School health promotion providers' roles in practice and theory: results from a case study

Strategies for Improving the Utilization of Preventive Care Services: Application of Importance-Performance Gap Analysis Method

The utilization of preventive care services is limited. Previous studies based on communities have looked at many types of barriers to preventive care (i.e., why not do). This study aimed to gain an insight into the key factors and performance gaps (i.e., why do and how to do) of people who attended a regional teaching hospital to undergo health check-ups using a purposive sampling method to recruit people to complete a self-administered questionnaire. Paired sample t-tests and importance-performance gap and regression analyses were performed. The results indicated that the participants' wish to understand their health status, the quality of medical devices and the completeness of items, and process layout planning were the key factors that affect people's health check-up behavior. Promoting the effectiveness of hospital performance may improve the positive cycle of people's health check-up behavior from the community to the hospital. Continuing to promote the knowledge of preventive care services is necessary, and it is very important for people to have a good experience of undergoing health check-ups in the hospital. Important strategies for improving the utilization of preventive care services may include: meeting the person's personalization needs, improving the quality of medical devices and the completeness of items, and having appropriate process layout planning, a detailed interpretation of the results, and further follow-ups in the hospital.

Understanding whole school physical activity transition from a practice theory perspective

Purpose

In this study, the authors offer a practice theory framing of school physical activity transition with conceptual and managerial contributions to whole school approaches (WSAs).

Design/methodology/approach

Based on a literature overview of the limitations of WSA, ecological and systems theorisation and a practice theory framing of physical activity, the authors introduce a model that identifies signs of practice transition and conceptualises the relationship between signs and practice reconfigurations. To exemplify insights from the model, the authors provide illustrations from three cases from the national Estonian “Schools in Motion” programme.

Findings

The signs of practitioner effort, resistance and habituation indicate how practice ecosystem transition is unfolding across a spectrum from practice differentiation to routinisation. Several signs of transition, like resistance, indicate that reconfigured practices are becoming established. Also, there are signs of habituation that seemingly undermine the value of the programme but should instead be celebrated as valuable evidence for the normalisation of new practices.

Practical implications

The article provides a model for WSA programme managers to recognise signs of transition and plan appropriate managerial activities.

Originality/value

The practice theory framing of school physical activity transition advances from extant theorizations of WSAs that have failed to account for the dynamic ways that socio-cultural change in complex school settings can unfold. A model, based on a practice ontology and concepts from theories of practice, is proposed. This recognises signs of transition and can help with the dynamic and reflexive management of transition that retains the purpose of systemic whole school change.

The Impact of School and After-School Friendship Networks on Adolescent Vaccination Behavior

Psychological and social characteristics of individuals are important determinants of their health choices and behaviors. Social networks represent "pipes" through which information and opinions circulate and spread out in the social circle surrounding individuals, influencing their propensity toward important health care interventions. This paper aims to explore the relationship between students' vaccination health choices and their social networks. We administered a questionnaire to students to collect data on individual students' demographics, knowledge, and attitudes about vaccinations, as well as their social networks. Forty-nine pupils belonging to 4 classrooms in an Italian secondary school were enrolled in the study. We applied a logistic regression quadratic assignment procedure (LR-QAP) by regressing students' positive responsive behavior similarity as a dependent variable. LRQAP findings indicate that students' vaccination behavior similarity is significantly associated with after-school social ties and related social mechanisms, suggesting that pupils are more likely to share information and knowledge about health behaviors through social relationships maintained after school hours rather than through those established during the school day. Moreover, we found that vaccination behaviors are more similar for those students having the same ethnicity as well as for those belonging to the same class. Our findings may help policymakers in implementing effective vaccination strategies.

From Complex Interventions to Complex Systems: Using Social Network Analysis to Understand School Engagement with Health and Wellbeing

Challenges in changing school system functioning to orient them towards health are commonly underestimated. Understanding the social interactions of school staff from a complex systems perspective may provide valuable insight into how system dynamics may impede or facilitate the promotion of health and wellbeing. Ego social network analysis was employed with wellbeing leads within four diverse case study schools to identify variability in embeddedness of health and wellbeing roles. This variation, as well as the broader context, was then explored through semi-structured qualitative interviews with school staff and a Healthy Schools Coordinator, sampled from the wellbeing leads' ego-networks. Networks varied in terms of perceived importance and frequency of interactions, centrality, brokerage and cliques. Case study schools that showed higher engagement with health and wellbeing had highly organised, distributed leadership structures, dedicated wellbeing roles, senior leadership support and outside agencies embedded within school systems. Allocation of responsibility for wellbeing to a member of the senior leadership team alongside a distributed leadership approach may facilitate the reorientation of school systems towards health and wellbeing. Ego-network analysis to understand variance in complex school system starting points could be replicated on a larger scale and utilised to design complex interventions.

A methodology to design a performance management system in preventive care

Background

Preventive care has gained increasing attention in health reforms around the world due to its ability to reduce the burden of disease and to save health costs. Nevertheless, there is a gap in terms of the development of reliable systems to measure and evaluate performance of preventive care in order to support decision-making and increase service outcomes. The aim of this study is to define a methodology for designing a performance management system (PMS) in order to effectively support the planning, control and evaluation of preventive care and to identify the factors that influence such a process.

Methods

The methodology is based on the participatory action research approach, which implies collaboration between researchers and practitioners. The study was articulated in four phases and carried out in an Italian regional healthcare system that was undergoing a major reorganization process.

Results

The findings provide insights into the peculiarities that affect preventive care and highlight two categories of critical factors: general issues regarding the process and specific issues regarding preventive care. The first category includes the importance of interactions between academics, physicians and policy-makers, the impact of workloads and red tape on employee involvement and the increased conservation mechanisms during periods of institutional change. The second category concerns the strong heterogeneity of preventive activities within health organizations, the huge amount of regulations and the incompleteness of information systems.

Conclusion

The development of a PMS for preventive care can best be served by collaborative methods that involve academics, professionals and policy-makers, whose roles and responsibilities must be clearly defined, and by an improvement in transparency and communication within organizations in order to enhance the involvement of different professionals at appropriate times and in appropriate ways. Key recommendations that may improve the maintenance and use of information systems are proposed to policy-makers.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3837-8) contains supplementary material, which is available to authorized users.

The life-skills program Lions Quest in Austrian schools: implementation and outcomes

This article investigates the importance of implementation level for the effectiveness of the school-based life skills program Lions Quest in a sample of Austrian students (n = 363 from three schools; aged 9-15 at T1). A quasi-experimental pre- and post-test design with intervention and control group over 2 years was used. The effects of low, average, and high implementation levels on the outcome variables classroom climate, bullying and psychosocial health were analyzed. Multilevel analyses of the longitudinal data indicated greatest effects in the intervention group with highest implementation level, smaller effects with average implementation level, and no or rather detrimental effects in one case with the low implementation level (always compared with the control group who received no intervention). A moderate implementation level was necessary to foster the programs aims for three out of four aspects of class climate and bullying, while no effects were found for psychosocial health. These results are discussed with respect to key factors that are important for successful implementation of school programs.