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Die „gesunde Kommune“ im Lichte „großer Wenden“ – ein sozialökologisch fundiertes Ziel kommunaler Gesundheitsförderung (KoGeFö). PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2022. [PMCID: PMC8353934 DOI: 10.1007/s11553-021-00889-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Zusammenfassung
Hintergrund
In Kommunen wird die Gesundheit der Bewohner*innen durch Lebensumstände geschützt, gefördert oder gefährdet. Kommunale Gesundheitsförderung (KoGeFö) findet in und mit der Kommune statt. In der Kommune konzentrieren sich Programme und Maßnahmen auf Endpunkte der Morbidität und Mortalität. Die Krankheitslast soll reduziert, sowie die individuelle Lebensqualität gestärkt werden. Mit der Kommune will Gesundheitsförderung die „gesunde Kommune“ entwickeln.
Fragestellung
Wann ist eine Kommune „gesund“? Welche Absichten werden in der Gesundheitsförderung mit der Kommune jenseits von Programmen verfolgt, die auf die Reduktion der Inzidenz und Prävalenz nicht-ansteckender Erkrankungen zielen, indem sie die Bewohner*innen motivieren und unterstützen, sich gesundheitsfördernd zu verhalten?
Material und Methoden
Vor dem Hintergrund „großer gesellschaftlicher Herausforderungen“ und mit Rückgriff auf sozialökologische Ansätze wird erörtert, was eine „gesunde Kommune“ ausmacht, worauf die Gesundheitsförderung mit der Kommune zielt.
Ergebnisse
Die „gesunde Kommune“ entwickelt sich in der intersektoralen Zusammenarbeit von Akteur*innen der Politik, von Verwaltungseinheiten, der Zivilgesellschaft und der Bewohner*innen. Die „gesunde Kommune“ ist als faire Umgebung gestaltet. Sie öffnet den Einzelnen Möglichkeitsräume für dessen Handeln und gewährt Verwirklichungschancen für persönlich wichtige Ziele.
Schlussfolgerung
Die bevorzugte sozialökologische Perspektive schärft den Blick für die dynamische Interaktion von Umwelt- und Personenfaktoren. Mit Fairness, Möglichkeitsräumen und Verwirklichungschancen sind drei Kriterien benannt, die sich als Gradmesser für den Endpunkt „gesunde Kommune“ einer Gesundheitsförderung mit der Kommune eignen.
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Stark AL, Geukes C, Albrecht J, Dockweiler C. [Digital Applications in the Planning and Implementation of Structural Health Promotion and Prevention Settings: Results of a Scoping Review]. DAS GESUNDHEITSWESEN 2022; 85:380-387. [PMID: 35738302 PMCID: PMC10125336 DOI: 10.1055/a-1757-9264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND OBJECTIVES In health promotion and prevention, digital applications, especially for behavioral changes, are being increasingly researched and applied. The aim of this study was to investigate possible uses of digital applications in the context of structurally oriented interventions in these settings. METHODS This is a supplementary analysis of the results of a scoping review. Eight scientific databases were searched for digital structural primary prevention and health promotion in settings from 2010-2020. RESULTS A total of 34 articles were included. Digital applications were found to be used only marginally for structural change in health promoting settings. They served as tools for project management, networking, problem identification, consensus building or participation. Participatory methods and projects were used, as well as tools such as labeling, placement, prompting, incentives, nudges, and political strategies. CONCLUSIONS More evidence is needed on how digital applications can be used to change structures in health promoting settings. Public health or sociological methods and theories can play a supporting role. The interdisciplinary and participatory development and implementation of health promoting technologies is of high relevance.
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Affiliation(s)
- Anna Lea Stark
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany.,Department Digitale Gesundheitswissenschaften und Biomedizin, Lebenswissenschaftliche Fakultät, Universität Siegen, Siegen, Germany
| | - Cornelia Geukes
- Centre for ePublic Health Research, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Germany
| | - Joanna Albrecht
- Department Digitale Gesundheitswissenschaften und Biomedizin, Lebenswissenschaftliche Fakultät, Universität Siegen, Siegen, Germany
| | - Christoph Dockweiler
- Department Digitale Gesundheitswissenschaften und Biomedizin, Lebenswissenschaftliche Fakultät, Universität Siegen, Siegen, Germany
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[School from the spirit of public health? : Health promotion in schools from a sociology of education perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:768-775. [PMID: 35648160 PMCID: PMC9232413 DOI: 10.1007/s00103-022-03547-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 11/06/2022]
Abstract
Im Rahmen der Gesundheitsförderung im Sinne der Ottawa-Charta wird der Schule eine Reihe von Aufgaben und Funktionen zugeschrieben, die unter anderem zur Reduktion von gesundheitlichen und sozialen Ungleichheiten beitragen sollen. Dabei finden allerdings in der Public-Health-Diskussion zur schulischen Gesundheitsförderung wichtige theoretische Überlegungen und empirische Erkenntnisse aus der Bildungssoziologie, die Schule als eine hierarchisierende, segregierende, Ungleichheiten produzierende und reproduzierende Institution analysiert, kaum Platz. In diesem Diskussionsbeitrag werden einige bildungssoziologische Positionen und die normative Rahmung der schulischen Gesundheitsförderung vorgestellt. Ferner wird auf die Widersprüche zwischen den Zielen der Gesundheitsförderung und den aktuellen schulischen Bedingungen eingegangen. Zum Schluss werden konzeptionelle Überlegungen für eine Perspektive vorgestellt, die Bildung aus dem Geist der Gesundheitsförderung entwickelt, dabei werden Verbindungen zu Inklusion, Demokratiebildung sowie Menschenrechten hergestellt.
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Stark AL, Geukes C, Dockweiler C. Digital Health Promotion and Prevention in Settings: Scoping Review. J Med Internet Res 2022; 24:e21063. [PMID: 35089140 PMCID: PMC8838600 DOI: 10.2196/21063] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/16/2020] [Accepted: 12/02/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Digital technologies are increasingly integrating into people's daily living environments such as schools, sport clubs, and health care facilities. These settings play a crucial role for health promotion and prevention because they affect the health of their members, as the World Health Organization has declared. Implementing digital health promotion and prevention in settings offers the opportunity to reach specific target groups, lower the costs of implementation, and improve the health of the population. Currently, there is a lack of scientific evidence that reviews the research on digital health promotion and prevention in settings. OBJECTIVE This scoping review aims to provide an overview of research targeting digital health promotion and primary prevention in settings. It assesses the range of scientific literature regarding outcomes such as applied technology, targeted setting, and area of health promotion or prevention, as well as identifies research gaps. METHODS The scoping review was conducted following the Levac, Colquhoun, and O'Brien framework. We searched scientific databases and gray literature for articles on digital setting-based health promotion and prevention published from 2010 to January 2020. We included empirical and nonempirical publications in English or German and excluded secondary or tertiary prevention and health promotion at the workplace. RESULTS From 8888 records, the search resulted in 200 (2.25%) included publications. We identified a huge diversity of literature regarding digital setting-based health promotion and prevention. The variety of technology types extends from computer- and web-based programs to mobile devices (eg, smartphone apps) and telemonitoring devices (sensors). We found analog, digital, and blended settings in which digital health promotion and prevention takes place. The most frequent analog settings were schools (39/200, 19.5%) and neighborhoods or communities (24/200, 12%). Social media apps were also included because in some studies they were defined as a (digital) setting. They accounted for 31.5% (63/200) of the identified settings. The most commonly focused areas of health promotion and prevention were physical activity (81/200, 40.5%), nutrition (45/200, 22.5%), and sexual health (34/200, 17%). Most of the interventions combined several health promotion or prevention methods, including environmental change; providing information, social support, training, or incentives; and monitoring. Finally, we found that the articles mostly reported on behavioral rather than structural health promotion and prevention. CONCLUSIONS The research field of digital health promotion and prevention in settings is heterogeneous. At the same time, we identified research gaps regarding the absence of valid definitions of relevant terms (eg, digital settings) and the lack of literature on structural health promotion and prevention in settings. Therefore, it remains unclear how digital technologies can contribute to structural (or organizational) changes in settings. More research is needed to successfully implement digital technologies to achieve health promotion and prevention in settings.
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Affiliation(s)
- Anna Lea Stark
- School of Public Health, Centre for ePublic Health, Bielefeld University, Bielefeld, Germany
| | - Cornelia Geukes
- School of Public Health, Centre for ePublic Health, Bielefeld University, Bielefeld, Germany
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Fischer F. [Digital interventions in prevention and health promotion: What kind of evidence do we have and what is needed?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:674-680. [PMID: 32355991 DOI: 10.1007/s00103-020-03143-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Digital technologies increasingly affect our daily lives and interact with our living environment. A high potential for prevention and health promotion is referred to digital interventions. So far, however, there is a lack of well-founded evidence on the effectiveness of such measures. This paper will address the challenges of evidence-based digital interventions in prevention and health promotion. The results are summarised in the form of a narrative review.So far, evidence-based medicine methods have not been sufficiently used in the evaluation of benefits and harms in the field of prevention and health promotion. The reasons for this are found in the complexity of the corresponding measures. This complexity is further increased by digital interventions. Nevertheless, it is urgently recommended to place a stronger focus on evidence-based interventions in order to enable meaningful and comprehensible evaluation procedures with regard to the effectiveness of digital interventions in prevention and health promotion.Digitalisation leads to new demands on prevention and health promotion. A critical perspective on the actual impact of digital interventions and their social implications is needed. The development of a solid knowledge base is necessary in order to promote acceptance of the technologies and to achieve sustainable implementation.
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Affiliation(s)
- Florian Fischer
- Institut für Gerontologische Versorgungs- und Pflegeforschung, Hochschule Ravensburg-Weingarten, Weingarten, Deutschland. .,Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland.
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Wichmann F, Brandes M, Jahn I, Muellmann S, Peters M, Pischke CR, Zeeb H. [DEVASYS - Development of an Online Tool to Support Systematic Evaluation of Intervention Projects in Prevention and Health Promotion]. DAS GESUNDHEITSWESEN 2019; 82:1010-1017. [PMID: 31842242 DOI: 10.1055/a-1005-6755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To date, knowledge about the effects and implementation quality of disease prevention and health promotion projects in Germany is limited. Only a few structured evaluation systems exist that can be easily used and which include features for evaluating research and practice projects. The aim of the current project was to develop and carry out a pilot study of an online evaluation tool that enables structured self-evaluation of projects in disease prevention and health promotion practice and contributes to an improved documentation and cyclical development of projects. METHODS The mixed-methods approach taken in this project included 2 steps: a) search of literature and database to develop a theoretical framework for the tool and b) adaptation process to test the fit of the tool for practice, including a focus group discussion and a usability test with different disease prevention and health promotion stakeholders (N=12). RESULTS The resulting documentation and evaluation system (DEVASYS) is comprised of the components "planning", "documentation", and "evaluation" which can be used independently of one another. The conceptual basis of the tool is the RE-AIM framework. To determine the quality of an individual project, dimensions of both the output (reach, acceptance, implementation) and the outcome levels (effectiveness, maintenance) can be documented with the tool. CONCLUSION DEVASYS is a practice-oriented tool contributing to an improved evaluation of existing practice-related intervention projects and the overall quality of future projects in the area of disease prevention and health promotion. Systematic dissemination and implementation of the tool are the next steps to be taken.
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Affiliation(s)
- Frauke Wichmann
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen.,Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen
| | - Mirko Brandes
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
| | - Ingeborg Jahn
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
| | - Saskia Muellmann
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
| | - Manuela Peters
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
| | - Claudia Ruth Pischke
- Medizinische Fakultät, Institut für Medizinische Soziologie, Centre for Health and Society, Heinrich-Heine- Universität Düsseldorf, Düsseldorf
| | - Hajo Zeeb
- Abt. Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen.,Wissenschaftsschwerpunkt Gesundheitswissenschaften, Universität Bremen, Bremen
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Timpel P, Harst L, Reifegerste D, Weihrauch-Blüher S, Schwarz PEH. What should governments be doing to prevent diabetes throughout the life course? Diabetologia 2019; 62:1842-1853. [PMID: 31451873 DOI: 10.1007/s00125-019-4941-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/05/2019] [Indexed: 11/25/2022]
Abstract
Health systems and governments are increasingly required to implement measures that target at-risk populations to prevent noncommunicable diseases. In this review we lay out what governments should be doing to prevent diabetes throughout the life course. The following four target groups were used to structure the specific recommendations: (1) pregnant women and young families, (2) children and adolescents, (3) working age population, and (4) the elderly. The evidence to date supports the effectiveness of some known government policy measures, such as sugar taxes and regulatory measures in the (pre-)school setting for children and adolescents. Many of these appear to be more effective if they are part of a bundle of strategies and if they are supplemented by communication strategies. Although there is a current focus on strategies that target the individual, governments can make use of evidence-based population-level prevention strategies. More research and continuous evaluation of the overall and subgroup-specific effectiveness of policy strategies using high-quality longitudinal studies are needed.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Lorenz Harst
- Research Association Public Health Saxony/Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Doreen Reifegerste
- Department of Media and Communication Science, University of Erfurt, Erfurt, Germany
| | - Susann Weihrauch-Blüher
- Department of Pediatrics I, Pediatric Endocrinology and Diabetology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
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Bödeker W, Moebus S. [Study Designs for Effect Evaluation in Disease Prevention and Health Promotion - Meaning of Internal and External Validity in Intervention Studies]. DAS GESUNDHEITSWESEN 2019; 82:e147-e157. [PMID: 30974466 DOI: 10.1055/a-0832-2220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health promotion and disease prevention in Germany have become more important as a result of the Prevention Act that gives special attention to the setting. So far, however, there is neither a common understanding of the terms of this approach, nor are its potentials empirically derived. Therefore, a discussion about suitable evaluation and study concepts is required. AIMS AND METHODS The aims of this study were to address the meaning of internal and external validity of intervention studies in health promotion and disease prevention. We provide an overview of the achievable bias control for different study designs and provide examples for the evaluation of setting-based approaches. RESULTS Interventions in settings are often characterized by a multitude of measures, actors and intervention contexts. Methods of analysis from evidence-based medicine are viewed critically for health promotion and disease prevention in Germany. Such studies are considered to provide a high degree of internal validity, but the extrapolation of the results to "reality" is viewed as low. In contrast, the extrapolation of study results is not more of a challenge for setting projects than for any other research area. It is not limited by different contexts, but rather by different causal relationships. Impact assessment aims at causally attributing an observed outcome to the intervention. Thus, the epistemological requirements do not differ between studies that are designed for internal or external validity. The international discussion focuses on the refinement of (quasi)-experimental study designs. Examples for the evaluation of setting projects, mainly from Germany, illustrate that those alternative methods have already been used in evaluation practice. CONCLUSION A challenge for health promotion and disease prevention in settings is to systematically assess the different needs for evidence-basing. At present, there is a wealth of findings in a large number of intervention fields. These findings must be compiled and analyzed to determine whether and to what extent further evaluations need to be initiated and by which methods.
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Affiliation(s)
| | - Susanne Moebus
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Zentrum für Urbane Epidemiologie, Universitätsklinikum Essen, Essen
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Hartmann T, Baumgarten K, Hildebrand C, Sonntag U. Gesundheitsfördernde Hochschulen. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2016. [DOI: 10.1007/s11553-016-0564-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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[Settings-based prevention of overweight in childhood and adolescents : Theoretical foundation, determinants and intervention planning]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1394-1404. [PMID: 27695936 DOI: 10.1007/s00103-016-2439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Childhood and adolescent overweight can still be seen as a global public health problem. Based on our socioeconomic understanding, overweight is the result of a complex interplay of a diverse array of factors acting on different levels. Hence, in addition to individual level determinants overweight prevention should also address environmental related factors as part of a holistic and integrated setting approach. OBJECTIVE This paper aims to discuss the setting approach with regard to overweight prevention in childhood and adolescence. In addition to a summary of environmental factors and their empirical influence on the determinants of overweight, theoretical approaches and planning models of settings-based overweight prevention are discussed. RESULTS While settings can be characterized as specific social-spatial subsystems (e. g. kindergarten, schools), living environments relate to complex subject-oriented environments that may include various subsystems. Direct social contexts, educational contexts and community contexts as relevant systems for young people contain different evidence-based influences that need to be taken into account in settings based overweight prevention. To support a theory-driven intervention, numerous planning models exist, which are presented here. DISCUSSION Given the strengthening of environments for health within the prevention law, the underlying settings approach also needs further development with regard to overweigth prevention. This includes the improvement of the theoretical foundation by aligning intervention practice of planning models, which also has a positive influence on the ability to measure its success.
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