[Study Designs for Effect Evaluation in Disease Prevention and Health Promotion - Meaning of Internal and External Validity in Intervention Studies]

[Decentralized Health Promotion in Nuremberg according to the Prevention Bill: Assessment of results and experiences of the project "Health for Everyone in the District"]

BACKGROUND

The project "Health for Everyone in the District" was implemented in Nuremberg from May 2017 to October 2022 as part of the law passed to strengthen health promotion and disease prevention with funding from Public Health Insurance, Bavaria. The aim was to implement health promotion measures through a decentralized system in four deprived parts of the city and thus promote health equity on site. Among other aspects, program loyalty, project scope, and acceptance, as well as continuity and establishment of permanent structures underwent external assessment.

METHOD

As part of the evaluation, quantitative data from the paper-and-pencil feedback forms of the measures (n=580), four qualitative focus group interviews with participants of the project (n=20), and an in-depth partially standardized predominantly quantitative online survey of participants and course instructors from the districts (n=67) were conducted.

RESULTS

The programs were accepted by those most in need, namely women, elderly people and those with a migration background. Women, senior citizens and people with a migration background were well reached by the measures. The very high level of satisfaction with the measures showed that there were opportunities for implementation of health promotion measures into daily life taking into consideration the local environment and deprived target groups. The specifications of the guidelines for prevention, however, represented a hurdle for the long-term establishment of the measures in these districts.

CONCLUSION

The project "Health for Everyone in the District " represents a local low-threshold approach to social situation-related health promotion in the municipal setting and is suitable for reaching deprived target groups with health-promoting measures. Adjustments to the guidelines for prevention could help create permanent structures on a broader scale.

Implementation of evidence-based health promotion and disease prevention interventions: theoretical and practical implications of the concept of transferability for decision-making and the transfer process

Evidence-based health promotion and disease prevention require incorporating evidence of the effectiveness of interventions into policy and practice. With the entry into force of the German Act to Strengthen Health Promotion and Prevention (PrävG), interventions that take place in people’s everyday living environments have gained in importance. Decision-makers need to assess whether an evidence-based intervention is transferable to their specific target context. The Federal Centre for Health Education (BZgA) recommends that transferability of an intervention should be clarified before any decision to implement it. Furthermore, transferability needs to be finally determined after an evaluation in the target context. In this article, we elaborate on theoretical and practical implications of the concept of transferability for health promotion and disease prevention based on the Population–Intervention–Environment–Transfer Models of Transferability (PIET-T). We discuss how decision-makers can anticipate transferability prior to the intervention transfer with the help of transferability criteria and how they can take transferability into account in the further process. This includes the steps of the analysis of a health problem and identification of effective interventions, the steps of the initial transferability assessment and identification of the need for adaptation, and the steps of the implementation and evaluation. Considering transferability is a complex task that comes with challenges. But it offers opportunities to select a suitable intervention for a target context and, in the transfer process, to understand the conditions under which the intervention works in this context. This knowledge helps to establish an evidence base, which is practically relevant.

[Teacher's Health Promotion - Participation in Health-Promoting Interventions in the School Setting]

AIM

This study examined the participation in health-promoting measures by teachers and the perceived fit between offers and subjective needs from the teachers' perspective.

METHODS

In the academic year 2017/18, questionnaire-based data were collected at schools in the German state of Brandenburg (n=830). The teachers answered questions about the use, offer and subjective need regarding health-promoting measures.

RESULTS

81.3% of teachers had participated in one or more health-promoting measures in the past 24 months. We found no significant differences in age, gender, type and sponsorship of school. In most subjects of health promotion, teachers indicated a considerably higher need for such measures compared to the perceived offer. From the teachers' point of view, there was a particular need for measures to change individual behavior and the health-promoting design of the schools and classrooms.

CONCLUSION

When implementing prevention measures, the fit between offers and subjective needs from the teachers' point of view should be given greater consideration.