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Ndumbe-Eyoh S. What would it take for health promotion to take structural racism seriously? Glob Health Promot 2020; 27:3-5. [PMID: 33331227 DOI: 10.1177/1757975920972259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sume Ndumbe-Eyoh
- Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health, Antigonish, NS Canada
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102
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Ndumbe-Eyoh S. ¿Qué se necesita para que la promoción de la salud tome en serio al racismo estructural? Glob Health Promot 2020. [DOI: 10.1177/1757975920972622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sume Ndumbe-Eyoh
- Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health, Antigonish, NS, Canada
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103
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Ndumbe-Eyoh S. Que faudrait-il pour que la promotion de la santé prenne au sérieux le racisme structurel ? Glob Health Promot 2020. [DOI: 10.1177/1757975920972621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sume Ndumbe-Eyoh
- Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
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104
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Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for a new approach? Disabil Rehabil 2020; 44:3270-3284. [PMID: 33284644 DOI: 10.1080/09638288.2020.1851783] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Low back pain (LBP) is the leading cause of disability worldwide. Clinical research advocates using the biopsychosocial model (BPS) to manage LBP, however there is still no clear consensus regarding the meaning of this model in physiotherapy and how best to apply it. The aim of this study was to investigate how physiotherapy LBP literature enacts the BPS model. MATERIAL AND METHODS We conducted a critical review using discourse analysis of 66 articles retrieved from the PubMed and Web of Science databases. RESULTS Analysis suggest that many texts conflated the BPS with the biomedical model [Discourse 1: Conflating the BPS with the biomedical model]. Psychological aspects were almost exclusively conceptualised as cognitive and behavioural [Discourse 2: Cognition, behaviour, yellow flags and rapport]. Social context was rarely mentioned [Discourse 3: Brief and occasional social underpinnings]; and other broader aspects of care such as culture and power dynamics received little attention within the texts [Discourse 4: Expanded aspects of care]. CONCLUSION Results imply that multiple important factors such as interpersonal or institutional power relations, cultural considerations, ethical, and social aspects of health may not be incorporated into physiotherapy research and practice when working with people with LBP.IMPLICATIONS FOR REHABILITATIONWhen using the biopsychosocial model with patients with low back pain, researchers narrowly focus on biological and cognitive behavioural aspects of the model.Social and broader aspects such as cultural, interpersonal and institutional power dynamics, appear to be neglected by researchers when taking a biopsychosocial approach to the care of patients with low back pain.The biopsychosocial model may be inadequate to address complexities of people with low back pain, and a reworking of the model may be necessary.There is a lack of research conceptualising how physiotherapy applies the biopsychosocial model in research and practice.
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Affiliation(s)
- Karime Mescouto
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rebecca E Olson
- School of Social Science, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jenny Setchell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Awareness and use of nutrition information predict measured and self-rated diet quality of older adults in the USA. Public Health Nutr 2020; 24:1687-1697. [PMID: 33203482 DOI: 10.1017/s1368980020004681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine: (1) diet quality of older adults, using the Healthy Eating Index 2010 (HEI-2010) and self-rated diet quality, (2) characteristics associated with reported awareness and use of nutrition information and (3) factors associated with HEI score and self-rated diet quality. DESIGN Cross-sectional study. Based on Day 1 and/or Day 2 dietary recalls, the Per-Person method was used to estimate HEI-2010 component and total scores. T-tests and ANOVA were used to compare means. Logistic and linear regressions were used to test for associations with diet quality, controlling for potential confounders. SETTING National Health and Nutrition Examination Survey, 2009-2014. PARTICIPANTS Three thousand and fifty-six adults, aged 60 years and older, who completed at least one 24-h recall and answered questions on awareness and use of nutrition information. RESULTS Mean HEI score for men was significantly lower than for women (56·4 ± 0·6 v. 60·2 ± 0·6, P < 0·0001). Compared with men, more women were aware of (44·8 % v. 33·7 %, P < 0·05) and used (13·7 % v. 5·9 %, P < 0·05) nutrition information. In multivariable analyses, awareness and use of nutrition information were significant predictors of both HEI and self-rated diet quality for both women and men. Groups with lower nutrition awareness included men, non-Whites, participants in nutrition assistance programmes and those with lower education and socio-economic status. CONCLUSIONS Nutrition awareness and use of nutrition information are associated with diet quality in adults 60 years and older. Gaps in awareness of dietary guidelines in certain segments of the older adult population suggest that targeted education may improve diet quality for these groups.
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106
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Townsend B, Friel S, Freeman T, Schram A, Strazdins L, Labonte R, Mackean T, Baum F. Advancing a health equity agenda across multiple policy domains: a qualitative policy analysis of social, trade and welfare policy. BMJ Open 2020; 10:e040180. [PMID: 33158831 PMCID: PMC7651713 DOI: 10.1136/bmjopen-2020-040180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While there is urgent need for policymaking that prioritises health equity, successful strategies for advancing such an agenda across multiple policy sectors are not well known. This study aims to address this gap by identifying successful strategies to advance a health equity agenda across multiple policy domains. DESIGN We conducted in-depth qualitative case studies in three important social determinants of health equity in Australia: employment and social policy (Paid Parental Leave); macroeconomics and trade policy (the Trans Pacific Partnership agreement); and welfare reform (the Northern Territory Emergency Response). The analysis triangulated multiple data sources included 71 semistructured interviews, document analysis and drew on political science theories related to interests, ideas and institutions. RESULTS Within and across case studies we observed three key strategies used by policy actors to advance a health equity agenda, with differing levels of success. The first was the use of multiple policy frames to appeal to a wide range of actors beyond health. The second was the formation of broad coalitions beyond the health sector, in particular networking with non-traditional policy allies. The third was the use of strategic forum shopping by policy actors to move the debate into more popular policy forums that were not health focused. CONCLUSIONS This analysis provides nuanced strategies for agenda-setting for health equity and points to the need for multiple persuasive issue frames, coalitions with unusual bedfellows, and shopping around for supportive institutions outside the traditional health domain. Use of these nuanced strategies could generate greater ideational, actor and institutional support for prioritising health equity and thus could lead to improved health outcomes.
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Affiliation(s)
- Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Toby Freeman
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Ashley Schram
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology and Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ronald Labonte
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Tamara Mackean
- Aboriginal and Torres Strait Islander Health, Flinders University, Adelaide, South Australia, Australia
| | - Fran Baum
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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107
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Shi F, Shaver LG, Kong Y, Yi Y, Aubrey-Bassler K, Asghari S, Etchegary H, Adefemi K, Wang PP. Sociodemographics and their impacts on risk factor awareness and beliefs about cancer and screening: results from a cross-sectional study in Newfoundland and Labrador. BMC Public Health 2020; 20:1513. [PMID: 33023574 PMCID: PMC7539438 DOI: 10.1186/s12889-020-09616-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 09/27/2020] [Indexed: 12/24/2022] Open
Abstract
Background Our objective was to examine cancer risk factor awareness and beliefs about cancer treatment, outcomes, and screening, and how these are mediated by sociodemographic variables, among Newfoundland and Labrador residents. Methods Participants aged 35 to 74 were recruited through Facebook advertising, and a self-administered online questionnaire was used to collect data. Descriptive statistics, Spearman rank correlations, and multivariate logistic regression analyses were performed. Results Of the 1048 participants who responded and met the inclusion criteria for this study, 1019 were selected for this analysis. Risk factor recognition was generally good, though several risk factors had poor awareness: being over 70 years old (53.4% respondents aware), having a low-fiber diet (65.0%), and drinking more than 1 unit of alcohol per day (62.8%). Our results showed that the participants’ awareness of risk factors was significantly associated with higher income level (rs = 0.237, P < 0.001), higher education (rs = 0.231, P < 0.001), living in rural regions (rs = 0.163, P < 0.001), and having a regular healthcare provider (rs = 0.081, P = 0.010). Logistic regression showed that among NL residents in our sample, those with higher income, post-secondary education, those in very good or excellent health, and those with a history of cancer all had higher odds of having more positive beliefs about cancer treatment and outcomes. Those with a history of cancer, and those with very good or excellent health, also had higher odds of having more positive beliefs about cancer screening. Finally, compared to Caucasian/white participants, those who were non-Caucasian/white had lower odds of having more positive beliefs about cancer screening. Conclusion Among adults in NL, there was poor awareness that low-fiber diets, alcohol, and age are risk factors for cancer. Lower income and education, rural residence, and not having a health care provider were associated with lower risk factor awareness. We also found a few associations between sociodemographic factors and beliefs about cancer treatment and outcomes or screening. We stress that while addressing awareness is necessary, so too is improving social circumstances of disadvantaged groups who lack the resources necessary to adopt healthy behaviours.
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Affiliation(s)
- Fuyan Shi
- School of Public Health & Management, Weifang Medical University, Weifang, Shandong, China.,Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | | | - Yujia Kong
- School of Public Health & Management, Weifang Medical University, Weifang, Shandong, China.,Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Yanqing Yi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | | | - Shabnam Asghari
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Holly Etchegary
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Kazeem Adefemi
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada
| | - Peizhong Peter Wang
- School of Public Health & Management, Weifang Medical University, Weifang, Shandong, China. .,Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, A1B 3V6, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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108
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Møller A, Merrild CH. Exploring targeted preventive health checks in a socially disadvantaged neighborhood in Denmark. Health Promot Int 2020; 35:1150-1158. [PMID: 31697350 DOI: 10.1093/heapro/daz110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recently studies have focused on how health promotion interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health promotion interventions often do not draw on situated understandings of the contextual aspects of health and illness practices. Theoretically, this study departs in practice theory and contemporary public heath discussions on targeted health promotion. Based on semi-structured interviews with 18 people living in a social housing association we explored the significance of participating in a preventive health check and how participation configured into everyday life. All participants in our study had been identified with a 'risk' health profile. Overall, we found that they were well aware of their health risks and challenges, and that they reflected a great deal on how their health status was intrinsically linked with their lifestyle and health practices, such as lack of exercise or smoking. The health checks were, however, not able to support or improve their general health, and did not seem to address the challenges the participants seemed to struggle with in life. By way of conclusion, we suggest that we implement a more practice-oriented form of public health that focus on the 'lives' that people live, and the problems that they face. Moreover, attention should be paid to how and to whom health promotion initiatives are offered, in order to ensure the relevance of targeted interventions.
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Affiliation(s)
- Anne Møller
- Department of Public Health, Health, Aarhus University, Aarhus, Denmark
| | - Camilla Hoffmann Merrild
- Department of Public Health, Health, Aarhus University, Aarhus, Denmark.,Center for General Practice, Aalborg University, Aalborg, Denmark
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109
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Adewusi OJ, Adetunji A, Ibitoye SE. Factors associated with direct use of laptop on the lap among male university undergraduates in Southwestern Nigeria. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:282-290. [PMID: 33000706 DOI: 10.1080/19338244.2020.1825211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Laptop use comes with potential reproductive health risks for men. This study assessed the knowledge of reproductive health hazards and factors associated with direct use of laptop on the lap among male undergraduates of the University of Ibadan, Nigeria. A cross-sectional study conducted among 444 male undergraduates using multi-stage sampling and data collected through a validated questionnaire. Mean age was 21.0 years ± 2.6. Knowledge and perception of reproductive health hazards associated with direct laptop use were fairly good but practice was high. The knowledge of reproductive health hazards associated with direct laptop use on the lap was not associated with use (p = 0.08) and factors influencing use include; influence by colleagues (67.6%), non-availability of laptop cooling pads (42.6%), high cost of cooling pads (39.9%), perception of convenience (41.7%). Interventions on laptop ergonomics awareness and provision of affordable laptop ergonomic products for university students are recommended.
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Affiliation(s)
| | | | - Segun E Ibitoye
- Faculty of Public Health, Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Nigeria
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110
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Lowell A, Maypilama EL, Gundjarranbuy R. Finding a pathway and making it strong: Learning from Yolŋu about meaningful health education in a remote Indigenous Australian context. Health Promot J Austr 2020; 32 Suppl 1:166-178. [PMID: 32808441 DOI: 10.1002/hpja.405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/07/2020] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Access to meaningful health information is limited in remote regions of Australia where Indigenous languages and culture are strong but the prevalence of chronic conditions is extremely high. This qualitative study aimed to support and understand the evolution of an educational approach to improve communication about chronic conditions for Yolŋu (Aboriginal people of Northeast Arnhem Land). METHODS Within a culturally responsive research design, data were gathered through participant observation and semi-structured interviews with educators and community members. An iterative and continuous process of data collection and inductive analysis, exploring key elements of the process as it evolved, supported the Project Team to modify and refine their approach as the project progressed. RESULTS A high level of community participation and control was a critical element of the project. Collaboration between Yolŋu educators and community experts, with culturally competent support from others, enabled Yolŋu to share health information in ways that could not be achieved by outsiders. Yolŋu and biomedical knowledges were integrated to build and share meaningful, in-depth (not simplified or directive) oral explanations in local languages using culturally responsive communication processes. The urgent need for ongoing, sufficient and meaningful health education was a consistent and recurring theme in this context where chronic conditions are having a devastating impact. CONCLUSION Sustained and equitable access to meaningful information, using a culturally responsive approach led by community educators, is crucial to improve health literacy and to enable genuinely informed decisions in prevention and management of chronic conditions. Long-term funding is needed to support ongoing programs. These findings may have relevance for others who do not share the culture and language of the majority population. SO WHAT?: Equity of access to meaningful health information through sustained support for community-led education processes is essential to improve First Nations health outcomes.
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Affiliation(s)
- Anne Lowell
- Northern Institute, Charles Darwin University, Darwin, Australia
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111
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Iriarte-Roteta A, Lopez-Dicastillo O, Mujika A, Ruiz-Zaldibar C, Hernantes N, Bermejo-Martins E, Pumar-Méndez MJ. Nurses' role in health promotion and prevention: A critical interpretive synthesis. J Clin Nurs 2020; 29:3937-3949. [PMID: 32757432 DOI: 10.1111/jocn.15441] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Role confusion is hampering the development of nurses' capacity for health promotion and prevention. Addressing this requires discussion to reach agreement among nurses, managers, co-workers, professional associations, academics and organisations about the nursing activities in this field. Forming a sound basis for this discussion is essential. AIMS AND OBJECTIVES To provide a description of the state of nursing health promotion and prevention practice expressed in terms of activities classifiable under the Ottawa Charter and to reveal the misalignments between this portrayal and the ideal one proposed by the Ottawa Charter. METHODS A critical interpretive synthesis was conducted between December 2018 and May 2019. The PubMed, CINAHL, Scopus, PsychINFO, Web of Science and Dialnet databases were searched. Sixty-two papers were identified. The relevant data were extracted using a pro-forma, and the reviewers performed an integrative synthesis. The ENTREQ reporting guidelines were used for this review. RESULTS Thirty synthetic constructs were developed into the following synthesising arguments: (a) addressing individuals' lifestyles versus developing their personal skills; (b) focusing on environmental hazards versus creating supportive environments; (c) action on families versus strengthening communities; (d) promoting community partnerships versus strengthening community action; and (e) influencing policies versus building healthy public policy. CONCLUSIONS There are notable misalignments between nurses' current practice in health promotion and prevention and the Ottawa Charter's actions and strategies. This may be explained by the nurses' lack of understanding of health promotion and prevention and political will, research methodological flaws, the predominance of a biomedical perspective within organisations and the lack of organisational prioritisation for health promotion and prevention.
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Affiliation(s)
| | - Olga Lopez-Dicastillo
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | - Agurtzane Mujika
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
| | | | - Naia Hernantes
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain
| | - Elena Bermejo-Martins
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain
| | - María J Pumar-Méndez
- Department of Community, Maternity and Pediatric Nursing, School of Nursing, University of Navarra, Navarra, Spain.,IdiSNA, Navarra Institute for Health Research, Navarra, Spain
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112
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Browne J, Lock M, Walker T, Egan M, Backholer K. Effects of food policy actions on Indigenous Peoples' nutrition-related outcomes: a systematic review. BMJ Glob Health 2020; 5:e002442. [PMID: 32816952 PMCID: PMC7437701 DOI: 10.1136/bmjgh-2020-002442] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Indigenous Peoples worldwide endure unacceptable health disparities with undernutrition and food insecurity often coexisting with obesity and chronic diseases. Policy-level actions are required to eliminate malnutrition in all its forms. However, there has been no systematic synthesis of the evidence of effectiveness of food and nutrition policies for Indigenous Peoples around the world. This review fills that gap. METHODS Eight databases were searched for peer-reviewed literature, published between 2000 and 2019. Relevant websites were searched for grey literature. Articles were included if they were original studies, published in English and included data from Indigenous Peoples from Western colonised countries, evaluated a food or nutrition policy (or intervention), and provided quantitative impact/outcome data. Study screening, data extraction and quality assessment were undertaken independently by two authors, at least one of whom was Indigenous. A narrative synthesis was undertaken with studies grouped according to the NOURISHING food policy framework. RESULTS We identified 78 studies from Canada, Australia, Aotearoa/New Zealand and the USA. Most studies evaluated targeted interventions, focused on rural or remote Indigenous communities. The most effective interventions combined educational strategies with policies targeting food price, composition and/or availability, particularly in retail and school environments. Interventions to reduce exposure to unhealthy food advertising was the only area of the NOURISHING framework not represented in the literature. Few studies examined the impact of universal food policies on Indigenous Peoples' diets, health or well-being. CONCLUSION Both targeted and universal policy action can be effective for Indigenous Peoples. Actions that modify the structures and systems governing food supply through improved availability, access and affordability of healthy foods should be prioritised. More high-quality evidence on the impact of universal food and nutrition policy actions for Indigenous Peoples is required, particularly in urban areas and in the area of food marketing.
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Affiliation(s)
- Jennifer Browne
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mark Lock
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Troy Walker
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, Melbourne, Victoria, Australia
| | - Kathryn Backholer
- Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria, Australia
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de Jong MAJG, Wagemakers A, Koelen MA. "We Don't Assume That Everyone Has the Same Idea About Health, Do We?" Explorative Study of Citizens' Perceptions of Health and Participation to Improve Their Health in a Low Socioeconomic City District. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17144958. [PMID: 32660158 PMCID: PMC7400410 DOI: 10.3390/ijerph17144958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/24/2022]
Abstract
In community health promotion programs that aim to reduce health inequities, citizen participation is recommended, as it strengthens citizens’ active involvement and has a positive impact on health. A prerequisite for citizen participation is recognizing and incorporating citizens’ perceptions of health. Therefore, this study aimed to explore these perceptions and actions needed to improve the health of citizens living in a low socioeconomic city district. Concept mapping was used to actively engage community members as part of the action research method. Eleven community groups (n = 89 citizens) together with community workers participated in the study. Participants in all groups agreed that health entails more than the absence of disease, and therefore it is a multidimensional concept. Social relations, physical activity, positive life attitude, healthy eating, and being in control were important perceptions about health. Although the participants were aware of the relation between lifestyle and health, actions to improve health included doing things together, collaboration, self-confidence, focusing on possibilities, and socially shared meanings. Creating a supportive environment to address health behavior appeared to be the most important action for citizens to facilitate behavior change. Concept mapping helped to involve citizens and provided community workers with valuable information to shape the program together with citizens.
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Affiliation(s)
| | - Annemarie Wagemakers
- Health and Society, Social Sciences Group, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, The Netherlands; (A.W.); (M.A.K.)
| | - Maria A. Koelen
- Health and Society, Social Sciences Group, Wageningen University & Research, P.O. Box 8130, 6700 EW Wageningen, The Netherlands; (A.W.); (M.A.K.)
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114
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Buse K, Aftab W, Akhter S, Phuong LB, Chemli H, Dahal M, Feroz A, Hofiani S, Pradhan NA, Anwar I, Skhiri HA, El Ati J, Giang KB, Puri M, Noormal B, Rabbani F, Hawkes S. The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach. Health Policy Plan 2020; 35:503-521. [PMID: 32091080 PMCID: PMC7225567 DOI: 10.1093/heapol/czz175] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.
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Affiliation(s)
- Kent Buse
- UNAIDS, Avenue Appia 20, 1211 Genève, Switzerland
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sadika Akhter
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Linh Bui Phuong
- Center for Population Health Sciences, Hanoi University of Public Health, No. 1A, Duc Thang Street, Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
| | - Haroun Chemli
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007, Tunis, Tunisia
| | - Minakshi Dahal
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sayad Hofiani
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Nousheen Akber Pradhan
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Iqbal Anwar
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Hajer Aounallah Skhiri
- Faculty of Medicine of Tunis, University of Tunis El-Manar, Rue de la Faculte de Medecine, Tunis, Tunisia
- National Health Institute, Ministry of Health, 5/7 Rue El Khartoum, Diplomat, Bloc IV, 10ème étage, le Belvédère 1002 Tunis, Tunisia
| | - Jalila El Ati
- National Institute of Nutrition and Food Technology, SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Kim Bao Giang
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, No 1 Ton That Tung, Dong da District, Hanoi, Vietnam
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Bashir Noormal
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sarah Hawkes
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH5, UK
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Van der Veken K, Lauwerier E, Willems SJ. How community sport programs may improve the health of vulnerable population groups: a program theory. Int J Equity Health 2020; 19:74. [PMID: 32448226 PMCID: PMC7245920 DOI: 10.1186/s12939-020-01177-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Groups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called ‘community sports’, to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting. Methods We developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations. Results The health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics. Conclusions The program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.
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Affiliation(s)
- Karen Van der Veken
- Department of Public Health & Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Emelien Lauwerier
- Department of Public Health & Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,Department of Experimental-Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Sara J Willems
- Department of Public Health & Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
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116
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Implementing without guidelines, learning at the coalface: a case study of health promoters in an era of community health workers in South Africa. Health Res Policy Syst 2020; 18:46. [PMID: 32408900 PMCID: PMC7222311 DOI: 10.1186/s12961-020-00561-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 04/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, there has been renewed focus on primary healthcare (PHC). PHC revitalisation is one of the mechanisms to emphasise health promotion and prevention. However, it is not always clear who should lead health promotion activities. In some countries, health promotion practitioners provide health promotion; in others, community health workers (CHWs) are responsible. South Africa, like other countries, has embarked on reforms to strengthen PHC, including a nationwide CHW programme – resulting in an unclear role for pre-existing health promoters. This paper examined the tension between these two cadres in two South African provinces in an era of primary health reform. Methodology We used a qualitative case study approach. Participants were recruited from the national, provincial, district and facility levels of the health system. Thirty-seven face-to-face in-depth interviews were conducted with 16 health promotion managers, 12 health promoters and 13 facility managers during a 3-month period (November 2017 to February 2018). Interviews were audio-recorded and transcribed verbatim. Both inductive and deductive thematic content analysis approaches were used, supported by MAXQDA software. Results Two South African policy documents, one on PHC reform and the other on health promotion, were introduced and implemented without clear guidelines on how health promoter job descriptions should be altered in the context of CHWs. The introduction of CHWs triggered anxiety and uncertainty among some health promoters. However, despite considerable role overlap and the absence of formal re-orientation processes to re-align their roles, some health promoters have carved out a role for themselves, supporting CHWs (for example, providing up-to-date health information, jointly discussing how to assist with health problems in the community, providing advice and household-visit support). Conclusions This paper adds to recent literature on the current wave of PHC reforms. It describes how health promoters are ‘working it out’ on the ground, when the policy or process do not provide adequate guidance or structure. Lessons learnt on how these two cadres could work together are important, especially given the shortage of human resources for health in low- and middle-income settings. This is a missed opportunity, researchers and policy-makers need to think more about how to feed experience/tacit knowledge up the system.
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117
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Spotswood F, Shankar A, Piwek L. Changing emotional engagement with running through communal self-tracking: the implications of 'teleoaffective shaping' for public health. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:772-788. [PMID: 32052463 DOI: 10.1111/1467-9566.13057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Emerging research explores the role of self-tracking in supporting healthy behaviour. Self-tracking comprises a number of interrelated practices; some individual some communal. In this article, we focus on practices that enable interaction between self-trackers through data sharing and communication around personal data. For public health, communal self-tracking has been explored for the additional benefits it provides in addition to self-knowledge. However, under-explored is the emotional entanglement of self-tracking and tracked activities, or the role of practitioners in the dynamic evolution of tracked practices. Qualitative, mixed methods data were collected from leisure-time runners in the SW England who self-track using social fitness app 'Strava', and were interpreted through the lens of practice theory. We find that communal self-tracking affords the active shaping of the emotion and purpose of running. This 'teleoaffective shaping' allows practitioners to negotiate and reconstitute appealing meanings associated with running to protect their practice loyalty. We identify three mechanisms for teleoaffective shaping afforded by Strava: labelling, reward and materialising effort. Findings advance our understanding of how social fitness apps work to retain practitioners of physically active leisure practices. Future research should further explore the multiple ways that associations with tracked physical activity evolve through entanglement with self-tracking practices.
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Affiliation(s)
| | - Avi Shankar
- Institute for Policy Research (IPR), Marketing, Business & Society, Centre for Business, Organisations and Society (CBOS), University of Bath, Bath, UK
| | - Lukasz Piwek
- Bath Centre for Healthcare Innovation and Improvement, Applied Digital Behaviour Lab, University of Bath, Bath, UK
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118
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Jimenez Carrillo M, León García M, Vidal N, Bermúdez K, De Vos P. Comprehensive primary health care and non-communicable diseases management: a case study of El Salvador. Int J Equity Health 2020; 19:50. [PMID: 32252764 PMCID: PMC7132977 DOI: 10.1186/s12939-020-1140-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 02/07/2020] [Indexed: 01/12/2023] Open
Abstract
Background One of today’s greatest challenges in public health worldwide - and especially its key management from Primary Health Care (PHC) - is the growing burden of non-communicable diseases (NCDs). In El Salvador, since 2009 the Minister of Health (MoH) has scaled up a national public health system based on a comprehensive PHC approach. A national multi-sectorial strategic plan for a comprehensive approach to NCDs has also been developed. This analysis explores stakeholders’ perceptions related to the management of NCDs in PHC and, in particular, the role of social participation. Methods A case-study was developed consisting of semi structured interviews and official document reviews. Semi-structured interviews were developed with chronic patients (14) and PHC professionals working in different levels within PHC (12). Purposive sampling was used to recruit participants. A non-pure, deductive approach was implemented for coding. After grouping codes into potential themes, a thematic framework was elaborated through a reflexive approach and the triangulation of the data. The research was conducted between March and August of 2018 in three different departments of El Salvador. Results The structure and the functioning of the Salvadoran PHC system and its intersectoral approach is firstly described. The interdisciplinary PHC-team brings holistic health care closer to the communities in which health promoters play a key role. The findings reflect the generally positive perception of the PHC system in terms of accessibility, quality and continuity of care by chronic patients. Community engagement and the National Health Forum are ensuring accountability through social controllership mechanisms. However, certain challenges were also noted during the interviews related to the shortage of medication and workforce; coordination between the levels of care and the importance of prevention and health promotion programmes for NCDs. Conclusions The Salvadoran PHC and its comprehensive approach to NCDs with an emphasis on intersectoral participation has been positively perceived by the range of stakeholders interviewed. Social engagement and the NHF works as a driving force to ensure accountability as well as in the promotion of a preventive culture. The challenges identified provide keys to amplify knowledge for addressing inequalities in health by strengthening PHC and its NCDs management.
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Affiliation(s)
| | - Montserrat León García
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.,Biomedical Research Institute Sant Pau (IIBSant Pau), Iberoamerican Cochrane Centre, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nicole Vidal
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Keven Bermúdez
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Pol De Vos
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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119
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Werder O, Holland K, Munro J. Communication's role in overcoming challenges for obesity prevention partnerships. Health Promot Int 2020; 35:205-216. [PMID: 30805614 DOI: 10.1093/heapro/daz005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
With obesity rates growing worldwide calls have increased to coordinate efforts in nationwide partnership models. Yet, the necessity for professional partnerships has brought into sharper focus a problem in jointly communicating obesity and its prevention. Following a social representation framework and using episodic interviewing of members from different professions directly or indirectly involved in obesity prevention, this report critically analysed concepts and communicative approaches held by those professional areas. Key findings included different perspectives about communication orientations, namely distribution of responsibility, control and communication goals. This suggests that the profession-specific world-views prevented respondents from communicating with members from other professions. We conclude that health communication experts bring unique skills to bring together professional teams to not only develop a common language and conceptual framework but also facilitate a sense of inclusion and personal accomplishment.
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Affiliation(s)
- Olaf Werder
- Department of Media and Communications, The University of Sydney, Sydney, NSW, Australia
| | - Kate Holland
- Faculty of Arts and Design, University of Canberra, Canberra, NSW, Australia
| | - Jay Munro
- Department of Media and Communications, The University of Sydney, Sydney, NSW, Australia
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120
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Lardier DT, Opara I, Reid RJ, Garcia-Reid P. The Role of Empowerment-Based Protective Factors on Substance Use Among Youth of Color. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2020; 37:271-285. [PMID: 34732976 PMCID: PMC8562725 DOI: 10.1007/s10560-020-00659-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Youth of color continue to be disproportionately affected by the consequences of engaging in high rates of daily substance use. Racial-ethnic minority adolescents are often viewed through a deficit lens. There is limited research that examines the strengths of these young people and their communities as a prevention strategy to lower rates of drug use. Using an empowerment-based framework, this study examines the role of intrapersonal and cognitive psychological empowerment, community civic engagement, and ethnic identity on 30-day drug use among a sample of youth of color (N=383; 53.1% Female; 75% Hispanic), between 14 and 18 years of age, from a northeastern urban community. Structural equation modeling was used to test indirect and direct associations between constructs. Results revealed that both intrapersonal and cognitive psychological empowerment were associated with lower rates of 30-day substance use mediated by ethnic identity and community civic engagement. Findings from this study contribute to the social work field by highlighting the importance of strengths-based approaches to improving health outcomes and decreasing risky behaviors such as drug use among youth of color.
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Affiliation(s)
- David T. Lardier
- Department of Individual, Family, and Community Education, Family and Child Studies Program, The University of New Mexico, Albuquerque, NM 87131, USA
- Department of Psychiatry and Behavioral Sciences, The University of New Mexico School of Medicine, The University of New Mexico, Albuquerque, NM 87131, USA
| | - Ijeoma Opara
- School of Social Welfare, Stony Brook University, Stony Brook, NY, USA
| | - Robert J. Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
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121
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Advancing Global Health through Environmental and Public Health Tracking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061976. [PMID: 32192215 PMCID: PMC7142667 DOI: 10.3390/ijerph17061976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/18/2022]
Abstract
Global environmental change has degraded ecosystems. Challenges such as climate change, resource depletion (with its huge implications for human health and wellbeing), and persistent social inequalities in health have been identified as global public health issues with implications for both communicable and noncommunicable diseases. This contributes to pressure on healthcare systems, as well as societal systems that affect health. A novel strategy to tackle these multiple, interacting and interdependent drivers of change is required to protect the population’s health. Public health professionals have found that building strong, enduring interdisciplinary partnerships across disciplines can address environment and health complexities, and that developing Environmental and Public Health Tracking (EPHT) systems has been an effective tool. EPHT aims to merge, integrate, analyse and interpret environmental hazards, exposure and health data. In this article, we explain that public health decision-makers can use EPHT insights to drive public health actions, reduce exposure and prevent the occurrence of disease more precisely in efficient and cost-effective ways. An international network exists for practitioners and researchers to monitor and use environmental health intelligence, and to support countries and local areas toward sustainable and healthy development. A global network of EPHT programs and professionals has the potential to advance global health by implementing and sharing experience, to magnify the impact of local efforts and to pursue data knowledge improvement strategies, aiming to recognise and support best practices. EPHT can help increase the understanding of environmental public health and global health, improve comparability of risks between different areas of the world including Low and Middle-Income Countries (LMICs), enable transparency and trust among citizens, institutions and the private sector, and inform preventive decision making consistent with sustainable and healthy development. This shows how EPHT advances global health efforts by sharing recent global EPHT activities and resources with those working in this field. Experiences from the US, Europe, Asia and Australasia are outlined for operating successful tracking systems to advance global health.
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122
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Hickie IB, Davenport TA, Burns JM, Milton AC, Ospina-Pinillos L, Whittle L, Ricci CS, McLoughlin LT, Mendoza J, Cross SP, Piper SE, Iorfino F, LaMonica HM. Project Synergy: co-designing technology-enabled solutions for Australian mental health services reform. Med J Aust 2020; 211 Suppl 7:S3-S39. [PMID: 31587276 DOI: 10.5694/mja2.50349] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Project Synergy aims to test the potential of new and emerging technologies to enhance the quality of mental health care provided by traditional face-to-face services. Specifically, it seeks to ensure that consumers get the right care, first time (delivery of effective mental health care early in the course of illness). Using co-design with affected individuals, Project Synergy has built, implemented and evaluated an online platform to assist the assessment, feedback, management and monitoring of people with mental disorders. It also promotes the maintenance of wellbeing by collating health and social information from consumers, their supportive others and health professionals. This information is reported back openly to consumers and their service providers to promote genuine collaborative care. The online platform does not provide stand-alone medical or health advice, risk assessment, clinical diagnosis or treatment; instead, it supports users to decide what may be suitable care options. Using an iterative cycle of research and development, the first four studies of Project Synergy (2014-2016) involved the development of different types of online prototypes for young people (i) attending university; (ii) in three disadvantaged communities in New South Wales; (iii) at risk of suicide; and (iv) attending five headspace centres. These contributed valuable information concerning the co-design, build, user testing and evaluation of prototypes, as well as staff experiences during development and service quality improvements following implementation. Through ongoing research and development (2017-2020), these prototypes underpin one online platform that aims to support better multidimensional mental health outcomes for consumers; more efficient, effective and appropriate use of health professional knowledge and clinical skills; and quality improvements in mental health service delivery.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | - Jane M Burns
- Swinburne Research, Swinburne University of Technology, Melbourne, VIC
| | | | - Laura Ospina-Pinillos
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,Department of Psychiatry and Mental Health, School of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Lisa Whittle
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | | | - Larisa T McLoughlin
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, QLD
| | - John Mendoza
- Brain and Mind Centre, University of Sydney, Sydney, NSW.,ConNetica, Caloundra, QLD
| | - Shane P Cross
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Sarah E Piper
- Brain and Mind Centre, University of Sydney, Sydney, NSW
| | - Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, NSW
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123
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Anderson A, Spray J. Beyond awareness: Towards a critically conscious health promotion for rheumatic fever in Aotearoa, New Zealand. Soc Sci Med 2020; 247:112798. [PMID: 32007766 DOI: 10.1016/j.socscimed.2020.112798] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
Since 2014, the Rheumatic Fever Prevention Programme has targeted communities in Aotearoa, New Zealand affected by high rates of rheumatic fever (RF): namely, Māori and Pacific families. Initiated with the aim of reducing ethnic health disparities, the Health Promotion Agency attempted to use culturally appropriate approaches by engaging in consultative processes with Māori and Pacific communities and health leaders in developing the intervention. However, these consultations largely focused on evaluating strategies for reaching "priority" audiences with the message to get sore throats checked and on changing health-seeking behaviours. There was little regard for what the structural roots of RF in Aotearoa might suggest about equitable interventions, nor for the potentially harmful effects of the messages and their presentation. The concept of structural violence can be a useful analytical tool to critically evaluate such interventions which attempt to address health disparities but do not meaningfully attend to equity. Drawing on three ethnographic studies with: 1) Northland Māori families (Anderson et al., 2015); 2) North Island Māori and Pacific families (Anderson et al., 2017); and 3) Māori and Pacific children at a South Auckland school (Spray, 2020), we show how recategorising RF disparities as expressions of violence reveals how, despite including cultural consultation, interventions may still inequitably distribute responsibility. In particular, by responsibilising communities affected with the highest rates of RF, the intervention creates collateral damage of stigma, internalised blame, emotional suffering and hypervigilance that reproduces structural violence. We suggest that attending to how families experience public health messaging in the context of their daily lives may guide a more critical and culturally safe health promotion that looks beyond awareness and behaviour and towards equity.
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Affiliation(s)
- Anneka Anderson
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Julie Spray
- Anthropology, School of Social Sciences, Faculty of Arts, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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124
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Spotswood F, Wiltshire G, Spear S, Morey Y, Harris J. A practice theory approach to primary school physical activity: opportunities and challenges for intervention. CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1695746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | - Gareth Wiltshire
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Sara Spear
- Bristol Business School, University of the West of England, Bristol, UK
| | - Yvette Morey
- Bristol Business School, University of the West of England, Bristol, UK
| | - Jennifer Harris
- Physiotherapy Department, Doncaster Royal Infirmary, Doncaster, UK
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125
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Marshall AD, Madden A, Treloar C. Enhancing engagement in hepatitis C care among people who inject drugs. Addiction 2019; 114:2104-2106. [PMID: 31140205 DOI: 10.1111/add.14698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2019] [Accepted: 05/10/2019] [Indexed: 01/26/2023]
Affiliation(s)
- Alison D Marshall
- The Kirby Institute, University of New South Wales, Sydney, Australia.,Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Annie Madden
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
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Abstract
BACKGROUND Wellbeing is seen as a matter of concern for governments and public policy. However, current theories on wellbeing are not well placed to inform this concern, because they fail to take account of and explain evidence on social determinants of mental health. DISCUSSION This article proposes a new theory of public wellbeing which does takes account of such evidence, by explaining the role of stress within three basic functions of social cognition. Building on this description, the article then proposes that wellbeing consists in seven basic abilities, which are always developed and exercised (or not) through constant processes of interaction between individual and environment. The article explains why contemporary theories on wellbeing are poorly placed to inform public policy for wellbeing. It also positions the proposed theory in relation to evidence on social determinants of health (SDH) and the associated public policy agenda. It is argued the proposed theory of wellbeing extends on and challenges the SDH policy agenda in relation to the normative target of policy proposals, factors identified as determinants, impacts of determinants on populations, and proposals for political and social change. CONCLUSION Improved theory on public wellbeing can inform policy for wellbeing because it explains the contingent nature of wellbeing within contemporary social environments, and extends understanding of social determinants of wellbeing.
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Affiliation(s)
- Matthew Fisher
- Southgate Institute for Health, Society & Equity, Flinders University, GPO Box 2100, Adelaide, 5001, Australia.
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127
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Rich E, Miah A, Lewis S. Is digital health care more equitable? The framing of health inequalities within England's digital health policy 2010-2017. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41 Suppl 1:31-49. [PMID: 31599987 PMCID: PMC7586788 DOI: 10.1111/1467-9566.12980] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Informed by a discourse analysis, this article examines the framing of equity within the UK's digital health policies between 2010 and 2017, focusing on England's development of NHS Digital and its situation within the UK Government's wider digital strategy. Analysis of significant policy documents reveals three interrelated discourses that are engaged within England's digital health policies: equity as a neoliberal imaginary of digital efficiency and empowerment; digital health as a pathway towards democratising health care through data-sharing, co-creation and collaboration; and finally, digital health as a route towards extending citizen autonomy through their access to data systems. It advances knowledge of the relationship between digital health policy and health inequalities. Revealing that while inclusion remains a priority area for policymakers, equity is being constituted in ways that reflect broader discourses of neoliberalism, empowerment and the turn to the market for technological solutionism, which may potentially exacerbate health inequalities.
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Affiliation(s)
- Emma Rich
- Department for HealthUniversity of BathBathUK
| | - Andy Miah
- School of Environment and Life SciencesUniversity of SalfordSalfordUK
| | - Sarah Lewis
- Department for HealthUniversity of BathBathUK
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128
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Henwood F, Marent B. Understanding digital health: Productive tensions at the intersection of sociology of health and science and technology studies. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41 Suppl 1:1-15. [PMID: 31599984 DOI: 10.1111/1467-9566.12898] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio-material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long-standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time-lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision-making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research.
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Affiliation(s)
- Flis Henwood
- School of Applied Social Science, University of Brighton, Brighton, UK
| | - Benjamin Marent
- School of Applied Social Science, University of Brighton, Brighton, UK
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129
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Riva S. Cognitive tips for changing mindsets: improving policies to protect health and environment. J Epidemiol Community Health 2019; 73:985-987. [PMID: 31488513 DOI: 10.1136/jech-2018-210465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 07/15/2019] [Accepted: 08/20/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Silvia Riva
- School of Sport Health and Applied Science, St Mary's University Twickenham, Twickenham TW1 4SX, UK
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130
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Ravaghi V, Hargreaves DS, Morris AJ. Persistent Socioeconomic Inequality in Child Dental Caries in England despite Equal Attendance. JDR Clin Trans Res 2019; 5:185-194. [PMID: 31487468 DOI: 10.1177/2380084419872136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Despite a decline in the prevalence of dental caries among children in England and ongoing arrangements for the provision of free dental care up to the age of 18 y, there is limited information on the pattern and trend of socioeconomic inequalities in dental caries and dental attendance. METHODS We estimated the magnitude of deprivation-related inequalities for dental caries and dental attendance in young children, using publicly available data and 2 regression-based summary measures of inequalities: slope index of inequality and relative index of inequality. RESULTS We found no significant absolute or relative inequalities in dental attendance across English areas in the past decade, while there were persistent absolute and relative inequalities in dental caries. Socioeconomic inequalities in dental caries decreased between 2007 and 2012; thereafter, the relative inequalities increased. CONCLUSIONS The apparent widening inequality in child dental caries in England despite equal access to dental care is a challenge for policy makers. KNOWLEDGE TRANSFER STATEMENT While caries prevalence among English children has declined over the past decade, there has been an increase in socioeconomic inequalities in oral health despite there being no inequality in dental attendance. This has implications for the development of oral health strategy and planning dental services.
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Affiliation(s)
- V Ravaghi
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - D S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - A J Morris
- School of Dentistry, University of Birmingham, Birmingham, UK
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131
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Luca NR, Hibbert S, McDonald R. Understanding behaviour change in context: examining the role of midstream social marketing programmes. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:1373-1395. [PMID: 31099093 DOI: 10.1111/1467-9566.12951] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This research examines how midstream social marketing programmes that adopt a relational and community-based approach create opportunities for individuals to make incremental changes to health behaviour. Specifically, it applies Bourdieusian theory to explore how interactions between community healthcare workers (CHWs) and members of the public generate impetus for change and foster individual agency for improved health. Qualitative interviews were carried out with members of the public and CHWs engaged in a Smokefree home and cars initiative. The findings suggest that although CHWs are challenged by resource constraints, their practices in working with individuals and families build trust and enable dialogue that bridges smoking-related health insight with home logics. These interactions can promote individual agency with a transformative effect through small changes to smoking-related dispositions, norms and practices. However, tensions with the habitus of other household members and other capital deficits can inhibit progress towards embedding new practices. The study concludes that interventions built upon community relationships show potential for addressing limitations of information-focused campaigns but there is a need to also respond to key social structures relating to the field of action for new health dispositions to become embedded in practice.
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Affiliation(s)
- Nadina R Luca
- York Management School, University of York, York, UK
| | - Sally Hibbert
- Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Ruth McDonald
- Manchester Business School, University of Manchester, Manchester, UK
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132
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Olstad DL, Collins C. Smaller dishware to reduce energy intake: fact or fiction? Int J Behav Nutr Phys Act 2019; 16:73. [PMID: 31455333 PMCID: PMC6712639 DOI: 10.1186/s12966-019-0831-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
The potential effects of dishware size on energy intake are unclear, as many previous studies have been of low methodological quality. A newly published paper by Kosīte et al. (IJBNPA 10.1186/s12966-019-0826-1, 2019) reports findings from a rigorous, pre-registered investigation of the effects of manipulating plate size on total energy intake within a single eating occasion. This Editorial considers the implications of these new findings in light of previous evidence pertaining to the efficacy of behavioral nudges in particular, and in relation to contextual drivers of food consumption more generally. We conclude that the potential impact of behavioral nudges may have been exaggerated in the past, and call for future high-quality randomized controlled trials to establish whether reducing dishware size and other behavioral nudges might offer an effective complement to more comprehensive, multi-level interventions to reduce overconsumption of foods and beverages at a population-level.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6 Canada
| | - Clare Collins
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre in Physical Activity and Nutrition, ATC Building, University of Newcastle, Callaghan, New South Wales 2308 Australia
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133
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Lynch J. Reframing inequality? The health inequalities turn as a dangerous frame shift. J Public Health (Oxf) 2019; 39:653-660. [PMID: 28069990 DOI: 10.1093/pubmed/fdw140] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Indexed: 11/15/2022] Open
Abstract
Background Politicians in many countries have embraced the notion that health inequalities derive from socioeconomic inequalities, but European governments have for the most part failed to enact policies that would reduce underlying social inequalities. Methods Data are drawn from 84 in-depth interviews with policy-makers in four European countries between 2012 and 2015, qualitative content analysis of recent health inequalities policy documents, and secondary literature on the barriers to implementing evidence-based health inequalities policies. Results Institutional and political barriers are important barriers to effective policy. Both policy-making institutions and the ideas and practices associated with neoliberalism reinforce medical-individualist models of health, strengthen actors with material interests opposed to policies that would increase equity, and undermine policy action to tackle the fundamental causes of social (including health) inequalities. Conclusions Medicalizing inequality is more appealing to most politicians than tackling income and wage inequality head-on, but it results in framing the problem of social inequality in a way that makes it technically quite difficult to solve. Policy-makers should consider adopting more traditional programs of taxation, redistribution and labor market regulation in order to reduce both health inequalities and the underlying social inequalities.
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Affiliation(s)
- Julia Lynch
- Department of Political Science, University of Pennsylvania, Philadelphia, PA 19104, USA
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134
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Walker J. Determinants of health—Are we arguing for the right things for better rural health and well‐being? Aust J Rural Health 2019; 27:366-367. [DOI: 10.1111/ajr.12559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joanne Walker
- Director Policy and Strategy Development National Rural Health Alliance Canberra ACT Australia
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135
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Aranda K. The Political Matters: Exploring material feminist theories for understanding the political in health, inequalities and nursing. Nurs Philos 2019; 20:e12278. [DOI: 10.1111/nup.12278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/21/2019] [Accepted: 07/02/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Kay Aranda
- School of Health Sciences University of Brighton Falmer UK
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136
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Velardo S, Drummond M. Australian children's discourses of health, nutrition and fatness. Appetite 2019; 138:17-22. [PMID: 30880084 DOI: 10.1016/j.appet.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
Talking to children about their health-related understandings and experiences can provide valuable information for public health practitioners who seek to improve children's dietary behaviours. To date, however, research on children's food consumption has generally prioritized the views of parents and caregivers, rather than children themselves. This paper reports results from a qualitative study that explored preadolescent children's attitudes and perceptions towards health and nutrition. 38 children aged 11-12 years, across three state government schools, took part in an individual interview or group interview. Interviews were recorded, transcribed verbatim and analysed using thematic analysis techniques. Our results indicate that children inextricably linked the concept of health to diet and physical activity. They pondered the connection between different types of foods and physical implications for the body, emphasising nutrition and physical activity as a resource for preventing the onset of chronic disease and specifically the state of 'fatness'. Children collectively overemphasised the correlation between body size and health, and expressed that people should take responsibility for healthy choices to prevent fatness. In their discussions, they referred to aesthetic elements of the body and negative consequences of obesity. Overall, we argue that children's discourses of health and nutrition are potentially problematic. Results suggest that it is important to reshape these ideas to encourage children to develop more positive relationships with food and physical activity.
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Affiliation(s)
- Stefania Velardo
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; Sport, Health, Activity, Performance and Exercise Research Centre, Flinders University, Adelaide, Australia.
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; Sport, Health, Activity, Performance and Exercise Research Centre, Flinders University, Adelaide, Australia
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137
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Stuij M, Elling A, Abma T. Negotiating exercise as medicine: Narratives from people with type 2 diabetes. Health (London) 2019; 25:86-102. [PMID: 31117826 PMCID: PMC7768888 DOI: 10.1177/1363459319851545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The dominant notion that exercise is medicine puts a strong normative emphasis on individual responsibility for participation in sport and physical activity. The aim of this article was to explore how people with type 2 diabetes, a condition strongly linked to lifestyle behaviour both in origin and in management, translate this notion into their daily life. Based on a critical narrative analysis of stories of 18 Dutch people diagnosed with type 2 diabetes collected between 2012 and 2016, we found a range of meanings given to sport and physical activity. In addition, almost all respondents seemed to subscribe to the notion of exercise as medicine on a general level, either quite explicitly or in more subtle ways, for example, elicited by the interview setting. However, they employed different strategies to negotiate with the translation of this notion into their daily life, ranging from (almost) total acceptance to resistance. In addition, nearly all stories revealed mostly negative experiences with care and professional support regarding the uptake or continuation of sport or physical activity participation after diagnosis.
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Affiliation(s)
- Mirjam Stuij
- Amsterdam UMC, location VUmc, The Netherlands; Mulier Institute, The Netherlands
| | | | - Tineke Abma
- Amsterdam UMC, location VUmc, The Netherlands
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138
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Wilkinson TM. Obesity, equity and choice. JOURNAL OF MEDICAL ETHICS 2019; 45:323-328. [PMID: 30377216 DOI: 10.1136/medethics-2018-104848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/05/2018] [Accepted: 10/08/2018] [Indexed: 05/19/2023]
Abstract
Obesity is often considered a public health crisis in rich countries that might be alleviated by preventive regulations such as a sugar tax or limiting the density of fast food outlets. This paper evaluates these regulations from the point of view of equity. Obesity is in many countries correlated with socioeconomic status and some believe that preventive regulations would reduce inequity. The puzzle is this: how could policies that reduce the options of the badly off be more equitable? Suppose we distinguish: (1) the badly off have poor options from (2) the badly off are poor at choosing between their options (ie, have a choosing problem). If obesity is due to a poverty of options, it would be perverse to reduce them further. Some people in public health say that preventive regulations do not reduce options but, I shall argue, they are largely wrong. So the equity case for regulations depends on the worst off having a choosing problem. It also depends on their having a choosing problem that makes their choices against their interests. Perhaps they do. I ask, briefly, what the evidence has to say about whether the badly off choose against their interests. The evidence is thin but implies that introducing preventive regulations for the sake of equity would be at least premature.
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139
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Robson M, Riley S. A Deleuzian rethinking of time in healthy lifestyle advice and change. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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140
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Williams O, Swierad EM. A Multisensory Multilevel Health Education Model for Diverse Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E872. [PMID: 30857345 PMCID: PMC6427730 DOI: 10.3390/ijerph16050872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/18/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022]
Abstract
Owing to their enormous capacity to improve health and save lives, effective health promotion frameworks have been at the forefront of public health research and practice. A multilevel focus, as exemplified by the Socio-Ecological Model (SEM), is one common denominator among these frameworks. The SEM highlights important social and ecological influences on health behavior by delineating the different levels of influence. These include public policy, organizational, community, interpersonal, and intrapersonal levels, which, when considered during the development of health promotion campaigns, especially those that focus on health education, strengthen the potential influence of that campaign on targeted behaviors. However, the SEM lacks a complimenting framework for understanding the role of conventional and unconventional approaches to health education; that is, how to design a health education intervention that considers both the context, such as the social and ecological levels of influence, and the best approaches for developing and delivering the health education in a manner that optimizes their effectiveness in today's modern and increasingly diverse world. Addressing this gap, the current article presents an integrative Multisensory Multilevel Health Education Model (MMHEM), which incorporates three key domains-(1) Art (innovativeness/creativity), (2) Culture (cultural tailoring), and (3) Science (evidence-based), while promoting the importance of considering the socio-ecological levels of influence on targeted behaviors. Using a successful health education intervention, called the Hip Hop Stroke, we deconstruct the Multisensory Multilevel Health Education Model and discuss its potential role as a guide for developing public health education interventions.
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Affiliation(s)
- Olajide Williams
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA.
| | - Ewelina M Swierad
- Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA.
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141
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Zadeh NK, Robertson K, Green JA. Lifestyle determinants of behavioural outcomes triggered by direct-to-consumer advertising of prescription medicines: a cross-sectional study. Aust N Z J Public Health 2019; 43:190-196. [PMID: 30830719 DOI: 10.1111/1753-6405.12883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 12/01/2018] [Accepted: 01/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Direct-to-consumer advertising of prescription medicines encourages individuals to search for or request advertised medicines, can stimulate taking medications rather than making lifestyle behaviour changes, and may target individuals with poorer demographic and socioeconomic status and riskier health-related behaviours. This study thus explored whether responses to medicine advertising vary as a function of lifestyle behaviours, and demographic and socioeconomic factors. METHODS Data were collected through an online survey of a nationally representative sample of 2,057 adults in New Zealand. Multivariate binary logistic regressions were used to explore whether lifestyle behaviours, including nutritional habits, alcohol consumption, illegal drug consumption, physical activity, attitudes towards doing exercise, as well as demographic and socioeconomic status were associated with self-reported behavioural responses to medicine advertising. RESULTS Individuals who had unhealthier lifestyle behaviours were more likely to respond to medicine advertising. CONCLUSIONS The findings raise concerns regarding the misuse or overuse of medications for diseases that may otherwise be improved by a healthier lifestyle. Implications for public health: To improve public health and wellbeing of society, we call for regulatory changes regarding advertising of medicines. Where applicable, lifestyle changes should be advertised as potential substitutes for the advertised medicines. Interprofessional collaboration is also recommended to educate individuals and convey the value of health behaviour changes.
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Affiliation(s)
- Neda Khalil Zadeh
- School of Business, and School of Pharmacy, University of Otago, New Zealand
| | | | - James A Green
- School of Pharmacy, University of Otago, New Zealand.,School of Allied Health, University of Limerick, Ireland.,Health Research Institute (HRI), University of Limerick, Ireland
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142
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Plamondon KM, Pemberton J. Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem. Health Res Policy Syst 2019; 17:24. [PMID: 30832660 PMCID: PMC6399857 DOI: 10.1186/s12961-019-0424-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The persistence of health inequities is a wicked problem for which there is strong evidence of causal roots in the maldistribution of power, resources and money within and between countries. Though the evidence is clear, the solutions are far from straightforward. Integrated knowledge translation (IKT) ought to be well suited for designing evidence-informed solutions, yet current frameworks are limited in their capacity to navigate complexity. Global health governance (GHG) also ought to be well suited to advance action, but a lack of accountability, inclusion and integration of evidence gives rise to politically driven action. Recognising a persistent struggle for meaningful action, we invite contemplation about how blending IKT with GHG could leverage the strengths of both processes to advance health equity. DISCUSSION Action on root causes of health inequities implicates disruption of structures and systems that shape how society is organised. This infinitely complex work demands sophisticated examination of drivers and disrupters of inequities and a vast imagination for who (and what) should be engaged. Yet, underlying tendencies toward reductionism seem to drive superficial responses. Where IKT models lack consideration of issues of power and provide little direction for how to support cohesive efforts toward a common goal, recent calls from the field of GHG may provide insight into these issues. Additionally, though GHG is criticised for its lack of attention to using evidence, IKT offers approaches and strategies for collaborative processes of generating and refining knowledge. Contemplating the inclusion of governance in IKT requires re-examining roles, responsibilities, power and voice in processes of connecting knowledge with action. We argue for expanding IKT models to include GHG as a means of considering the complexity of issues and opening new possibilities for evidence-informed action on wicked problems. CONCLUSION Integrated learning between these two fields, adopting principles of GHG alongside the strategies of IKT, is a promising opportunity to strengthen leadership for health equity action.
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Affiliation(s)
- Katrina Marie Plamondon
- University of British Columbia, 3333 University Way, Kelowna, BC Canada
- Interior Health, 505 Doyle Avenue, Kelowna, BC Canada
| | - Julia Pemberton
- McMaster University, 1280 Main Street West, Hamilton, ON Canada
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143
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McPhail-Bell K, Appo N, Haymes A, Bond C, Brough M, Fredericks B. Deadly Choices empowering Indigenous Australians through social networking sites. Health Promot Int 2019; 33:770-780. [PMID: 28387801 DOI: 10.1093/heapro/dax014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The potential for health promotion through social networking sites (SNSs) is widely recognized. However, while health promotion prides itself in focusing on the social determinants of health, its partiality for persuading individuals to comply with health behaviours dominates the way health promotion utilizes SNSs. This paper contributes to an understanding of collaborative ways SNSs can work for health promotion agendas of self-determination and empowerment in an Indigenous Australia context. An ethnographic study was undertaken with Deadly Choices, an Indigenous-led health promotion initiative. The study involved participant observation of interactions on Deadly Choices SNSs between Deadly Choices and its online community members. Deadly Choices provides an example of SNSs providing a powerful tool to create a safe, inclusive and positive space for Indigenous people and communities to profile their healthy choices, according to Indigenous notions of health and identity. The study found five principles that underpin Deadly Choices' use of SNSs for health promotion. These are: create a dialogue; build community online and offline; incentivise healthy online engagement; celebrate Indigenous identity and culture; and prioritize partnerships. Deadly Choices SNSs empowers Indigenous people and communities to be health promoters themselves, which represents a power shift from health promotion practitioner to Indigenous people and communities and more broadly, an enactment of Indigenous self-determination on SNSs. Mainstream health promotion can learn from Indigenous health promotion practice regarding the use of SNSs for health promotion agendas.
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Affiliation(s)
- Karen McPhail-Bell
- University Centre for Rural Health, Level 3, Edward Ford Building, University of Sydney, Camperdown, NSW, Australia
| | - Nathan Appo
- Deadly Choices, Institute for Urban Indigenous Health, Bowen Hills, QLD, Australia
| | - Alana Haymes
- Deadly Choices, Institute for Urban Indigenous Health, Bowen Hills, QLD, Australia
| | - Chelsea Bond
- Aboriginal and Torres Strait Islander Studies Unit (ATSIS Unit), The University of Queensland, St Lucia, QLD, Australia
| | - Mark Brough
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Bronwyn Fredericks
- Pro Vice-Chancellor (Indigenous Engagement), BHP Billiton Mitsubishi Alliance (BMA) Chair in Indigenous Engagement and President of Academic Board, Central Queensland University, Rockhampton, QLD, Australia
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144
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Abstract
OBJECTIVE School food policies are an important component of comprehensive strategies to address child obesity and improve children's health. Evaluations have demonstrated that these policies can be initially well accepted and appropriately implemented, however little is known about how acceptance levels may change over time. The present study aimed to re-evaluate a school food policy 10 years after its introduction to assess key stakeholders' support for various policy extensions that would strengthen the scope of the policy. DESIGN Online surveys administered 1 year after policy introduction (n 607, 2008) and 10 years after policy introduction (n 307, 2016). SETTING Western Australia.ParticipantsSchool principals, teachers, canteen managers and presidents of parents & citizens associations from Western Australian Government primary schools. RESULTS At both time points, and especially at time 2 (10 years post policy implementation), high levels of support were reported for the policy and possible policy extensions. Support was strongest for an additional requirement to integrate the canteen menu with the classroom health curriculum. CONCLUSIONS The results suggest that once a policy has become embedded into school practices, stakeholders may be receptive to modifications that strengthen the policy to enhance its potential effects on children's diets.
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145
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Phiddian E, Hoepner J, McKinnon M. Can interactive science exhibits be used to communicate population health science concepts? CRITICAL PUBLIC HEALTH 2019. [DOI: 10.1080/09581596.2019.1575948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ellen Phiddian
- Centre for the Public Awareness of Science, Australian National University, Canberra, Australia
| | - Jacqui Hoepner
- Centre for the Public Awareness of Science, Australian National University, Canberra, Australia
| | - Merryn McKinnon
- Centre for the Public Awareness of Science, Australian National University, Canberra, Australia
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146
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Taylor Smith A, Dumas A. Class-based masculinity, cardiovascular health and rehabilitation. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:303-324. [PMID: 30515828 DOI: 10.1111/1467-9566.12827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Men in economically advanced societies are more at-risk of dying prematurely due to heart disease than women, and this risk is inversely related to their socioeconomic status (SES). While the strong influence of socioeconomic factors on self-management of chronic diseases is important, the impact of masculinity must also be considered. This study examines the social variation in preventive health lifestyles of men from two contrasting socioeconomic groups who have suffered from a cardiovascular incident requiring hospitalization. It draws chiefly on Pierre Bourdieu's sociocultural theory of the practice (habitus and symbolic violence). Qualitative data was collected through 60 in-depth, semi-structured interviews with Canadian men (average age 57.3). Results indicate that participants from both socioeconomic groups share aspirations towards personal fulfilment (achieving a sense of security, preserving autonomy and gaining social recognition) after their heart incident, but apply different strategies in pursuit of these aspirations that have distinctive effects on healthy lifestyles. This study emphasise the importance of drawing on theoretical approaches in public health that have the potential to combine universal with context-specific views of human experience in order further understand health and lifestyle inequalities.
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Affiliation(s)
| | - Alex Dumas
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
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147
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Hanson S, Gilbert D, Landy R, Okoli G, Guell C. Cancer risk in socially marginalised women: An exploratory study. Soc Sci Med 2019; 220:150-158. [PMID: 30445340 PMCID: PMC6323356 DOI: 10.1016/j.socscimed.2018.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/13/2018] [Accepted: 11/05/2018] [Indexed: 12/02/2022]
Abstract
BACKGROUND Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. METHODS This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness; and views on health promoting activities within the context of the women's social circumstances. FINDINGS Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. CONCLUSION Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need.
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Affiliation(s)
- Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK.
| | | | | | | | - Cornelia Guell
- European Centre for Environment and Human Health, University of Exeter Medical School, UK
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148
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Williams O, Fullagar S. Lifestyle drift and the phenomenon of 'citizen shift' in contemporary UK health policy. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:20-35. [PMID: 30073681 DOI: 10.1111/1467-9566.12783] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite political change over the past 25 years in Britain there has been an unprecedented national policy focus on the social determinants of health and population-based approaches to prevent chronic disease. Yet, policy impacts have been modest, inequalities endure and behavioural approaches continue to shape strategies promoting healthy lifestyles. Critical public health scholarship has conceptualised this lack of progress as a problem of 'lifestyle drift' within policy whereby 'upstream' social contributors to health inequalities are reconfigured 'downstream' as a matter of individual behaviour change. While the lifestyle drift concept is now well established there has been little empirical investigation into the social processes through which it is realised as policies are (re)formulated and implementation is localised. Addressing this gap we present empirical findings from an ethnography conducted in a deprived English neighbourhood in order to explore: (i) the local context in the process of lifestyle drift and; (ii) the social relations that reproduce (in)equities in the design and delivery of lifestyle interventions. Analysis demonstrates how and why 'precarious partnerships' between local service providers were significant in the process of 'citizen shift' whereby government responsibility for addressing inequity was decollectivised.
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Affiliation(s)
- Oli Williams
- Department of Health Sciences, University of Leicester, Leicester, UK
- NIHR CLAHRC East Midlands, Leicester General Hospital, Leicester, UK
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149
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Alvidrez J, Castille D, Laude-Sharp M, Rosario A, Tabor D. The National Institute on Minority Health and Health Disparities Research Framework. Am J Public Health 2019; 109:S16-S20. [PMID: 30699025 PMCID: PMC6356129 DOI: 10.2105/ajph.2018.304883] [Citation(s) in RCA: 364] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2018] [Indexed: 11/04/2022]
Abstract
We introduce the National Institute on Minority Health and Health Disparities (NIMHD) research framework, a product that emerged from the NIMHD science visioning process. The NIMHD research framework is a multilevel, multidomain model that depicts a wide array of health determinants relevant to understanding and addressing minority health and health disparities and promoting health equity. We describe the conceptual underpinnings of the framework and define its components. We also describe how the framework can be used to assess minority health and health disparities research as well as priorities for the future. Finally, we describe how fiscal year 2015 research project grants funded by NIMHD map onto the framework, and we identify gaps and opportunities for future minority health and health disparities research.
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Affiliation(s)
- Jennifer Alvidrez
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Dorothy Castille
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Maryline Laude-Sharp
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Adelaida Rosario
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Derrick Tabor
- All of the authors are with the National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
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150
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Lardier DT, Bergeson C, Bermea AM, Herr KG, Forenza B, Garcia-Reid P, Reid RJ. Community coalitions as spaces for collective voice, action, and the sharing of resources. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:21-33. [PMID: 30506936 DOI: 10.1002/jcop.22096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 04/26/2018] [Accepted: 05/02/2018] [Indexed: 06/09/2023]
Abstract
This study examined how a community coalition, focused on prevention efforts, can aid in bridging resources between community organizations in a resource-deprived area. We also explored how it may serve as a venue to support significant changes to the community, adults, and youth who live there. Drawing on 18 individual interviews with adult coalition members from various community organizations, in a large, underserved city in the northeastern United States, we examined these data for narrations of the coalition's place within the broader prevention community and how the coalition may be an organizational venue for collective voice. We were specifically interested in hearing if these adult community members saw the coalition as filling a gap within their community. Our data revealed that while organizations within the community have been decimated due to reduced funding, the present coalition aided in meeting a variety of needs. These needs included the facilitation of community voice while helping to bridge resources between organizations, which would otherwise work alone.
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