Sustainable Health Promotion Programs Research Articles

Designing Intersectoral Environments to Address Isolation/Loneliness as a Risk Factor for Dementia: A Mixed Methods Health Promotion Program

AbstractBackgroundIntersectoral partnerships are critical for effective and sustainable health promotion programs. The aim of our Public Health Agency of Canada Dementia Community Investment project, What Connects Us∼Ce Qui Nous Lie (2020‐2023) was to collaboratively cultivate sociocultural environments worth living in using shared activities and events. In this paper, we present initial results on the effectiveness of using shared activities and events to link academic, arts/culture, mental health, and community‐based organizations and generate a sustainable web of resources for, while positively impacting on, the quality of life and connectivity as a protective factor for persons living with Alzheimer’s and related disorders (PLWA) and their carers.MethodWe used a mixed methods ethnographic approach to describe and measure the impact of shared activities and events on the intersectoral networks by fielding pre‐/post‐partner social network surveys distributed across four social sectors using standard intersectoral network metrics such as density, clustering, centralization, and average path length; as well as measures of centrality and bridging among partners. We measured the impact of this intervention se with pre‐/post‐activity participant surveys using the UCLA Loneliness scale and the CDC health quality of life instrument. All partners and participants answered demographic questions.ResultNetwork measures showed an increase from the initial number of organizations who submitted letters of support for the project (N = 16), as well as increases in network density at the intersectoral level. Patterns of centrality and bridging in the partner data are still emerging, with arts/cultural organizations being the most engaged in facilitating activities and events. For the participants in activities who completed surveys, emerging data demonstrate that those who participated in multiple activities had lower loneliness scores (N = 117 of the 370). Descriptions of context across the project support its upscaling, including the mechanisms that supported the continued growth in number, variety, and modifications of activities despite the impact of Covid‐19 on social distancing.ConclusionCommunity‐based efforts to create environments to reduce loneliness are possible but require effort to create sustainable intersectoral networks amidst structural and other leadership changes.

Designing Attitudinal Environments to Address Stigma: Virtual Film Screenings and Panel Discussions on Dementia in a Health Promotion Program

AbstractBackgroundIntersectoral partnerships are critical for effective and sustainable health promotion programs. Yet stigma and misperception continue to interfere with public engagement in dementia prevention programs, outreach, and willingness to access to dementia and‐or mental health related services for persons living with Alzheimer’s and‐or related disorders and personal carers. The aim of our Public Health Agency of Canada Dementia Community Investment project, What Connects Us∼Ce Qui Nous Lie (2020‐2023), was to collaboratively cultivate sociocultural environments worth living in using shared activities and events to address stigma at the intersection of dementia, aging and mental health. In this paper, we present initial results on the effectiveness of using on‐line, community screenings of short films featuring stories about living with dementia, followed by curated panel discussions with the film directors, arts/culture partners, policy makers and other stakeholders.MethodWe employed a mixed methods ethnographic approach to describe and measure the impact of six film screenings with pre/post‐film and then later post‐discussion measures of semantic sentiment. All discussions were simultaneously interpreted, and based on open‐ended qualitative questions that had been developed with panelists prior to the screening. The qualitative questions asked for one word/phrase responses to generate word clouds in French and English. Three researchers then assessed the words/phrases until agreement on positive or negative value was reached. French words were back‐translated into English prior to analysis using suzy‐net, a natural language processor, to confirm positive/negative valence and to measure changes within each film screening and across all film screenings.ResultThere was a significant change in sentiment from negative (e.g., frustration, lies, loss, confusion) to positive sentiment (e.g., humanity, empathy, compassion, understanding) across all waves within and across the six screenings, with the most change occurring post‐discussion. In addition, partners and project‐related team members were removed from the analysis to test for partner participation confounding with the overall shift in valence remaining the same.ConclusionFilms about living with dementia, and curated questions developed in collaboration with panelists and directors of 1st person experiences can positively impact changes in sentiment about dementia.

Occupational choices of school-going adolescents: a study in the Pitseng Area, Leribe District, Lesotho

Adolescents require opportunities to engage in occupations and need to have the requisite aptitude and agency to choose the occupations they want or need to engage in. Occupations are defined as the everyday activities that people choose to engage in individually or as groups that bring meaning and purpose to their lives. These occupations can be chosen or enforced. There is a paucity of literature around the occupations that adolescents in rural contexts choose and the meaning underlying their choices. This study explored the occupations of school-going adolescents of Pitseng, Lesotho, to gain insight into adolescent behaviour, and the strategies needed to develop sustainable health promotion programs for adolescents in this area. A descriptive qualitative research design was used. Purposive sampling was used to recruit 47 adolescents aged between 13 and 15 years from three high schools in Pitseng, Leribe district, Lesotho. Data was collected using focus group interviews after consent was obtained from the parents or caregivers and assent from the adolescents. Data were analysed thematically using Braun and Clarke's method. Three main themes emerged from the study: realities of customary rural life, facilitators of occupational engagement, and wellbeing versus risky behaviour. Participation in daily routine occupations, cultural norming, resource scarcity, school milieu and leisure engagement were subthemes derived under the first theme. The subthemes identified under the theme facilitators of occupational engagement were intrinsic motivation, and vicarious modelling and peer support. The third theme encompassed the conceptualisation of wellbeing and risky behaviour as subthemes. The adolescents were found to engage in risky behaviour to escape the monotony in their daily lives. This could be attributed to them having fewer choices for recreational activities during their free time. Some adolescents were able to improvise and attempted to enjoy their lives with fewer occupational choices. The natural environment, coupled with creativity, facilitated the engagement of adolescents in fun activities. The dominant influences relating to the adolescents' occupational choices and participation in activities were the impoverished rural context and the traditional inherited practices. The protracted timeframes for completing basic activities and household responsibilities and the scarcity of resources for leisure led to a restricted range of leisure activities. The traditional cultural context influenced gender-based differences in the manifestation of occupations. Despite the challenges, the adolescents showed resilience, creativity and a strong desire to improve their futures. Moreover, in this culturally steeped environment, the school and the community chief may be the two best entry points for organisations planning to facilitate health promotion programs. They are recognised and sanctioned power bases in rural communities. Recommendations for education, leisure, health promotion and further study were made for Pitseng.

Health Promotion Programs to Reduce Noncommunicable Diseases: A Call for Action in Kuwait.

Most public health issues in Kuwait are related to unhealthy behaviours. Research shows that behaviours are the result not only exclusively of personal choices but also of myriads of other social and environmental factors. Kuwait is one of the leading countries in obesity and tobacco use in the world. Cardiovascular diseases stemming from complications related to these and other risk factors are important health issues based on their morbidity and mortality implications. These risks are spread across society and affect the old as well as young boys. The serious gaps between Kuwait’s health-related needs and the existing policies to reduce public health risks in Kuwait create a significant obstacle to healthy behaviour change. Kuwait requires adequate laws, policies, regulations, activities, and programs to promote people’s health. The Socio-Ecological Model (SEM) has been used successfully in health promotion in various behavioural settings, including obesity, physical inactivity, and smoking. We propose the use of SEM as a planning framework in building sustainable health promotion programs in Kuwait while paying attention to other concepts such as systems thinking, authentic community participation, community capacity, policy development, public health infrastructure enhancement, health coaching, and equity.

Rationale and design of the SI! Program for health promotion in elementary students aged 6 to 11 years: A cluster randomized trial

Unhealthy habits in children are increasing at an alarming rate. The school provides a promising setting for effective preventive strategies to improve children's lifestyle behaviors. The SI! Program is a multilevel multicomponent school-based educational intervention aimed at all stages of compulsory education in Spain. Here, we present the design of the SI! Program for Elementary School cluster-randomized controlled trial, targeting children aged 6 to 11 years. This trial aims to study the impact of different timings and intensities of exposure to SI! Program activities on elementary school children and their immediate environment (parents/caregivers, teachers, and school). The trial includes 1770 children from 48 public elementary schools in Madrid (Spain), together with their parents and teachers. Schools and their children were randomly assigned to the intervention group (the SI! curriculum-based educational program over 3 or 6 academic years) or to the control group (standard curriculum). The primary outcomes are the change from baseline at 3-year and 6-year follow-up in children's scores for knowledge, attitudes, and habits (KAH) and health factors (blood pressure, height, weight, waist circumference, and skinfold thickness). Secondary outcomes include 3-year and 6-year changes from baseline in lifestyle questionnaire scores for parents/caregivers and teachers, and in the school environment questionnaire. The overarching goal of the SI! Program is to provide an effective and sustainable health promotion program for the adoption of healthy behaviors in children. The present trial will address the impact and the optimal timing and duration of this educational intervention in the elementary school setting.

“Al-Khabith”—The malignant cunning disease: Sociocultural complexity and social representations of cancer in the occupied Palestinian territory

This qualitative research aims to understand the sociocultural complexity and social representations of cancer in the occupied Palestinian territory. The researcher conducted 16 in-depth semi-structured individual interviews with Palestinians from the occupied Palestinian territory, using thematic analysis as a methodology and social representation theory as the theatrical framework. The findings revealed three main themes. The first theme is social representations of cancer and cancer treatments divided into four subthemes: (1.1) manifestations of dilemmatic indeterminacy and vagueness. The second subtheme (1.2) refers to social representations of cancer in close proximity with death. The third subtheme (1.3) is constituted by metaphorical social representations of cancer, and the fourth (1.4) refers to social re-presentations of cancer. The second theme is the paradoxical social representations of cancer patients as divided into three subthemes: (2.1) pity-based societal responses, (2.2) manifestations of stigma, and (2.3) cancer rumors, a form of collective sense-making. The third theme, religious discourses and social representations of cancer, is divided into three subthemes: (3.1) cancer as predestined by the will of God, (3.2) cancer as a punishment or a trial, and (3.3) a spiritual journey of healing. The implications of this research suggest that social representations research can take a lead in promoting social and health change. The biomedical paradigm alone is failing in Palestine to encounter the sociocultural complexity connected to representations of cancer and its impact on future-health behaviors. Thus, stakeholders and policy-makers in Palestine need to build a mutual interaction between scientific encounters and lay thinking encounters. This requires building community-based health interventions and a sustainable health promotion programs to ensure higher penetration to the social outreach (families, hospital setting, clinics, and schools). To combat ill-health beliefs, stakeholders can benefit from utilization of community participation through creating space for dialogue and debate about cancer and its representations, which accordingly moving towards social and health change.

Assessing Organizational Readiness for a Participatory Occupational Health/Health Promotion Intervention in Skilled Nursing Facilities.

The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was then reviewed to evaluate and modify our selection criteria after the fact. Lessons learned include adding assessment of communication and the structure of problem solving to our selection criteria, improving methods to assess management support in a concrete (potentially nonverbal) form, and obtaining a stated financial commitment and resources to enable the team to function. Assessment of organizational readiness for change is challenging, although necessary to implement effective and sustainable health promotion programs in specific organizations.

Qualitative Inquiry into Church-Based Assets for HIV/AIDS Prevention and Control: A Forum Focus Group Discussion Approach

Assets church members believed they needed to engage in effective HIV/AIDS prevention and control activities. We used the three-step forum focus group discussion (FFGD) methodology to elicit responses from 32 church leaders and lay members, representing five denominations in Aba, Nigeria. Concrete resources, health expertise, finances, institutional support, capacity building, and spiritual support connected to the collective interest of members were indicated as useful for church members to engage in HIV/AIDS prevention and control activities. Adequate planning and delivery of cost-effective, appropriate and sustainable health promotion programs require an understanding of perceived church-based assets.

A cluster randomized trial to evaluate the efficacy of a school-based behavioral intervention for health promotion among children aged 3 to 5.

BackgroundThe onset of inadequate behaviors leading to the development of risk factors for chronic diseases is known to occur early in life. An effective program for health promotion should therefore focus on children and their environment, as the starting point for behavior development. The overarching objective of the Program SI! (Salud Integral - Comprehensive Health) is to intervene at the school level, to establish and develop life-lasting habits that will help preserving health during adulthood. The Program SI! comprises five consecutive subprograms according to the five stages of education in Spain, the first being in preschoolers. This study aims to evaluate the efficacy of Program SI! to establish and improve lifestyle behaviors in children (preschoolers aged 3–5 years), their parents, and teachers, and also improving the school environment. A secondary objective is to evaluate improvements in cardiovascular health-related markers (anthropometric parameters, blood pressure, and dietary and physical activity patterns) in these same children.Methods/design24 public schools from the city of Madrid (Spain) were allocated through stratified randomization to intervention or control. The intervention schools follow the Program SI!, which provides didactic units, emotions cards, healthy tips, and online resources. The intervention schools integrate the Program SI! into their scholar curriculum organized in four complete weeks during each academic year during the 3 years of preschool education. Control schools follow their normal curriculum. Primary outcomes are 1-year, and 3-year changes from baseline of scores for knowledge, attitudes, and habits (KAH) of children, their parents and teachers in regards to a healthy lifestyle. Secondary outcomes are 1-year, and 3-year changes from baseline in clinical and anthropometric parameters of children.DiscussionThe Program SI! is a long-term health promotion program starting in 3 years old. It incorporates the traditional areas of intervention (diet and physical activity), introducing additional components such as knowledge of the human body and management of emotions to achieve a comprehensive intervention. The Program SI! is designed to be an effective, sustainable health promotion program for the adoption of healthy behaviors from early in life.Trial registrationTrial registration number: NCT01579708

Book Review: Health Matters for People with Developmental Disabilities: Creating a Sustainable Health Promotion Program

Book Review: Health Matters for People with Developmental Disabilities: Creating a Sustainable Health Promotion Program