Social-ecological Model Of Health Research Articles

Identifying Factors That Influence Physical Activity and Healthy Aging Among Older Latino Adults.

For older Latinos, some benefits of leisure-time physical activity (LTPA) include enhanced cognitive functioning, decreased loneliness, and reduced premature mortality. Despite LTPA benefits, adults ≥50 years are one of the most inactive age groups in the United States. This qualitative study aimed to add to the limited evidence of LTPA in older Latino adults by exploring the barriers and facilitators for fitness class uptake and park use. Guided by a Social-Ecological Model of Health and Social Determinants of Health theoretical and a phenomenological research design, qualitative research data were collected via 27 personal interviews with Latino adults using a semistructured interview guide. Participants were recruited using purposive sampling strategies in collaboration with community partners. Bicultural data collectors conducted the semistructured interviews over Zoom. Thematic analysis was performed using Dedoose, following an inductive and deductive approach. The main barriers to fitness class attendance and park use were family and/or work commitments, perceived safety, and perceived discrimination. Conversely, the critical facilitators for participation were socialization into a group, social connectedness with group members, fitness instructor characteristics, and exercise history. Findings from this study hold important implications for the design of fitness programming and park-based recreation, including the need to increase the cultural diversity of recreation staff and culturally relevant programming. Future research is needed on time poverty related to family/work commitments and whether discriminatory practices at fitness centers, like ageism and race/ethnicity, influence physical activity behavior.

Attitudes toward dementia and cognitive aging among Syrian refugees resettled in Jordan: A qualitative study

AbstractBackgroundMounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite hosting the majority of the world’s refugee burden, limited‐resource countries like Jordan are facing challenges supporting older migrants’ needs. Syrian refugees experience high rates of dementia risk factors including cardiovascular disease, mental ill‐health, and traumatic exposures. The attitudes toward dementia amongst refugees in Jordan and what cognitive healthcare gaps this population faces remain a research gap. This study’s objectives are to identify refugees’ knowledge and attitudes toward dementia and cognitive aging, and to explore factors that facilitate or prevent access to cognitive healthcare in resource‐limited settings.Method32 older Syrian refugees were recruited through a local community‐based organization and interviewed in four gender‐concordant focus groups. Interviews were transcribed and translated, then coded using inductive thematic analysis.ResultAll refugees were 55 years or older and lived below the Jordanian poverty line. Results were organized using the Social Ecological Model of Health: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to its possible impact and caregiving burden on loved ones, particularly with the stigma that surrounds the disease. 3) At the community level, participants noted that resettlement in Jordan – with shared language, religion, and culture – offered protective effects due to facilitated access to social connection, information, and mental health self‐care. 4) Finally, at the policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging.ConclusionFindings from this study are the first to examine the perceptions of aging Syrian refugees in Jordan toward their cognitive aging. These results could provide essential data as the country develops its national dementia plan. Overall, participants understand their risk factors for dementia and endorse poor cognitive aging in a country that struggles to support its own population’s basic needs.

Development of the Workplace Health Promotion Perception Scale

In this study, we developed a scale to assess employee perceptions of the presence of workplace health promotion (WHP) programs within their organizational environment. After reviewing the literature and following the social-ecological model of health, 14 scale items were generated and initially tested with university staff and students. From these analyses and feedback from reviewers, six items were removed. The remaining eight items were completed by an independent sample of employees in various companies. A two-factor model fit the data well, assessing the perceived support provided by the organization, such as financial support for health improvements at work, and the strategic approach of the organization in addressing workplace health, such as holding meetings and training about improving health. The sub-scales and total score were found to be internally consistent/reliable (α = 0.85 and 0.79, respectively), and correlated significantly with a work performance measure in one of the samples. The new Workplace Health Promotion Perception (WHPP) scale demonstrates initially sound measurement properties for use in organizations, although further research is suggested, and examples provided.

Arts Engagement as a Health Behavior: An Opportunity to Address Mental Health Inequities.

The significance of mental health inequities globally is illustrated by higher rates of anxiety and depression amongst racial and ethnic minority populations as well as individuals of lower socioeconomic status. The COVID-19 pandemic has further exacerbated these pre-existing mental health inequities. With rising mental health concerns, arts engagement offers an accessible, equitable opportunity to combat mental health inequities and impact upstream determinants of health. As the field of public health continues to shift its focus toward social ecological strategies, the social ecological model of health offers an approach that prioritizes social and structural determinants of health. To capture the impacts of arts engagement, this paper creates an applied social ecological model of health while aiming to advocate that engaging in the arts is a protective and rehabilitative behavior for mental health.

Sexual and reproductive health services for autistic young people in the United States: A conceptual model of utilization.

Sexual and reproductive health services promote the ability of people to have safe, satisfying, non-coercive sexual experiences and make informed decisions about pregnancy. Stakeholder input is needed to understand barriers or facilitators to service access for autistic people, who report unmet needs. We recruited 18 autistic people, 15 parents, and 15 service providers in the United States to participate in an interview and two surveys. Using their input, we created a conceptual model of sexual and reproductive health service needs, access barriers, and facilitators. Stakeholders rated a variety of sexual and reproductive health services as important for autistic people, including those with intellectual disability or minimal verbal language. Stakeholders identified barriers to sexual and reproductive health service utilization including lack of service availability, lack of service providers with autism or neurodiversity training, lack of accurate information about autism and sexuality, verbal and communication differences that are not accommodated by service providers, and socio-cultural attitudes about sexuality. Stakeholders identified facilitators to service access including person-centered, trauma-informed care, service accommodations such as clear and detailed expectations, and long-enough appointments. We created a conceptual model based on the social ecological model of health to organize these utilization factors and support future research, provider, and policy action. Stakeholders provided feedback and responded favorably on the model's accuracy, utility for spurring research, practice, and policy improvements, and application to diverse groups of autistic people. The model shows the many feasible ways to support equitable access to services for autistic people.

“You have to drink with a little bit of shame”: Alcohol and other drug use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia

Migrant and ethnic minority groups are underrepresented in alcohol and other drug (AOD) research. This qualitative study explored AOD use among young people from migrant and ethnic minority backgrounds in Melbourne, Australia. We conducted one focus group and 16 interviews and thematically analyzed data drawing on the social-ecological model of health. Theme one showed AOD use was considered a “normal” part of youth identity, particularly for participants who had grown up with peer groups in Australia. Theme two highlighted participant’s sense of responsibility to meet expectations and make informed decisions about AOD use to protect themselves and their friends. Theme three highlighted participant’s risk of experiencing AOD-related stigma through negative stereotypes and fear of consequences within families and communities, particularly among female participants. Participants’ perceptions and experiences differed by individual factors, interpersonal relationships, AOD accessibility across settings and broader gender, cultural and religious norms. Interventions developed with young people from migrant and ethnic minority backgrounds are needed to target the social-ecological factors underpinning AOD use, particularly stigma.

Breastfeeding as a balancing act \u2013 pregnant Swedish women\u2019s voices on breastfeeding

BackgroundBreastfeeding provides health benefits to both women and children. The rationale behind an individual woman’s decision to breastfeed or not can depend on several factors, either independently or in combination. The aim of the current study was to explore attitudes towards breastfeeding among pregnant women in Sweden who intend to breastfeed.MethodsEleven mothers-to-be, one of whom had previous breastfeeding experience, participated in the study. The women were interviewed either by telephone or face-to-face during late pregnancy, with the aim of exploring their attitudes towards breastfeeding. A semi-structured interview-guide was used, and the transcripts of the interviews were analyzed using thematic analysis. The social ecological model of health is the theory-based framework underpinning this study. The model provides a comprehensive approach to understanding the factors that influence breastfeeding intention.ResultsWhen interviewed during pregnancy, women described breastfeeding as a balancing act between societal norms and personal desires. The women perceived a societal pressure to breastfeed, however it was accompanied by boundaries and mixed messages. This perceived pressure was balanced by their own knowledge of breastfeeding, in particular their knowledge of other women’s experience of breastfeeding. When envisioning their future breastfeeding, the women made uncertain and preliminary plans, and negotiated the benefits and drawbacks of breastfeeding. There was a wish for individual breastfeeding support and information.ConclusionsPregnant Swedish women perceive their future breastfeeding as a balancing act between societal norms and personal desires. These findings suggest that while discussing breastfeeding during pregnancy, it could be of interest to collect information from pregnant women on their knowledge of breastfeeding and from where they have gained this knowledge, since stories from family and friends may make them question their own capacity to breastfeed. A thorough review of the woman’s experiences and attitudes of breastfeeding is important in order to offer the best evidence-based breastfeeding support.Trial registrationEthical approval for the study was obtained from the Regional Ethical Review Board in Uppsala (Dnr: 2017/256).

Education Leaders’ Health in the Integral Perspective. A Research Account

The article aims at presenting the integral approach to the health of Polish education leaders’ (head teachers) in light of Ken Wilber’s map (four classes of factors responsible for health), in the social-ecological model of health. Material and Methods: The Matrix of ReflectivenessDevelopment, an original self-observation schedule, was applied as a research tool. 46 head teachers were examined. Results: The results show that the respondents look after their own health the least. Relaxation is something they associate with mental health, while physical health is not high on their list of priorities. Conclusions: The respondents mainly focus on professional and family lives. Very little focus is placed on reflectionand an integral approach to health. The analysis of research results highlights the challenges that education at each level, including health education, must face.

Influence of the social determinants of health on access to healthcare services among refugees in Australia.

Refugees in Australia are not fully utilising the healthcare system for several reasons and this may be affecting their overall health outcomes. This qualitative systematic review examined the influence of the social determinants of health on refugees' access to healthcare services in Australia. Electronic databases were searched using terms relating to refugees, social determinants, healthcare services, barriers, enablers and Australia. Only peer-reviewed studies published in English since 2006, which focused on refugees and specifically discussed social determinants influencing refugees' access to healthcare services in Australia, were included. The studies were critically analysed using standard Critical Appraisal Skills Programme Tools. Eight studies were included in the review. Findings reveal multiple factors influence refugees' access to healthcare in Australia, and these can be conceptualised within a social-ecological model of health; that is, they operate across individual, interpersonal, environmental, organisational and policy levels. The novel finding of this review was the re-occurrence of similar influences across multiple healthcare service settings in Australia. The prevalence and re-occurring nature of the social determinants of health suggests that refugees are experiencing multilayered barriers to accessing Australian healthcare. All levels of a social-ecological model must be addressed in any attempt to break down these barriers.

Abstract P341: Community Environment Associated with Cardiovascular Disease Hospitalization Rates in Denver, Colorado

Introduction: Hospitalization rates for acute myocardial infarction (AMI), coronary heart disease (CHD), and stroke have decreased over time, although trends are debatable for heart failure (HF). These trends are unequally distributed. There is a growing literature documenting the relationship between social and economic characteristics of people’s communities and cardiovascular disease (CVD). Based on a social ecological model of health through the life course, we descriptively examined associations between CVD hospitalization rates and patient characteristics and census tract (CT)-level community environment. Hypothesis: CVD hospitalization rates will be higher in community environments with higher percentages of individuals living below the federal poverty level, racial/ethnic minority groups, and non-residential (i.e., commercial/office, industrial, open space, public/civic, vacant, and miscellaneous space) vs. residential land use. Methods: Colorado Hospital Association (2009-2013) data were used to measure ICD-9 coded hospitalization rates (per 1,000) for Denver, Colorado residents ≥20 years. Data were merged with American Community Survey (2009-2013) and Denver County land use (2010) data. Using chi-square analysis, we examined associations between age-adjusted CVD hospitalization rates (N=15,521) and CT-level community environment (in quartiles) (N=144). Results: Denver’s annual CVD hospitalization rate was 6.6. Patient-level AMI (1.7), CHD (2.8), and HF (2.2) rates were higher among men. Women had higher stroke-related rates (2.4). Across CVD types, rates for those ≥65 years (6.5-13.5) were higher than middle-aged groups (2.1-3.4). Average annual age-adjusted AMI hospitalization rates were higher in CTs with the highest quartile of Hispanic Americans (2.0), Native Americans (1.9), and individuals below poverty (1.9). CHD rates were higher in CTs with higher percentages of Hispanic Americans (3.1), individuals below poverty (3.1), and Native Americans (3.1). HF rates were higher in CTs with higher percentages of industrial/office land use (3.5), individuals below poverty (3.3), and Hispanic Americans (3.2). Stroke rates were higher in CTs with higher percentages of Native Americans (3.0), industrial/office land use (3.0), and African Americans (3.0). The largest disparities for rate ratios comparing the highest to the lowest quartiles for each exposure by CVD outcome were the percentage of individuals below poverty (AMI 2.2; CHD 2.1; HF 2.4; Stroke 1.7), non-Hispanic Whites (AMI 0.7; CHD 0.7; HF 0.7; Stroke 0.7), Hispanic Americans (AMI 1.5; CHD 1.5; HF 1.5), and Native Americans (Stroke 1.30). Conclusions: In conclusion, associations exist between community environment and CVD hospitalization rates, suggesting opportunities for health policy development in Denver’s city government, council districts, and neighborhoods .

A national school-based health lifestyles interventions among Chinese children and adolescents against obesity: rationale, design and methodology of a randomized controlled trial in China.

BackgroundThe prevalence of obesity among children and adolescents has been rapidly rising in Mainland China in recent decades, both in urban and rural areas. There is an urgent need to develop effective interventions to prevent childhood obesity. Limited rigid data regarding children and adolescent overweight prevention in China are available. A national random controlled school-based obesity intervention program was developed in the mainland of China.Methods/DesignThe study was designed as a national multi-centered cluster randomized controlled trial involving more than 70,000 children and adolescents aged 7–18 years from 7 provinces in China. In each center, about 12–16 primary and secondary schools, with totally at least 10000 participants were randomly selected (Primary: Secondary = 1:1). All of the selected schools were randomly allocated to either intervention or control group (Intervention: Control = 1:1).The multi-components school-based and family-involved scheme was conducted within the intervention group for 9 month, while students in the control group followed their usual health practice. The intervention consisted of four components: a) Create supportive school and family environment, b) Health lifestyles education and related compulsory physical activities, c) Instruct and promote school physical education, d) Self-monitor obesity related behaviors. Four types of outcomes including anthropometric, behavioral, blood chemical and physical fitness were measured to assess the effectiveness of the intervention program.DiscussionThis is the first and largest multi-centered school-based obesity intervention program with the consideration of geographical and social-demographic characteristics of the rapidly increased obesity prevalence of Chinese children and adolescent. The intervention is based on Social Cognitive Theory and Social-Ecological Model of Health, and follows a stepwise approach guided by PRECEDE-PROCEED (P-P) Model and Intervention Map. The results of and lesson learned from this study will help guide future school-based national childhood obesity prevention programs in Mainland China.Trial registrationJanuary 22, 2015; Registration number: NCT02343588

Housing and Health: A Social Ecological Perspective on the US Foreclosure Crisis

This study adds to the literature linking housing and health by illustrating how poor health can increase the risk of foreclosure, and how the threat of foreclosure can negatively affect mental health. Our findings support the social ecological model of health and housing disparities and point to health care, employment, and social welfare policies as fundamental social causes that place populations at risk for foreclosure and illness. Medical debt, illness and injury, lack of adequate health insurance, as well as caring for extended family are triggers for mortgage delinquency and risk of home loss. Poor health becomes a key point of entry into mortgage delinquency and foreclosure. Changes in mental health may result from the stress and anxiety of financial hardship, from efforts to remedy the situation, and from loss of ontological security. These effects may worsen prospects for avoiding foreclosure by impairing decision-making, straining marriages to the point of divorce, and reducing homeowners’ earning capacities. These findings are based on a secondary analysis of data from 14 focus groups conducted with low- and moderate-income homeowners threatened with foreclosure and foreclosure intervention professionals in five cities in the USA.

Using the Social-Ecological Model as a research and intervention framework to understand and mitigate obesogenic factors in Samoan populations

Objective. The purpose of this study is to identify the relevant contributions and interactions of political, socioeconomic, cultural, and biological factors toward the increasing rates of obesity in Samoans. The constructs of the Social-Ecological Model of Health, which posit that there are multiple levels of influence on individual health behaviors, are used as a conceptual framework to synthesize the current research investigating obesity and chronic diseases in Samoan populations. Design. Twenty-five studies, representing over 20 years of empirical research with Samoans, were assessed and synthesized. These studies included quantitative and qualitative designs. The reviewed studies used participants from (Western) Samoa and American Samoa jurisdictions, as well as migrant Samoan populations living in the USA and New Zealand. Results. Analysis of the current research revealed a convergence of factors, including the effects of recent political and socioeconomic changes in Samoan jurisdictions, combined with specific Samoan cultural and biological dynamics, which have contributed to the current trends toward poor health in Samoans. Interventions designed to address obesity in Samoans must be able to modify multiple determinants of personal health, with particular emphasis on the appropriate use of Samoan cultural concepts. Conclusions. The application of the Social–Ecological Model of Health, as used in this review, provides guidance for future investigations that may identify multiple factors that contribute to disparities in health. The use of intervention strategies, designed to improve the health status of Samoans, may also indicate methods to address obesity and the development of chronic diseases in other population groups who share similar social conditions and health trends.

The Health of Children in Foster Care

This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses' practice through the lens of the Social Ecological Model of Health, identified interventions using the Minnesota Public Health Intervention Model, and analyzed the school organization using the Bolman-Deal Model (Bolman & Deal, 1997). A purposive sample of nurses was chosen to participate in interviews, and observations of their work and a survey on the frequency of their interventions was implemented. Interviews were analyzed using a phenomenological approach. Four themes derived from the data included structural barriers to client access, nonrecognition of the broad determinants of health, isolationism, and lack of political power. School nurses are aware of foster children's increased health care needs, yet increased services are not provided as a result of a lack of organizational support.

The Health of Children in Foster Care

This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses’ practice through the lens of the Social Ecological Model of Health, identified interventions using the Minnesota Public Health Intervention Model, and analyzed the school organization using the Bolman-Deal Model (Bolman & Deal, 1997). A purposive sample of nurses was chosen to participate in interviews, and observations of their work and a survey on the frequency of their interventions was implemented. Interviews were analyzed using a phenomenological approach. Four themes derived from the data included structural barriers to client access, nonrecognition of the broad determinants of health, isolationism, and lack of political power. School nurses are aware of foster children’s increased health care needs, yet increased services are not provided as a result of a lack of organizational support.