participate as a no-intervention control (n=53). Girls completed self-report assessments of body dissatisfaction, psychological (internalization of the thin ideal, appearance comparison, and self-esteem) and peer environment (weight-related teasing and appearance conversations) risk factors for body dissatisfaction, and dietary restraint, at baseline, post-intervention, and at 6-month follow-up. Significant improvements in body dissatisfaction and psychological risk factors were observed in the intervention group at post-intervention and these were maintained at follow-up for psychological risk factors. Importantly, no significant differences between universal and selective delivery were observed, suggesting that the intervention is appropriate for dissemination in both modes.

Discussion of “How to Have Sustainable Transportation without Making People Drive Less or Give Up Suburban Living” by Mark Delucchi and Kenneth S. Kurani

Billie Giles-Corti, Ph.D.; Takemi Sugiyama, Ph.D.; Hannah Badland, Ph.D.; Mohammad Javad Koohsari, Ph.D.; and Neville Owen, Ph.D. McCaughey VicHealth Community Wellbeing Unit, Melbourne School of Population and Global Health, Univ. of Melbourne, Level 5, 207 Bouverie St., Melbourne, VIC 3010, Australia (corresponding author). E-mail: b.giles-corti@unimelb.edu.au Spatial Epidemiology and Evaluation Research Group, Sansom Institute for Health Research and School of Population Health, Univ. of South Australia, North Terrace, Adelaide, SA 5000, Australia; Behavioural Epidemiology Laboratory, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd., Melbourne, VIC 3004, Australia. E-mail: Takemi.Sugiyama@unisa.edu.au McCaughey VicHealth Community Wellbeing Unit, Melbourne School of Population and Global Health, Univ. of Melbourne, Level 5, 207 Bouverie St., Melbourne, VIC 3010, Australia. E-mail: hannah .badland@unimelb.edu.au McCaughey VicHealth Community Wellbeing Unit, Melbourne School of Population and Global Health, Univ. of Melbourne, Level 5, 207 Bouverie St., Melbourne, VIC 3010, Australia; Behavioural Epidemiology Laboratory, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. E-mail: mohammad.koohsari@unimelb.edu.au Behavioural Epidemiology Laboratory, Baker IDI Heart and Diabetes Institute, Level 4, 99 Commercial Rd., Melbourne, VIC 3004, Australia. E-mail: Neville.Owen@bakeridi.edu.au

The grammar of agency: Studying possibilities for student agency in science classroom discourse

This article provides better understanding of the challenges related to engaging students in science and, operationalises the concept of “agency” in discursive terms for social research more generally. A core dilemma for educators and science teachers is that many capable students, especially girls, learn to do school well by being compliant, rather than doing science well and being agentic. The study draws from classroom discourse in a secondary school in Melbourne, Australia, filmed over an entire unit of work using four cameras and seven audio tracks. The inquiry is concerned with social acts involving three capable students, girls, in their science classroom and their relative positioning as agentic, or responsible for action in the discourse. The micro analysis reveals otherwise hidden moments of positioning where these girls act as responsible and inquiring. However, compliance and the maintenance of social identities as good students is jointly realised, limiting their agentic participation. The small group is shown to operate like a sub-community of practise, implying the need to better understand joint activity in small groups in science. The paper illustrates the potential of the discursive psychological approach for research concerned with human agency.

Sleep Duration and Sleep Quality: Associations With Depressive Symptoms Across Adolescence

This study explored whether short sleep duration and sleep quality mediate the relationship between age and depressive symptoms. For comparison, we also explored whether depressive symptoms mediate the relationship between age and short sleep duration and sleep quality. The sample comprised 741 adolescents (63.5% female, mean age 15.78 years, range 11.92–19.67 years) in grades 7–12 from 11 secondary schools in metropolitan Melbourne, Australia. Students completed the Pittsburgh Sleep Quality Index (PSQI) and Center for Epidemiologic Studies Depression Scale (CES-D). Path analyses suggested that short sleep duration significantly mediated the relationship between age and depressive symptoms. Poor sleep quality also significantly mediated this relationship when sleep quality was defined by subjective judgement, but not sleep disturbance, sleep efficiency, or sleep onset latency. Depressive symptoms significantly mediated the relationship between age and short sleep duration and sleep quality (subjective judgement, sleep disturbance, sleep efficiency, and sleep onset latency). These findings suggest that the population-wide increase in depressive symptoms across adolescence is partially mediated by sleep-related developmental changes. They also highlight the importance of examining specific sleep problems when investigating the relationship between sleep and mood in this age group.

Carey grammar school

Many senior managers in schools see the acquisition and implementation of new information and communication technologies (ICTs) as key drivers in the advancement of their schools. Over the last 20 years pioneering schools, such as Carey Grammar School (Carey) in Melbourne, Australia have invested heavily in ICTs and created communities of digitally rich individuals. However, the extent to which these schools can be considered to have the attributes of a digital society, where there are shared beliefs, policies and practices with respect to the use of ICTs, has not been fully explored. As schools such as Carey continue to heavily invest in ICTs, perhaps the biggest challenges senior managers will need to resolve are the apparent tensions that exist between the values and attitudes of staff, students and parents populations towards the ever changing digital environment. While it may never be possible for these schools to completely exhibit the characteristics of a digital society, it may be possible to measure the extent to which these schools shares common values and attitudes, and use the findings to inform future digital strategies. To determine the extent that Carey is progressing towards becoming a digital society a questionnaire will be circulated to students in the 11th Grade (16--17 years old) that seeks to present their values and attitudes which underpin their relationship with technology. The analysis of the quantitative information from these questionnaires will provide baseline information that can be used to develop digital strategies in the future.

Parents’ experiences of their children’s supplementary reading intervention: A qualitative exploration

We examined the lived experiences of twelve parents of low-progress readers. Parents were recruited from five state schools in Melbourne and each participated in individual interviews. Analyses revealed that most children received Reading Recovery which was the first and often only option. Parents were divided regarding satisfaction with their children’s reading outcomes following this program. Sources of dissatisfaction included: a waiting list for commencement of intervention, the sudden cessation of Reading Recovery based on the 100-session limit, and Reading Recovery’s theoretical orientation towards constructivist principles. Half the parents independently sought external reading intervention from conventional and non-conventional service providers. Moreover, many parents encountered a personal toll related to their children’s reading difficulty. This study highlights the needs of parents who are important stakeholders in the management of low-progress readers. Our findings call for a more systematic, integrated and mindful approach between educators, policy makers and parents of low-progress readers.

Adrenarche and the Emotional and Behavioral Problems of Late Childhood

PurposeMental and behavioral disorders increase in prevalence with the passage through puberty. Yet the first symptoms for many children emerge between seven and 11 years, before the pubertal rise in gonadal hormones. A possibility that symptom onset may be linked to the adrenarchal rise in androgens has been little explored. MethodsThe Childhood to Adolescence Transition Study recruited a stratified random sample of 1,239 eight–nine year olds from primary schools in Melbourne, Australia. Saliva samples were assayed for dehydroepiandrosterone, dehydroepiandrosterone-sulphate (DHEA-S), and testosterone. Emotional and behavioral problems were assessed through parental report on the Strengths and Difficulties Questionnaire. ResultsIn males, high levels of all androgens were associated with greater total difficulties and peer problems. Higher dehydroepiandrosterone and testosterone were associated with emotional symptoms and DHEA-S with conduct problems. In females, DHEA-S was associated with peer problems. ConclusionsIn late childhood, androgens are associated with emotional and behavioral problems in males, raising a possibility that the adrenarchal transition plays a contributing role. If so, the late primary school years may prove to be an important phase for preventing the onset of mental health and behavioral problems in boys.

The SENSE Study (Sleep and Education: learning New Skills Early): a community cognitive-behavioural therapy and mindfulness-based sleep intervention to prevent depression and improve cardiac health in adolescence.

BackgroundSleep problems are a major risk factor for the emergence of depression in adolescence. The aim of this study was to test whether an intervention for improving sleep habits could prevent the emergence of depression, and improve well-being and cardiovascular indices amongst at-risk adolescents.Methods/DesignA longitudinal randomised controlled trial (RCT) is being conducted across Victorian Secondary Schools in Melbourne, Australia. Adolescents (aged 12–17 years) were defined as at-risk for depression if they reported high levels of anxiety and sleep problems on in-school screening questionnaires and had no prior history of depression (assessed by clinical diagnostic interview). Eligible participants were randomised into either a sleep improvement intervention (based on cognitive behavioral and mindfulness principles) or an active control condition teaching study skills. Both programs consisted of seven 90 minute-long sessions over seven weeks. All participants were required to complete a battery of mood and sleep questionnaires, seven-days of actigraphy, and sleep diary entry at pre- and post-intervention. Participants also completed a cardiovascular assessment and two days of saliva collection at pre-intervention. Participants will repeat all assessments at two-year follow up (ongoing).DiscussionThis will be the first efficacy trial of a selective group-based sleep intervention for the prevention of depression in an adolescent community sample. If effective, the program could be disseminated in schools and greatly improve health outcomes for anxious adolescents.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612001177842. Date of Registration: 06-Nov-2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s40359-015-0096-x) contains supplementary material, which is available to authorized users.

Discretionary space: English teachers discuss curriculum agency

The move towards a national curriculum in Australia has created a new urgency to consider the extent to which teachers can claim agency within their profession. Drawing on data from interview transcripts of a small scale participant centred research project involving secondary English teachers in a school in Melbourne, Australia, this paper explores an apparent contradiction in teachers' perceptions of their role in curriculum decision-making. The focus of the project was to investigate teachers' attitudes to the teaching of poetry in an attempt to explain why this genre of literature is now almost entirely absent from the senior secondary 'taught' curriculum in the Australian state of Victoria. On one hand, the teachers in this study express frustration that the looming introduction of a national curriculum - combined with an increased emphasis on standardised testing - seems set to reduce their agency; on the other, they entertain the possibility that children from diverse socio-economic backgrounds and communities might be better served by a centrally set curriculum than has previously been recognised. We draw on Bernstein's theories to argue that an analysis of this apparent contradiction may lead to the development of more socially just pedagogical practices within the teaching profession and among teacher educators.

Autism spectrum disorder symptoms in children with ADHD: A community-based study

This study examined the prevalence of autism spectrum disorder (ASD) symptoms in a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. We also examined the relationship between ASD symptoms and ADHD subtype, ADHD symptom severity and child gender. Participants were 6–10-year-old children (164 ADHD; 198 non-ADHD control) attending 43 schools in Melbourne, Australia, who were participating in the Children's Attention Project. ADHD was assessed in two stages using the parent and teacher Conners’ 3 ADHD index and the Diagnostic Interview Schedule for Children IV (DISC-IV). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Unadjusted and adjusted linear and logistic regression examined continuous and categorical outcomes, respectively. Children with ADHD had more ASD symptoms than non-ADHD controls (adjusted mean difference=4.0, 95% confidence interval (CI) 2.8; 5.3, p<0.001, effect size=0.7). Boys with ADHD had greater ASD symptom severity than girls with ADHD (adjusted mean difference=2.9, 95% CI 0.8; 5.2, p=0.01, effect size=0.4). Greater ADHD symptom severity was associated with greater ASD symptom severity (regression co-efficient=1.6, 95% CI 1.2; 2.0, p<0.001). No differences were observed by ADHD subtype. Greater hyperactive/impulsive symptoms were associated with greater ASD symptoms (regression coefficient=1.0; 95% CI 0.0; 2.0, p=0.04) however, this finding attenuated in adjusted analyses (p=0.45). ASD symptoms are common in children with ADHD. It is important for clinicians to assess for ASD symptoms to ensure appropriate intervention.

Promoting mental health at school: short-term effectiveness of a popular school-based resiliency programme

Schools are increasingly seen as promising environments for initiatives to prevent mental disorders and to protect and promote mental health. This pilot study examined whether a school-based resiliency programme, Bounce Back, increased protective factors associated with resilience. Thirty-nine children aged 8–10 years (M = 9.17, SD = 0.58) from two schools in Melbourne, Australia, were allocated to the Bounce Back intervention (N = 17) or comparison (N = 22) group. Partial support for the effectiveness of the programme was found. Children's optimism and self-efficacy in the intervention group increased significantly with a large effect size from pre- to post-intervention. These changes were maintained at the 3-month follow-up; however, changes in perceived access to supportive relationships and emotional regulation were not detected. This pilot study represents an important step in the validation of one of the most widely used programmes in Australian schools, and provides some support for its continued use.

The Impact of Family Functioning and School Connectedness on Preadolescent Sense of Mastery

Families and schools are important environments that contribute to the resilience and positive development of preadolescent children. Sense of mastery, including its two central factors of optimism and self-efficacy, forms an important component of resilience during preadolescence (Prince-Embury, 2007). This study examined the interrelationships between family functioning, school connectedness, and sense of mastery in 75 children (46 girls and 29 boys) from a government school in Melbourne, Australia. Data was gathered from students aged 10 to 12 years through three self-report questionnaires. Negative perceptions of family functioning were significantly associated with the resilience factors of low sense of mastery, optimism, and self-efficacy. Higher school connectedness was significantly associated with greater sense of mastery, optimism, and self-efficacy. Additional evaluation revealed school connectedness to partially mediate the relationship between family functioning and sense of mastery. School connectedness appears to be a protective factor against the negative influence of poor family functioning. Findings highlight the important role of school connectedness in preadolescent resilience, as measured in terms of mastery, and suggest that interventions directed to enhance school connectedness are of value, particularly for children from poorly functioning families.

Evaluation of population health short courses: implications for developing and evaluating population health professional development initiatives.

Population health as an approach to planning is key to improving the health and well-being of whole populations and to reduce inequities within and between population groups. The Victorian Department of Health North and West Metropolitan Region, in collaboration with The University of Melbourne (School of Population Health), have delivered four annual population health short courses. The short courses were designed to equip participants with knowledge and skills to implement population health approaches upon their return to their workplaces. For three consecutive years, online surveys (n=41) and semi-structured interviews (n=35), underpinned by participatory and realist evaluation approaches, were conducted to obtain the perceptions and experiences of the population health short course participants. Evaluation findings indicate that participants' understanding of population health concepts increased; however, there were mixed outcomes in assisting participants' implementation of population health approaches upon their return to their workplaces. A core list of perceived requirements, enablers and barriers emerged at an individual, organisational and system level as influencing the capability of participants to implement population health approaches. Evaluation recommendations and actions taken to revise short course iterations are presented, providing evidence that the evaluation approaches were appropriate and increased the use of evaluation learnings. Implications of evaluation findings for professional development practice (i.e. shift from a 'Course' as a one-off event to a Population Health 'Program' of inter-dependent components) and evaluation (i.e. participatory realist evaluation approaches) are presented.