Curriculum mapping of health promotion competencies in dental and oral health training programmes in Australia

ISSUE ADDRESSED

Dental diseases are chronic conditions that place a significant burden on the population's health; however, they are mostly preventable using a range of health promotion strategies Health promotion is a core competency for all dental and oral health graduates, but little is known about what health promotion content is taught in undergraduate degrees. The aim of this study was to explore the dental and oral health content in Australian undergraduate dental and oral health degrees and map against the last two versions of the Australian Dental Council (ADC) health promotion competencies.

METHODS

All ADC-accredited dental and oral health courses delivered at Australian universities in 2019 were eligible to be included. Key words were used to locate subjects within the courses that contained health promotion content. This was analysed and ranked against the last two versions (2011 and 2016) of the ADC health promotion competencies. The competencies were then ranked using Blooms updated "six levels of thinking."

RESULTS

Seven oral health and eight dental courses were mapped. The number of health promotion subjects in courses varied substantially; the percentage of subjects that contained health promotion in oral health courses ranged from 30% to 75% and 16% to 60% for dental courses. All oral health courses were explicitly meeting the current ADC health promotion competencies, however, only half of the dental courses met the competency standards.

CONCLUSION

Curriculum mapping provided a snapshot of the health promotion content within dental and oral health degrees in Australia. Evaluations of the extent to which these courses meet the ADC competencies provide useful information for students, clinicians and policy makers. SO WHAT?: This study provides evidence that health promotion training is occurring at varying levels. However, in dentistry, not all the ADC health promotion competencies are being met. A change is needed in the ADC health promotion competencies and ethos of academics involved in the development of curriculum to include and give appropriate attention to health promotion theory, especially advocacy. This will enable future dental professionals to advocate for a range of oral health promotion activities such as water fluoridation, universal dental care and sugar-sweetened beverage taxes.

Strengthening health promotion practice: capacity development for a transdisciplinary field

The growing burden of non-communicable and newly emerging communicable diseases, multi-morbidity, increasing health inequalities, the health effects of climate change and natural disasters and the revolution in communication technology require a shift of focus towards more preventive, people-centred and community-based health services. This has implications for the health workforce, which needs to develop new capacities and skills, many of which are at the core of health promotion. Health promotion is thus being mainstreamed into modern public health. For health promotion, this offers both opportunities and challenges. A stronger focus on the enablers of health enhances the strategic importance of health promotion's whole-of-society approach to health, showcases the achievements of health promotion with regard to core professional competencies, and helps build public health capacity with health promotion accents. On the other hand, mainstreaming health promotion can weaken its organizational capacity and visibility, and bears the risk of it being absorbed into a traditional public health discourse dominated by medical professions. To address these challenges and grasp the opportunities, it is essential for the health promotion workforce to position itself within the diversifying primary care and public health field. Taking the transdisciplinary status of health promotion and existing capacity development systems in primary and secondary prevention and health promotion as reference points, this paper considers the possibilities to integrate and implement health promotion capacities within and across disciplinary boundaries, arguing that the contribution of health promotion to public health development lies in the complementary nature of specialist and mainstreamed health promotion.

Smoking behaviours and attitudes towards campus-wide tobacco control policies among staff and students: a cross-sectional survey at the University of Birmingham

Background

Tobacco control policies have potential to be an effective strategy for the reduction of smoking prevalence and secondhand smoke (SHS) exposure in tertiary educational settings worldwide. The aims of this study were to collect baseline data among staff and students, to measure smoking behaviours and attitudes towards introduction of campus-wide tobacco control policies within a UK higher education setting.

Methods

Cross-sectional study using data collected by web-based questionnaire administered to employed staff and enrolled students (undergraduate/postgraduate) at the University of Birmingham from May 2016 to April 2017. Information was obtained regarding demographic characteristics, tobacco usage patterns and attitudes towards a revised campus tobacco control policy using a 21-item survey tool. Logistic regression analyses were used to explore associations between participant characteristics and support for smoke-free or tobacco-free campus policy options, evaluated by crude and adjusted Odds Radios (OR) after controlling for confounding factors (significance level: P < 0.05).

Results

A total of 934 survey responses were received, of whom 780 participants provided complete information on staff or student status and were included in the present analysis. Current smoking prevalence was 14% (N = 109; 95% confidence interval (CI) 11.6–16.6). Overall, 66.3% (95% CI: 62.9–69.7) of participants supported a smoke-free campus; 68.5% (95% CI: 65.2–71.8) endorsed restrictions for tobacco sales and just under half of respondents (47.3%; 95% CI: 43.8–50.9) supported a ban for electronic cigarettes/vaping device use on campus. Smoking status was an independent predictor of support for tobacco control, with the lowest level of support for a smoke-free campus among daily (adjusted OR 0.02; 95% CI: 0.01–0.05) and intermittent smokers (adjusted OR 0.06; 95% CI: 0.02–0.16).

Conclusions

Overall, the majority of staff and students participating in this baseline survey supported implementation of a smoke-free or comprehensive tobacco-free campus policy. These findings may inform the development and future implementation of a revised tobacco control policy at the university which reflects contemporary attitudes and considers a broad range of implementation issues, including behaviour change and environmental adaptations.

Health promotion interventions for community-dwelling older people with mild or pre-frailty: a systematic review and meta-analysis

Background

Mild or pre-frailty is common and associated with increased risks of hospitalisation, functional decline, moves to long-term care, and death. Little is known about the effectiveness of health promotion in reducing these risks. This systematic review aimed to synthesise randomised controlled trials (RCTs) evaluating home and community-based health promotion interventions for older people with mild/pre-frailty.

Methods

We searched 20 bibliographic databases and 3 trials registers (January 1990 – May 2016) using mild/pre-frailty and associated terms. We included randomised controlled and crossover trials of health promotion interventions for community-dwelling older people (65+ years) with mild/pre-frailty and excluded studies focussing on populations in hospital, long term care facilities or with a specific condition. Risk of bias was assessed by two reviewers using the Cochrane Risk of Bias tool. We pooled study results using standardised mean differences (SMD) where possible and used narrative synthesis where insufficient outcome data were available.

Results

We included 10 articles reporting on seven trials (total n = 506 participants) and included five trials in a meta-analysis. Studies were predominantly small, of limited quality and six studies tested group exercise alone. One study additionally investigated a nutrition and exercise intervention and one evaluated telemonitoring. Interventions of exercise in groups showed mixed effects on functioning (no effects on self-reported functioning SMD 0.19 (95% CI -0.57 to 0.95) n = 3 studies; positive effects on performance-based functioning SMD 0.37 (95% CI 0.07 to 0.68) n = 3 studies). No studies assessed moves to long-term care or hospitalisations.

Conclusions

Currently the evidence base is of insufficient size, quality and breadth to recommend specific health promotion interventions for older people with mild or pre- frailty. High quality studies of rigorously developed interventions are needed.

PROSPERO registration

CRD42014010370 (Review 2).

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-017-0547-8) contains supplementary material, which is available to authorized users.

Specialist health promotion as a career choice in public health

Aims: Health promotion is a young discipline and area of practice that has struggled to establish a discrete identity but which is becoming consolidated as a specialist field of practice through the establishment of occupational standards, a voluntary register (UKVR) and a multidisciplinary public health career framework. This study sought to explore current health promotion managers' career pathways into health promotionand their perceptions of their career future within a public health workforce.

Methods: This exploratory study used semi-structured interviews, a stimulus vignette and a standardized questionnaire to explore the career pathways and motivations of specialist health promotion managers at this time of considerable change in the professional project of public health and health promotion in the United Kingdom.

Results: Specialist health promotion managers express a lack of role clarity and loss of control over the developments of their profession. This is compounded by a perceived lack of external credibility of health promotion and by the difficulties health promotion has in justifying itself in modern economic evaluative frameworks and establishing its legitimacy as an equal partner service within public health organizations. Recent moves to professionalize health promotion within the regulation of the public health workforce were not embraced by these participants for whom the consequent occupational closure was seen as restricting role independence and autonomy, and not necessarily enhancing occupational status.

Conclusions: This study revealed that, currently, health promotion managers experience a lack of role clarity in their work and are uncertain about future career pathways in public health. Health promotion managers (not working at assistant level) do not readily identify with public health as a profession, or with the UKVR's `defined health promotion specialist' accreditation process. The career choices and motivations of health promotion managers shed some light on the future of the `specialist health promotion' workforce and how this may be structured.

A cross sectional evaluation of an alcohol intervention targeting young university students

Background

Hazardous drinking has been found to be higher among young university students compared to their non-university peers. Although young university students are exposed to new and exciting experiences, including greater availability and emphasis on social functions involving alcohol there are few multi strategy comprehensive interventions aimed at reducing alcohol-related harms.

Methods

Random cross sectional online surveys were administered to 18–24 year old students studying at the main campus of a large metropolitan university in Perth, Western Australia. Prior to the completion of the second survey an alcohol intervention was implemented on campus. Completed surveys were received from 2465 (Baseline; T1) and 2422 (Post Year 1: T2) students. Students who consumed alcohol in the past 12 months were categorised as low risk or hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT). Due to the cross sectional nature of the two samples two-tailed two-proportion z-test and two sample t-tests were employed to determine statistical significance between the two time periods for categorical and continuous variables respectively.

Results

At T1 and T2 89.1 % and 87.2 % of the total sample reported drinking alcohol in the past month respectively. Hazardous levels of alcohol consumption reduced slightly between T1 (39.7 %) and T2 (38 %). In both time periods hazardous drinkers reported significantly higher mean scores for experienced harm, second-hand harm and witnessed harm scores compared to low risk drinkers (p <0.001). Hazardous drinkers were significantly more likely to experience academic problems due to their alcohol consumption and to report more positive alcohol expectations than low risk drinkers at both time periods (p <0.001).

Conclusions

Harms and problems for students who report hazardous drinking are of concern and efforts should be made to ensure integrated and targeted strategies reach higher risk students and focus on specific issues such as driving while intoxicated and alcohol related unplanned sexual activity. However there is also a need for universal strategies targeting all students and low risk drinkers as they too are exposed to alcohol harms within the drinking and social environment. Changing the culture of the university environment is a long term aim and to effect change a sustained combination of organisational actions, partnerships and educational actions is required.

Women's receptivity to Fetal Alcohol Spectrum Disorders prevention approaches: A case study of two regions in Russia

AIMS

This study obtained data to inform the development of programs for prevention of Fetal Alcohol Spectrum Disorders (FASD) by examining Russian women's perceptions about the determinants of their decisions regarding alcohol consumption during pregnancy; the importance of educating professionals and community about FASD; and the credibility of various sources of information.

DESIGN

Cross-sectional survey.

SETTING

Seven women's clinics in St. Petersburg and the Nizhny Novgorod region in Russia.

PARTICIPANTS

Six hundred and forty-eight pregnant and non-pregnant women of childbearing age.

MEASURES

A face-to-face structured interview assessed demographic characteristics, pregnancy status, alcohol consumption, and level of trust in and receptivity to FASD prevention messages.

FINDINGS

The most influential contributor to women's decisions regarding alcohol consumption during pregnancy was their own knowledge, followed by information from an obstetrician/gynecologist or nurse. It was most important to women that obstetrics and gynecology professionals and husbands or partners were knowledgeable about the effects of drinking during pregnancy. Physicians' recommendations and research data were regarded by the women as the most credible sources of information. There were significant variations in responses by socio-demographic characteristics and alcohol consumption levels. Younger women were more likely to report the contributions of husbands, mothers, and friends or coworkers to their decisions about alcohol consumption and indicated the importance of educating these people. Women at risk for alcohol use during pregnancy reported greater influence of husbands or partners and warning labels on containers on their alcohol consumption.

CONCLUSIONS

This study emphasizes the importance of broadly disseminating information about FASD, particularly research data, through education of health professionals and the general public in Russia. Women's socio-demographic characteristics and alcohol consumption levels should be considered in designing prevention programs.

"Moving forward: a cross sectional baseline study of staff and student attitudes towards a totally smoke free university campus"

Background

Baseline data were collected to inform the adoption, implementation and institutionalisation phases of a completely smoke free campus policy at a large Western Australian university with a diverse student and staff community.

Methods

An online survey was randomly emailed to staff and students to measure the attitudes towards and the acceptability and enforcement of the policy prior to implementation. In total, 969 respondents completed the survey.

Results

General attitudes towards smoking were negative. While smokers, ex-smokers and non-smokers were supportive of smoke free policy on campus, 65.7% of respondents felt the campus should be completely smoke free. Respondents indicated a smoke free policy should be stringently enforced. The majority of respondents reported that they had been exposed to second-hand smoke on campus (n = 768; 79.5%).

Conclusion

Theory of Organisational Change provides a useful framework to support the implementation of the completely smoke free policy in the University setting. The implementation process needs to consider the broad range of issues associated with implementing a completely smoke free policy and address issues such as safety of smokers, ensuring smokers are not marginalised and ensuring a comprehensive program is implemented. These baseline findings can be used to advocate for the implementation of a comprehensive range of strategies that recognise the addictive nature of tobacco smoking and address attitude and behaviour change, environmental adaptations and effective implementation of the policy. Administration should consider smokers and non-smokers when policy is implemented.

Reducing the environmental impact of dietary choice: perspectives from a behavioural and social change approach

Climate change is recognised as a significant public health issue that will impact on food security. One of the major contributors to global warming is the livestock industry, and, relative to plant-based agriculture, meat production has a much higher environmental impact in relation to freshwater use, amount of land required, and waste products generated. Promoting increased consumption of plant-based foods is a recommended strategy to reduce human impact on the environment and is also now recognised as a potential strategy to reduce the high rates of some chronic diseases such as cardiovascular disease and certain cancers. Currently there is a scant evidence base for policies and programs aiming to increase consumption of plant-based diets and little research on the necessary conditions for that change to occur and the processes involved in such a change. This paper reviews some of the environmental and health consequences of current dietary practices, reviews literature on the determinants of consuming a plant-based diet, and provides recommendations for further research in this area.

Gascoyne Growers Market: a sustainable health promotion activity developed in partnership with the community

OBJECTIVE

To explore the social, health and economic impact of a farmers' market on a small rural community in the north of Western Australia.

DESIGN

Qualitative and quantitative research using a random structured intercept survey, and focus group interviews around four domains of social capital: economic impact, governance and capacity building, healthy public places and social and civic participation.

SETTING

The Gascoyne Growers Markets in Carnarvon.

SUBJECTS

One hundred consumers and 28 market stallholders.

RESULTS

Consumers demonstrated community pride and an increase in fruit and vegetable consumption since they commenced shopping at the markets. The stallholders appear to have gained economically, professionally and socially from the market experience.

CONCLUSIONS

The Gascoyne Growers Markets demonstrate a sustainable health promotion activity developed in partnership with the community. It has contributed to the local economy, providing local quality fruit and vegetables directly to the community while also increasing social capital and creating a healthy public space.

Prisoner healthcare co-payment policy: a cost-cutting measure that might threaten inmates' health

Cost-effective provision of adequate healthcare to prisoners is a core problematic issue in contemporary correctional healthcare settings. An increasingly popular policy for reducing prison healthcare costs is prisoner co-payment systems for health services. Advocates of this policy assert that it facilitates efficient healthcare delivery in prison settings. This article examines the appropriateness and consequences of prisoner healthcare co-payment systems in US prisons. In conclusion, the policy has a strong potential to compromise prisoners' access to healthcare, while not significantly reducing prison healthcare costs. Alternative approaches for improving the efficiency of prison healthcare services are suggested, and implications for Australia are considered.

Preventing alcohol-related traffic injury: a health promotion approach

The conditions that give rise to drinking and driving are complex, with multiple and interrelated causes. Prevention efforts benefit from an approach that relies on the combination of multiple interventions. Health promotion provides a useful framework for conceptualizing and implementing actions to reduce drinking and driving since it involves a combination of educational, behavioral, environmental, and policy approaches. This review draws on data from a range of settings to characterize the effectiveness of various interventions embedded within the health promotion approach. Interventions considered part of the health promotion approach include: (1) economic interventions (2) organizational interventions, (3) policy interventions, and (4) health education interventions, including the use of media, school and community education, and public awareness programs. Effective health promotion strengthens the skills and capabilities of individuals to take action and the capacity of groups or communities to act collectively to exert control over the determinants of alcohol-impaired driving. There is strong evidence for the effectiveness of some components of health promotion, including economic and retailer interventions, alcohol taxation, reducing alcohol availability, legal and legislative strategies, and strategies addressing the servers of alcohol. There is also evidence for the effectiveness of sobriety checkpoints, lower BAC laws, minimum legal drinking age laws, and supportive media promotion programs. Other interventions with moderate evidence of effectiveness include restricting alcohol advertising and promotion, and actions involving counter advertising. Health education interventions alone that have insufficient evidence for effectiveness include passive server training programs, school drug and alcohol education programs, community mobilization efforts, and health warnings. Because each intervention builds on the strengths of every other one, ecological approaches to reducing alcohol-impaired driving using all four components of the health promotion model are likely to be the most effective. Settings such as schools, workplaces, cities, and communities offer practical opportunities to implement alcohol-impaired driving prevention programs within this framework.

What's new about the "new public health"?

From its origins, when public health was integral to societies' social structures, through the sanitary movement and contagion eras, when it evolved as a separate discipline, to the "new public health" era, when health promotion projects like Healthy Cities appear to be steering the discipline back to society's social structure, public health seems to have come full circle. It is this observation that has led some to ask, "What's new about the 'new public health'?" This article addresses the question by highlighting what is new about the health promotion era-including adapted components of previous eras that have been incorporated into its core activities-and its suitability in addressing established and emerging public health threats.