Influence of an oral health promotion program on the evolution of dental status in New Caledonia: A focus on health inequities

New Caledonia is a sui generis collectivity of overseas France situated in the south Pacific Ocean. Geographical and social inequalities are superimposed on ethnic disparities with high prevalence of chronic diseases such as oral diseases. In 2012, the health agency has evaluated the children's health status. Then, an oral health promotion program was developed in 2014. Another study was conducted in 2019 in New Caledonia to appreciate the evolution of children's oral health. A sample of 488 9-years-old children was randomly selected. Dental status was clinically recorded, families and children answered questionnaires about oral health determinants. The methodology (sampling, study variables…) was similar to the one used in the 2012 study. Multivariate mixed-models were conducted to compare 2012 and 2019 dental status and to explore the determinants of caries experience in 2019. Results indicated that caries prevalence and experience decreased between 2012 and 2019, with nonetheless various trends depending on the province or type of indexes. The number of carious lesions (d3t + D3T) in 2019 was used as an outcome variable in four models. Model 1 integrated social variables; ethnicity was found to be the only significant determinant. Model 2 was related to oral health care; participation in the program & and access to oral health care was found to be significant. For oral health behaviours (model 3), tooth brushing frequency and consumption of sugary snacks were significant risk factors. In a final model with significant variables from the previous models, ethnicity, accessibility of oral health care, number of sealed molars, consumption of sugary snacks remained explanatory factors. Five years after the implementation of the oral health promotion program, positive changes in oral health have been observed. However, health equity is still an issue with varying health status depending on ethnicity, behavioural factors and accessibility to oral health care.

QATCHEPP: A quality assessment tool for critical health promotion practice

Background

The origins of health promotion are based in critical practice; however, health promotion practice is still dominated by selective biomedical and behavioral approaches, which are insufficient to reduce health inequities resulting from the inequitable distribution of structural and systemic privilege and power. The Red Lotus Critical Health Promotion Model (RLCHPM), developed to enhance critical practice, includes values and principles that practitioners can use to critically reflect on health promotion practice. Existing quality assessment tools focus primarily on technical aspects of practice rather than the underpinning values and principles. The aim of this project was to develop a quality assessment tool to support critical reflection using the values and principles of critical health promotion. The purpose of the tool is to support the reorientation of health promotion practice toward a more critical approach.

Research design

We used Critical Systems Heuristics as the theoretical framework to develop the quality assessment tool. First, we refined the values and principles in the RLCHPM, then created critical reflective questions, refined the response categories, and added a scoring system.

Results

The Quality Assessment Tool for Critical Health Promotion Practice (QATCHEPP) includes 10 values and associated principles. Each value is a critical health promotion concept, and its associated principle provides a description of how the value is enacted in professional practice. QATCHEPP includes a set of three reflective questions for each value and associated principle. For each question, users score the practice as strongly, somewhat, or minimally/not at all reflective of critical health promotion practice. A percentage summary score is generated with 85% or above indicative of strongly critical practice, 50% ≤ 84% is somewhat critical practice, and < 50% minimally or does not reflect critical practice.

Conclusion

QATCHEPP provides theory-based heuristic support for practitioners to use critical reflection to assess the extent to which practice aligns with critical health promotion. QATCHEPP can be used as part of the Red Lotus Critical Promotion Model or as an independent quality assessment tool to support the orientation of health promotion toward critical practice. This is essential to ensure that health promotion practice contributes to enhancing health equity.

Examining Care Assessment Scores of Community-Dwelling Adults in Flanders, Belgium: The Role of Socio-Psychological and Assessor-Related Factors

One of the primary objectives of health systems is to provide a fair system by providing a comprehensive and holistic approach to caregiving rather than focusing on a single aspect of a person's care needs. This approach is often embodied by using standardized care assessments across health and social care settings. These assessments are completed by professional assessors and yield vital information regarding a person's health or contextual characteristics (e.g., civic engagement, psychosocial wellbeing, environmental characteristics, informal care). However, these scores may be subject to bias that endangers the fairness of the health system. In this study, we investigate to what extent socio-economic and psychological indicators and assessor-related indicators are associated with BelRAI Screener care assessment scores amongst 743 community-dwelling adults nested within 92 assessors in Flanders, Belgium. Findings indicate that there is significant variance in scores at the assessor-level. Socio-psychological characteristics of clients are associated with scores: being fluent in Dutch and providing informal care are associated with low care dependency, while living with children, feelings of depression, and the presence of an informal caregiver during assessment are associated with high care dependency. We discuss the importance of rigorous assessor training and the potential for socio-psychological factors to contribute to the allocation of welfare benefits in light of the Flemish home care system's potential (lack of) fairness.

An investigation of the health-promoting practices of Australian universities

Workplace health promotion programmes (WHPPs) are more likely to succeed where design and implementation account for the influence of health's complex, systemic nature. Thus, a greater understanding of how frameworks developed to progress WHPPs are operationalized across different countries and industries is needed. This study investigates health concerns targeted in an underexplored setting-Australian universities, describing how diverse programmes are implemented to target different health issues and health risk factors. Content analysis is used to outline how Australian universities implement WHPPs to target diverse health concerns. Content from 497 website documents is collected and analysed using NVivo software. A framework for examining diverse WHPPs currently used in practice is developed. Based on this framework, it was evident that Australian universities emphasized initiatives targeting health issues focusing on 'mental health' and 'diabetes'. Regarding health risk factors, 'alcohol and other addictions', 'discrimination and harassment', and 'physical activity' were emphasized. Links between different health concerns targeted and corresponding WHPPs implemented, provide workplaces with a benchmark for designing and implementing programmes. University WHPPs targeted a diverse range of health concerns when enough legal and political motivations to do so existed. These findings about the motivations for improving employee health indicate a potential gap between health promotion benefits reported in literature and the appreciation for these benefits in practice.

A snapshot of physical activity programs targeting Aboriginal and Torres Strait Islander people in Australia

Issue addressed Participation in physical activity programs can be an effective strategy to reduce chronic disease risk factors and improve broader social outcomes. Health and social outcomes are worse among Aboriginal and Torres Strait Islanders than non-Indigenous Australians, who represent an important group for culturally specific programs. The extent of current practice in physical activity programs is largely unknown. This study identifies such programs targeting this population group and describes their characteristics. Methods Bibliographic and Internet searches and snowball sampling identified eligible programs operating between 2012 and 2015 in Australia (phase 1). Program coordinators were contacted to verify sourced information (phase 2). Descriptive characteristics were documented for each program. Results A total of 110 programs were identified across urban, rural and remote locations within all states and territories. Only 11 programs were located through bibliographic sources; the remainder through Internet searches. The programs aimed to influence physical activity for health or broader social outcomes. Sixty five took place in community settings and most involved multiple sectors such as sport, health and education. Almost all were free for participants and involved Indigenous stakeholders. The majority received Government funding and had commenced within the last decade. More than 20 programs reached over 1000 people each; 14 reached 0-100 participants. Most included process or impact evaluation indicators, typically reflecting their aims. Conclusion This snapshot provides a comprehensive description of current physical activity program provision for Aboriginal and Torres Strait Islander people across Australia. The majority of programs were only identified through the grey literature. Many programs collect evaluation data, yet this is underrepresented in academic literature. So what? Capturing current practice can inform future efforts to increase the impact of physical activity programs to improve health and social indicators. Targeted, culturally relevant programs are essential to reduce levels of disadvantage experienced by Aboriginal and Torres Strait Islanders.