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Keshavarz Mohammadi N, Rezaei Z, Burggraf L, Pype P. Exploring settings as social complex adaptive systems in setting-based health research: a scoping review. Health Promot Int 2024; 39:daae001. [PMID: 38365190 DOI: 10.1093/heapro/daae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024] Open
Abstract
Since launching health health-promoting settings approach to health by WHO, valuable progress has happened in implementing its holistic concepts in settings such as cities, schools, workplaces, hospitals and healthcare services. However, significant knowledge-intention-success gaps still exist in creating sustainable health-promoting changes in settings. The complexity of the task of bridging this gap has contributed to the call for a complexity-informed paradigm shift to health as well as settings, followed by increasing consultation of relevant complexity theories, frameworks and tools in health research. This paper provides a critical scoping review of the application of complex adaptive system (CAS) theory in settings-based health promotion research. We included 14 papers, mostly qualitative studies, reporting on planning or implementation of change initiatives, less on its evaluation. CAS theory application was often incomplete thereby reducing the potential benefit of using this lens to understand change management. We suggest some recommendations how to comprehensively apply the CAS theory in setting-based health research and to report on all CAS characteristics to enhance the understanding of settings as adaptive health-promoting settings.
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Affiliation(s)
- Nastaran Keshavarz Mohammadi
- Department of Public Health, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, 1985717443 Tehran, Iran
| | - Zahed Rezaei
- Deprtment of Public health, Asadabad School of Medical Sciences, Imam Khomeini Square, 6541843189 Asadabad, Iran
| | - Larissa Burggraf
- Department for Sociology, University of Education, Oberbettringer Street 200, 73525 Schwäbisch Gmünd, Germany
| | - Peter Pype
- Department of Public Health and Primary Care, University Hospital, Ghent University, Gent, Belgium
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Al-Jawaldeh A, Matbouli D, Diab S, Taktouk M, Hojeij L, Naalbandian S, Nasreddine L. School-Based Nutrition Programs in the Eastern Mediterranean Region: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7047. [PMID: 37998278 PMCID: PMC10671197 DOI: 10.3390/ijerph20227047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/27/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023]
Abstract
This systematic review aims at documenting government-led school nutrition programs/interventions in countries of the Eastern Mediterranean Region (EMR). A systematic review of the available literature on this topic was conducted between 25 October 2022 and 15 November 2022 using 15 electronic databases as well as grey literature. The search was limited to materials published post 2000 in English, Arabic, or French. Articles/Reports were included in the review if they provided information on school-based nutrition programs/interventions developed, adopted or implemented by a governmental entity in the EMR countries, irrespective of study design. In total, 158 documents were retained until 16 May 2023. School-based programs/interventions were categorized into 13 types. In total, 298 school-based nutrition programs/interventions were identified. The most common were school meals and school feeding programs (all EMR countries) followed by nutrition education within the curriculum (77% of countries), extracurricular nutrition education (64%), standards for school canteens or foods/beverages available in schools (64%), and training of school staff (59%). Approximately half reported the inclusion of fruit and vegetable schemes (54%) or the establishment of hygienic cooking facilities (50%), while less than half reported standards for the marketing of food/beverages (45%), bans/standards for vending machines, milk feeding schemes, or micronutrient supplementation programs (41%). The least common interventions were school gardens (32%) and take-home rations (14%). Countries with the lowest gross domestic product and lowest government effectiveness score had the lowest number of programs/interventions. Many of the programs have tackled both school-aged children as well as preschoolers. We were able to identify monitoring and process evaluation for 21 programs in 14 countries. Few programs have undergone impact assessment.
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Affiliation(s)
- Ayoub Al-Jawaldeh
- Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo 11371, Egypt;
| | - Dana Matbouli
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Sarah Diab
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Mandy Taktouk
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Leila Hojeij
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
| | - Sally Naalbandian
- Science and Agriculture Library, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Lara Nasreddine
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut 1107 2020, Lebanon; (D.M.); (S.D.); (M.T.); (L.H.)
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Aliasgharzadeh S, Ebrahimi-Mameghani M, Mahdavi R, Karimzadeh H, Nikniaz L, Tabrizi JS, Pourali F. Prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran: a multi-criteria decision-making approach. BMC Med Res Methodol 2022; 22:293. [PMCID: PMC9666957 DOI: 10.1186/s12874-022-01761-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Numerous nutrition-related policy options and strategies have been proposed to tackle hypertension and other risk factors of non-communicable diseases (NCDs). In this study, we developed a comparative analysis using a multi-criteria decision-making (MCDM) model for prioritizing population-based nutrition-related interventions to prevent and control hypertension in Iran.
Methods
We employed a combination of Delphi technique and Analytic Hierarchy Process (AHP) method as the methodological tool to prioritize decision alternatives using multiple criteria. The prominent assessment criteria and intervention strategies were derived using a literature review, focus group discussion (n = 11), and a 2-round modified Delphi technique with specialists and experts involved in different stages of health policy-making (round 1: n = 50, round 2: n = 46). Then, the AHP was used to determine the weightage of the selected interventions and develop the decision-making model. The sensitivity analysis was performed to test the stability of the priority ranking.
Results
Nine alternative interventions were included in the final ranking based on eight assessment criteria. According to the results, the most priority interventions to prevent and control hypertension included reformulation of food products to contain less salt and changing the target levels of salt in foods and meals, providing low-sodium salt substitutes, and reducing salt intake through the implementation of front-of-package labeling (FOPL). The results of the sensitivity analysis and a comparison analysis suggested that the assessment model performed in this study had an appropriate level of robustness in selecting the best option among the proposed alternatives.
Conclusion
MCDM techniques offer a potentially valuable approach to rationally structuring the problem, along with the opportunity to make explicit the judgments used as part of the decision-making model. The findings of this study provide a preliminary evidence base to guide future decisions and reforms aiming to improve appropriate population-based interventions for tackling hypertension and other risk factors of NCDs.
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Westbury S, Ghosh I, Jones HM, Mensah D, Samuel F, Irache A, Azhar N, Al-Khudairy L, Iqbal R, Oyebode O. The influence of the urban food environment on diet, nutrition and health outcomes in low-income and middle-income countries: a systematic review. BMJ Glob Health 2021; 6:bmjgh-2021-006358. [PMID: 34635553 PMCID: PMC8506857 DOI: 10.1136/bmjgh-2021-006358] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction Diet and nutrition are leading causes of global morbidity and mortality. Our study aimed to identify and synthesise evidence on the association between food environment characteristics and diet, nutrition and health outcomes in low-income and middle-income countries (LMICs), relevant to urban settings, to support development and implementation of appropriate interventions. Methods We conducted a comprehensive search of 9 databases from 1 January 2000 to 16 September 2020 with no language restrictions. We included original peer-reviewed observational studies, intervention studies or natural experiments conducted in at least one urban LMIC setting and reporting a quantitative association between a characteristic of the food environment and a diet, nutrition or health outcome. Study selection was done independently in duplicate. Data extraction and quality appraisal using the National Heart Lung and Blood Institute checklists were completed based on published reports using a prepiloted form on Covidence. Data were synthesised narratively. Results 74 studies met eligibility criteria. Consistent evidence reported an association between availability characteristics in the neighbourhood food environment and dietary behaviour (14 studies, 10 rated as good quality), while the balance of evidence suggested an association with health or nutrition outcomes (17 of 24 relevant studies). We also found a balance of evidence that accessibility to food in the neighbourhood environment was associated with diet (10 of 11 studies) although evidence of an association with health outcomes was contradictory. Evidence on other neighbourhood food environment characteristics was sparse and mixed. Availability in the school food environment was also found to be associated with relevant outcomes. Studies investigating our other primary outcomes in observational studies of the school food environment were sparse, but most interventional studies were situated in schools. We found very little evidence on how workplace and home food environments are associated with relevant outcomes. This is a substantial evidence gap. Conclusion ‘Zoning’ or ‘healthy food cart’ interventions to alter food availability may be appropriate in urban LMIC. PROSPERO registration number CRD42020207475.
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Affiliation(s)
- Susannah Westbury
- School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Iman Ghosh
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Daniel Mensah
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Ana Irache
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Nida Azhar
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | | | - Romaina Iqbal
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
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Enabling Food Environment in Kindergartens and Schools in Iran for Promoting Healthy Diet: Is It on the Right Track? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084114. [PMID: 33924728 PMCID: PMC8070383 DOI: 10.3390/ijerph18084114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/06/2023]
Abstract
Enabling policies related to kindergarten and school food environments can be effective approaches in preventing childhood obesity. This study investigated policies and/or programs with direct or indirect effects on the food environment in kindergartens and schools in Iran. In this scoping review, we systematically searched PubMed, Scopus, and Web of science, as well as Iranian scientific search engines, including Scientific Information Database and Magiran from January 1990 to October 2020, to identify literature on policies/programs affecting the food environment in kindergartens and schools in Iran. A total of 30 studies and policy documents were included in this review relevant to eight policies/programs. These programs have helped to control food availability in schools, increase nutritional awareness, positively influence physical function and school performances, and reduce malnutrition in rural kindergartens. However, improving the food environment in schools and kindergartens requires proper revisions and local adaptation of many of these policies, strengthening of cross-sectoral collaborations, provision of necessary financial and human resources, and ensuring regular monitoring and evaluation. Reflecting on Iran's health policies and interventions provides insight into the progress achieved and challenges faced. Lessons can benefit the country itself, as well as other countries with similar contexts.
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Sartipizadeh M, Yazdi-Feyzabadi V, Alipouri Sakha M, Zarrin A, Bazyar M, Zahirian Moghadam T, Zandian H. Evaluating the health promoting schools in Iran: across-sectional study. HEALTH EDUCATION 2021. [DOI: 10.1108/he-04-2020-0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHealth-promoting schools have been associated with improvements in the health status of students globally. This study is a secondary analysis study assessing Iranian HPSs.Design/methodology/approachThis was a cross-sectional study on routinely collected data using an external audit 63-item checklist, which was utilized to evaluate 440 HPSs between 2014 and 2017. The mean score for each of the checklists' components was calculated. Nonparametric tests were conducted to investigate the association between the presence of a school caregiver, students' educational level and the school's score.FindingsWhile the number of five- and four-star schools increased significantly, one- to three-star schools declined. Providing clinical and counseling services had negative growth. Despite the steady growth of the staff's health, this category still had the lowest score among; on the contrary, physical activity had the highest score in 2017. The presence of a full-time school caregiver and middle schools were both significantly correlated with achieving higher scores (p < 0.005).Originality/valueIt seems that in addition to developing school facilities to promote physical activities, measures should be taken to promote access to counseling services, considering health issues of students and staff and finally increasing the number of full-time school caregiver
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Mohammadi S, Ramezankhani A, Montazeri A, Nasrollahi A, Keshavarz Mohammadi N. Why medical journalism wins public health journalism: systems thinking recommendations for health-promoting media. HEALTH EDUCATION 2021. [DOI: 10.1108/he-05-2020-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeHealth-related issues are widely covered in news agencies by medical and health journalists. The quantity, format and quality of their coverage influence the general public as well as policymakers and professions. Current studies and observations suggest that news agencies are more dominated by medical topics (disease, symptoms, epidemiology, treatment and medicines) than general public health issues (risk prevention, health protection, education and promotion). This study explores the causes of the current situation in Iran and generates solutions for supporting health-promoting media that may also prove beneficial for other countries.Design/methodology/approachA qualitative study was conducted to explore the coverage of health-related topics in selected news agencies. Stakeholders, including health journalists, health professionals and public relations staff at the Iranian Ministry of Health and Medical Education were interviewed. Data were collected until data saturation was reached. The transcripts of all the 17 interviews conducted were analyzed using conventional content analysis.FindingsFour groups of causes were identified, including individual factors, organizational factors, socioeconomic factors and the different nature of medicine and public health. The participants proposed several solutions that were classified into three categories, including the empowerment of stakeholders through capacity development, organizational change and mutual communication and culture change.Originality/valueCreating health-promoting media is a complex but urgent task, and providing a comprehensive and deep understanding of the dynamic interdependencies of the multiple factors at play in it and developing and implementing the most effective interventions for it requires a systematic approach.
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Moradi M, Hassanzadeh-Keshteli A, Feizi A, Azadbakht L, Esmaillzadeh A, Adibi P. Patterning of Food Preferences Among Iranian Adults: Results from SEPAHAN Study. Int J Prev Med 2020; 11:176. [PMID: 33456732 PMCID: PMC7804878 DOI: 10.4103/ijpvm.ijpvm_138_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/08/2019] [Indexed: 11/28/2022] Open
Abstract
Background: The present study was conducted to evaluate the pattern of food preference among a large sample of Iranian adults. Methods: In a cross-sectional study within the study on the epidemiology of psychological alimentary health and nutrition (SEPAHAN) projects, a total of 6239 of 8694 subjects completed a 106-item food preference questionnaire. Subjects indicated whether they liked, disliked or had gastrointestinal symptoms for each food item separately. They also reported the frequency of consumption for each food item. Results: We observed that presence of some foods such as yogurt, fruits and vegetables in the list of the most preferred food items and presence of kalbas, sausages and chips in the list of the most disliked food items, were representative of healthy dietary pattern in this population. Results also revealed that women liked unhealthy foods more than men (P value <0.05 for all significant food items). Moreover, in most of the food items, men reported less gastrointestinal symptoms than women (P value <0.05 for all significant food items). Our findings revealed that smokers disliked most of the healthy food items. We also observed that pregnant women regardless of the trimesters, reported dislike for sweet-tasting food items. Conclusions: More researches are suggested in order to indicate the origins of preferences and recommend some practical alternatives to improve the dietary pattern in society.
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Affiliation(s)
- Maedeh Moradi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ammar Hassanzadeh-Keshteli
- Department of Medicine, University of Alberta, Edmonton, Canada.,Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.,Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Peyman Adibi
- Integrative Functional Gastroenterology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Keshavarz Mohammadi N. One step back toward the future of health promotion: complexity-informed health promotion. Health Promot Int 2019; 34:635-639. [DOI: 10.1093/heapro/daz084] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Socio-economic inequality in unhealthy snacks consumption among adolescent students in Iran: a concentration index decomposition analysis. Public Health Nutr 2019; 22:2179-2188. [PMID: 31199208 DOI: 10.1017/s1368980019000740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present study aimed to assess and decompose the socio-economic inequality in unhealthy snacks consumption among adolescent students in Kerman, Iran. DESIGN The data were obtained from a cross-sectional study. Principal component analysis was done to measure the socio-economic status (SES) of the adolescents' families and the normalized concentration index (NCI) was used to measure the inequality in unhealthy snacks consumption among adolescent students of different SES. The contributions of environmental and individual explanatory variables to inequality were assessed by decomposing the concentration index. SETTING Forty secondary schools of Kerman Province in Iran in 2015. PARTICIPANTS Eighth-grade adolescent students (n 1320). RESULTS The data of 1242 adolescent students were completed for the current study. Unhealthy snacks consumption was unequally distributed among adolescent students and was concentrated mainly among the high-SES adolescents (NCI = 0·179; 95 % CI 0·056, 0·119). The decomposition showed that higher SES (62 %) and receiving pocket money allowance (31 %), as environmental variables, had the highest positive contributions to the measured inequality in unhealthy snacks consumption. Taste and sensory perception (7 %) as well as cost sensitivity (5 %), as individual variables, followed them in terms of their contribution importance. CONCLUSIONS It is highly suggested that both environmental and individual factors should be addressed at different settings including schools, families and suppliers of unhealthy snacks. These findings can help future health promotion strategies in Iran to tackle the observed inequality in unhealthy snacks consumption.
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