Sustainable Health Promotion Research Articles

In-school toothbrushing programs in Aboriginal communities in New South Wales, Australia: A thematic analysis of teachers' perspectives.

This qualitative analysis explores how school staff interacted with a daily in-school toothbrushing program in three schools in rural areas in Central Northern New South Wales, Australia, with a high population of enrolled Aboriginal students. Three focus groups were conducted in the schools. Participants included school teachers and one Aboriginal Oral Health Aide who manage the daily program. Focus groups were conducted, and where permitted, audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the transcripts. This study was granted ethics approval by the New South Wales Aboriginal Health and Medical Research Council (App 1281/17). Four themes were identified: 1) Belief of Program Need and Benefit; 2) Forming routine; 3) Children's responses and 4) Sustainability. School staff embraced the program and valued the need for and benefit of the program for children in their school, seeing it as part of the extended role of the school to promote students' health and well-being. Two important enablers for the program's sustainability emerged; promoting and supporting local school leadership and training existing school staff or local Aboriginal people to manage it. Training local Aboriginal people or existing school staff to implement a daily in-school toothbrushing program and facilitating school leadership is an important enabler for sustainable oral health promotion, including in-school toothbrushing programs, in Aboriginal communities.

Prevalence of metabolic syndrome and its determinants among Iranian adults: evidence of IraPEN survey on a bi-ethnic population

Metabolic syndrome (MetS) is a growing public health concern worldwide. It has been demonstrated that individuals with MetS are at an increased risk of cardiovascular events and diabetes. We aimed to investigate the prevalence of MetS and its components among Turkic and Kurds ethnic groups in a bi-ethnic (Turk and Kurd) population. This cross-sectional study is part of the national health transformation plan created in response to the emerging epidemic of non-communicable diseases (Iran’s Package of Essential Non-communicable Disease study), launched in 2014 in Naqadeh, Iran. In total, 3506 participants aged 30–70 years were randomly included in the study from urban and rural regions. Cardio-metabolic risk factors related to MetS diagnosis and other related sociodemographic factors were assessed for men and women in both the Turk and the Kurd population. Multivariate logistic regressions were applied to identify MetS -associated factors among both the Turk and the Kurd population. The mean (SD) age of the participants was 49.6 (12.3) years. Of the participants, 56.2% (n = 1969) were women, and 43.8% (n = 1537) were men. Three-fifths of the participants were Turk (60.3%, n = 1751). The overall prevalence of MetS was 37.05%, with a higher prevalence in women (49.8% versus 24.3% in men). The prevalence of MetS and its components among Turk people (41.6%) were significantly higher than that among Kurd people (33.9%) (p < 0.0001). In addition, the prevalence of MetS was higher among women, urban, and older people for both ethnicities. Strong associations were found between MetS prevalence and being older, being female, being overweight, being obese, having a higher waist-to-hip ratio, and having a history of diabetes and cardiovascular disease (CVD) in the family for both Turks and Kurds. The raised waist circumference (WC) is the most prevalent MetS component for Turk men and women. Meanwhile, the most prevalent MetS component for Kurd participants is low high-density lipoprotein for women and a raised WC for men. Significant differences were found between Kurdish men and women for all components, except for a raised WC and a raised fasting blood glucose (p < 0.05). Because the Iranian population features multiple ethnicities, the recognition of the prevalence of MetS components is a major step in establishing intervention strategies for modifying cardio-metabolic risk factors based on the population ethnicities and their socio-demographic, cultural, and lifestyle factors. We recommend future studies for planning an efficient and sustainable health education and promotion program to halt MetS prevalence.

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.

Towards sustainable mental health promotion: trial-based health-economic evaluation of a positive psychology intervention versus usual care

BackgroundMental well-being could be promoted and protected by positive psychology (PP) based interventions. Such interventions may be appealing for people at risk of anxiety and depressive disorders, but health-economic evaluations are scarce. The aim was to examine the cost-effectiveness of a PP intervention.MethodsParticipants with suboptimal levels of mental well-being were randomly assigned to an email guided PP-intervention (n = 137) or a wait-list control group (n = 138) with access to usual care (UC). At baseline and 6 months follow-up, data were collected on health care costs. Outcomes of interest were flourishing mental health and treatment response on anxiety and depressive symptoms.ResultsBootstrapped mean incremental cost-effectiveness ratios were €2359 ($2899) for flourishing, €2959 ($3637) for anxiety and €2578 ($3168) for depression, suggesting appreciable health gains for low additional costs. At a willingness to pay ceiling of €10,000 ($12,290) for a treatment response, the probability that the intervention is deemed cost-effective ranged between 90 and 93%.ConclusionsThe guided PP intervention appears to be a promising strategy as seen from both a public health and a health-economic perspective, especially when there is some willingness to pay. When the PP-intervention is scaled up, then outcome monitoring is recommended to better guarantee the longer term cost-effectiveness of the intervention.Trial registrationThe Netherlands National Trial Register NTR4297. Registered on 29 November 2013. The NTR is part of the WHO Primary Registries.

“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.

Development of tailored feedback reports on organizational capacity for health promotion in African American churches

Standard community-engaged research methods involve reporting research findings back to study participants. Project HEAL is an implementation trial conducted in 14 African American churches. This paper reports on a strengths-based approach to reporting Project HEAL organizational capacity data back to church leadership, through use of individualized church reports. Pastors in each church completed a church organizational capacity assessment. The study team, including community partners representing church leadership, co-created a channel and content to disseminate the capacity data back to Project HEAL church leaders. This consisted of a 4-page lay report that included the church’s capacity scores, and recommendations for future evidence-based health promotion programming matched to their capacity. The study team was able to meet with nine of the 14 churches to review the report, which took an average of six and a half weeks to schedule. The individualized church reports were well-received by pastors, who expressed an intention to share the information with others in the church and to sustain health promotion activities in their organizations. Though the individualized reports were embraced by the pastors, it is unknown whether this process will result in sustainable health promotion in these organizations without further follow-up.

Investigating the level of glaucoma awareness and perception of its risk factors in Anambra State, Nigeria

ObjectivesThe purpose of this study was to investigate the level of awareness of glaucoma and perception of its risk factors in Anambra State, and to examine and evaluate the health seeking behaviour of this target population and its relationship with the development glaucoma. Study designThis is a qualitative study that utilised face-to-face semi-structured interviews to investigate the level of glaucoma awareness in the state. MethodsPurposive, non-random sampling technique was used to recruit the participants, and data were collected from 28 participants [aged 21–73 years] using semi-structured interview. The resulting data were analysed using Nvivo 10 software and Interpretative phenomenological analysis framework. ResultsOf the 28 interviewees, 15 (53.6%) live in urban areas, and 13 (46.4%) live in the rural areas; 11 (39.3%) of the participants were male and 17 (60.7%) were females. In this study, people with more education, and people that live in the urban areas tend to have heard about glaucoma compared with people with less education, and who live in the rural areas; although this sample was too small to make substantive claims. Glaucoma was perceived as ‘a dangerous eye disease that can cause blindness if not treated early; serious eye problem; an incurable eye problem that can eventually result to blindness, and a dangerous eye problem that can easily render a person blind’. Four a priori themes and ten emergent themes were identified. ConclusionsThere is low awareness of glaucoma in this population, and this encourages people to indulge in certain risk behaviours that could predispose them to glaucoma. Therefore, providing sustained health promotion programmes and improved eye care services could help this population immensely in the current struggle against glaucoma blindness.

A local-level evaluation of capacity for health promotion in Lima, Peru: Comas and Callao health center areas utilizing the WHO health promotion capacity profile

Capacity mapping for health promotion in Peru is said to have been done in 2001 and 2010 by the Pan American Health Organization/World Health Organization through a regional exercise, but no specific report is available to examine in detail. This paper reviews the role of what has come to be termed ‘capacity-mapping’ in health promotion in three health center service areas in Peru that are part of a community-based health promotion project partially financed by KOICA. One international capacity mapping tool was used to evaluate the situation of the mentioned services areas, specifically the Health Promotion Capacity Profile, developed by WHO in 2004. Local-level capacity for health promotion was analyzed, and limitations are highlighted. The results of the local-level exercise are discussed and suggestions are made on how to improve the identified components in Lima, Peru that are the most lacking; primarily, the areas of partnerships among public, nongovernmental and private organizations, professional development, and health promotion financing. Community-based interventions such as local health promotion programmes should be encouraged as they foster partnerships and support the strengthening of health promotion education for local staff. In addition, the introduction of an earmarked tobacco tax system could be a solution to the considerable financing issue that also affects local health centers, so that the development of effective and sustainable health promotion programmes can be attained.

English

This paper introduces the concept of supportive supervision in community-based nursing intervention as a supervisory tool among health consumers. It provides overview of supportive supervision as management tool to facilitate delivery of quality service by the health care providers. It also describes the adaptability of this concept to supervision of community members following heath education and training with a view to enhancing and sustaining health promotion and prevention of diseases. The author describes utilisation of this tool in promoting and sustaining mothers’ skills in home management and prevention of malaria at a community level and recommends its usage by community health workers as a substitute to home visit for different populations within a community where there is dwindling human and material resources to carry out home visits so as to promote effective outcome. Key words: Supportive supervision, health education, sustaining, home management of malaria.

Online Positive Interventions to Promote Well-being and Resilience in the Adolescent Population: A Narrative Review.

Numerous studies have shown an alarming prevalence of depression, anxiety, and behavior disorders in youth. Thus, prevention of psychological problems in this population becomes crucial. According to the World Health Organization (1), prevention should also include the promotion and development of the individual’s strengths in order to reduce vulnerability to suffering from mental disorders. In addition, other key elements of prevention are the reach, adoption, implementation, and maintenance of interventions. The information and communication technologies, especially the Internet, have much to offer in terms of the prevention and promotion of positive mental health in adolescents. This paper reviews these fields of research—prevention, positive psychology, Internet, and adolescents—and discusses the potential of positive interventions delivered over the Internet as effective and sustainable health promotion tools. The paper provides a brief description of the systems developed so far and a summary of selected features of the studies detected in the literature review. The overall conclusions are that there is a need for more controlled studies with long-term follow-ups, the interventions should be designed considering the specific features of the target users and the specific contexts where the interventions will be delivered, and they could be enhanced by the use of other technologies, such as smartphones, sensors, or social networks.

Partnering on the PRAISE Program: Putting Health Equity into Practice

Purpose: The purpose of Preventive Health Education Resulting in Action Inspiring Success for Everyone (PRAISE) was to develop a community-driven program to encourage and support churches in sustainable health promotion and assessment efforts to improve African Americans' health knowledge and behaviors in Asheville, North Carolina.Methods: The PRAISE program provided technical support toward gaining recognition and an award for health promotion activities to 10 churches in year 1 and 5 additional churches in year 2. The Results-Based Accountability© (RBA) framework involved documentation of church health promotion activities and surveys of a convenience sample of congregants at nine churches before (presurvey, n=270) and after (postsurvey, n=241) the intervention. Differences in frequency of conduct of and participation in church health promotion activities and in congregant health knowledge and behaviors were assessed in 2015 and 2016.Results: Fourteen of the churches engaged in at least one health promotion activity and more than half offered healthier foods at gatherings, offered exercise opportunities, and held at least three health education activities. Seventy-two percent of congregants reported participating in at least one church health activity at postsurvey compared with 58% at presurvey. The proportion of congregants who had personal health knowledge and the proportion that rated their health as good or better were higher at postsurvey.Conclusion: Building on years of trust and collaboration among churches, local community organizations, and an academic partner, PRAISE in its first 2 years suggests that a community-driven approach can support health promotion and healthy behaviors, advancing health equity efforts.

Use of new media to support passage of Vietnam's national tobacco control legislation

In November 2012, the National Assembly (NA) of Vietnam passed the country's first comprehensive tobacco control legislation.1 Following guidelines of the Framework Convention on Tobacco Control, the legislation was implemented...

Healthy Study Start – A sustainable health promotion project for freshmen

Healthy Study Start – A sustainable health promotion project for freshmen

Medication Adherence Contributes to an Improved Quality of Life in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study.

IntroductionDiabetes mellitus is a chronic disease with a high prevalence world wide. This disease has also been reported to affect the quality of life (QOL) of the patient and their family due to its chronic nature and multi organ involvement. The aim of this study was to analyze the association between adherence to prescribed diabetes medication and diabetes-specific QOL in patients attending Secondary Health Care Facility in Bandung City, Indonesia.MethodsA cross-sectional survey was conducted in the Secondary Health Care Facility in Bandung City, Indonesia. Data were collected between February and April 2014 using consecutive sampling. Adherence was assessed using the eight-item Morisky Medication Adherence Scale while diabetes-specific-QOL was assessed using the Diabetes 39 instrument.ResultsThe results showed that among the patients, 49.4% exhibited low adherence, 29.7% exhibited medium adherence, and 20.9% exhibited high adherence to diabetes medication. Diabetes-specific QOL proved to be highly affected in the sexual functioning domain. Social-burden domain scores were better than overall QOL scores. There was a significant association between adherence and diabetes-specific QOL (p = 0.009) using The Kruskall-Wallis test of significance. The results of the post hoc Mann–Whitney tests (high vs medium adherence, p = 0.084; medium vs low adherence, p = 0.86; and high vs low adherence, p = 0.001) indicated that higher adherence to prescribed diabetes medication contributed to an improved QOL. Multiple regression analysis showed that the predictors of diabetes-specific QOL were adherence and patient income.ConclusionsAdherence to prescribed medication showed a positive effect on diabetes-specific QOL in patients. Patients with a high adherence to medication had an improved QOL. This result is important not only in developing intervention programs for patients but also in improving their QOL through sustainable health promotion.

Sustainable health promotion and resilience in urban environment

Part of resilience and sustainability in any urban environment is establishment and maintaining health. Sustainability in health is a dynamic process in which growth of physical, mental and social health is guaranteed. A city is sustainable when all aspect of life such as economy, environment, health and infrastructure are well defined and very often subjected to optimization.

Approaches to better engage parent-child in health home-visiting programmes: A content analysis.

Home visiting is an evidence-based strategy used to enhance child and family health outcomes. Such primary healthcare endeavours demand the full participation of individual and families. We conducted a review to identify approaches to planning, executing and assessing home-visiting health promotion interventions to determine how parents and children can be best engaged. A structured search (2000-2015) was undertaken using a defined search protocol. The quality of the papers was assessed using standard appraisal tools. Sixteen studies were retrieved. A content analysis of the findings sections of the papers was undertaken and guided by the eight phases of the PRECEDE-PROCEED health promotion planning framework. The analysis found that while all the PRECEDE assessment areas were represented no studies included all phases. Parents and children did not appear to be actively involved in undertaking the assessments and evaluation of the home-visiting health promotion programmes. The findings suggest that there is a need to develop a consistent home-visiting approach that includes comprehensive assessments in the planning phases and parent and child involvement at each step of programme development, implementation and evaluation. This approach enables the development of tailored and sustainable health promotion intervention in order to achieve optimal child health outcomes.

Judging, Tasting, Knowing “Good” Food

Though public discourses of “good” food exert a powerful influence, cooks and eaters construct our own understandings in ways that may simultaneously reflect and resist these norms. Our knowledge of “good” food may sometimes present itself as “vague” (Schaefer et al., this issue), yet is often quite nuanced, based on disparate factors—economic, logistical, nutritional, temporal and political, along with individual preferences—as the articles featured in this special cluster illustrate (Thomas et al., Tsui, this issue). Cooks (and also eaters) often exhibit sophisticated epistemic functions not unlike those of judges. They navigate multiple modes of knowledge—lay and expert, embodied, situated spatially and relationally—between eaters and food environments, between eaters and cooks. Cooks’ and eaters’ discussion of good food reveals moral imperatives translated into foodways, a range of interpersonal and institutional interactions and the traces of social hierarchies, as we see in these articles. Thus, “good” food is less a series of discrete choices by individuals than a domain in which cooks, eaters and their environments constitute interdependent networks. Through the emerging picture of these processes, this special cluster advances our knowledge of the cultural politics of “good” food, the epistemic politics of food “choices,” the workplace as an underexplored site of food cultures and just and sustainable health promotion efforts through food.

Empowerment for healthy nutrition in German communities: a study framework.

Empowerment is seen as a key strategy for sustainable health promotion efforts. However, there is only limited research on how to link the empowerment approach to the promotion of healthy eating, which is a major current public health issue. The article presents the development of a study framework for implementing and evaluating an empowerment intervention for healthy nutrition. This framework was created for a community intervention study meaning to involve elderly citizens in Bavaria, Germany. The study protocol was developed in an iterative process basing on (i) literature reviews on the topics empowerment in relation to healthy nutrition and mixed-methods evaluation, (ii) workshops with empowerment and public health experts and (iii) consultations with local community representatives. Through these measures we identified good practice criteria as well as specific challenges of integrating empowerment and healthy nutrition, e.g. engaging people in healthy nutrition, reconciling participants' nutrition preferences with public health nutrition priorities and evaluating bottom-up activities in the community. Consequences for the study design were deducted from the literature and the consultations, e.g. practical recommendations as to how power could be gradually assigned to group members. A qualitative mixed-method evaluation design was chosen to capture emergent empowerment processes. The study framework presented here is the first on empowerment and nutrition to provide explicit guidance on how empowerment may be applied to healthy nutrition and implemented and evaluated in the community context.

건강캠퍼스 구축을 위한 건강증진대학사업의 필수영역 및 추진전략

Objectives: Health behaviors among young people group are strongly linked to healthy habit or life style in adulthood. This study performed to explore the essential components and effective strategies to develop the standardized program on healthy campus that could contribute to health status and sustainable health promotion among students, faculty, and staff in university health. Methods: To set up the priority and weighting of essential components and strategies on health promoting university, thirty one professionals who had majored in health promotion were selected for Delphi in Oct. 2011. Results: Barriers to success of the health promoting university were lack of interest and policies, incomplete process of health planning, absence of health-related personnel, and inadequate action plan. Essential components of healthy campus were raising fund, healthy policy, participation, human resource, and health promotion programs. Effective strategies were expanding of health promotion programs to improve lifestyle, improvement of campus environment, planning of healthy campus, development of infrastructure, and building up a healthy and safety campus. Conclusions: Health promoting university services support to achieve academic goal of student and helps to reduce absenteeism of university faculty and staff through the on-campus services that are accessible, student-focused, cost-effective, and high quality.Key words: health promoting university, healthy campus, college & university health, essential components

Diabetes Prevention for Latino Youth: Unraveling the Intervention "Black Box".

The translation of research findings into sustainable health promotion and disease prevention programs in community settings remains a challenge. This report describes the process of substantiating a community-developed diabetes prevention program for Latino youth through research. Included are design considerations, measurement strategies, and the context through which the project is culturally grounded for relevance and fit within a local community. The process included (1) refining the program to include salient, stakeholder-identified behavioral components; (2) refining the collaborative effort to embrace the capacity for facilitating relevant behavior change on targeted health-related outcomes to enhance intervention effectiveness; and (3) including the accurate assessment of intervention efficacy via precise assessment of diabetes-related health outcomes. We explain the process of collaborating with community partners to enhance the cultural relevance and sustainability of intervention effects on both individuals and communities. We discuss the rationale for empirical support for academic-community collaborations that function in both a "top-down" and a "bottom-up" manner to advance the science and practice of sustainable and efficacious community health promotion.