NICE chief criticises "one size fits all" approach to health promotion

The impact of community engagement as a public health intervention to support the mental well-being of single mothers and children living under housing insecure conditions - a rapid literature review

BACKGROUND

In the UK, the population of homelessness and housing insecurity is increasing among families headed by mothers. The unique stressors of housing insecurity and living in accommodations ill-suited to long-term dwellings increase mental distress for mothers and children. Community engagement interventions present a public health opportunity to alleviate adverse outcomes for vulnerable families.

AIM

To synthesise and evaluate evidence of the impact of community engagement interventions in supporting the mental well-being of mothers and children living under housing insecure conditions. To synthesise the components of community engagement interventions as a public health intervention in alleviating mental well-being and non-health outcomes of mothers and children living under housing insecurity.

METHODS

A systematic search of five online bibliographic databases (MEDLINE, EMBASE, PsychINFO, Global Health and Child Development & Adolescent Studies) and grey literature (Carrot2) was conducted in May 2022. Primary studies with community engagement components and housing-insecure single-mother families were included. Intervention data was extracted using the TIDieR checklist and a community engagement keywording tool. The studies' quality was critically appraised using the MetaQAT framework.

RESULTS

Ten studies meeting inclusion criteria were identified, across two countries (USA & UK). Data from the studies reported positive significant effects for health and personal maternal outcomes in addition to higher positive effects for child health outcomes (e.g., decrease in depression symptoms). Interventions targeting social support and self-efficacy demonstrated potential to improve maternal and child outcomes via the maternal-child relationship. Community engagement at the design, delivery and evaluation intervention stages increased the level of community engagement, however there were tentative links to directly improving mental well-being outcomes.

CONCLUSION

There is evidence to suggest that community engagement may be applied as an effective intervention in supporting the mental well-being of mothers and children living under housing insecurity. Proposed intervention effectiveness may be achieved via psychosocial pathways such as improved maternal self-efficacy and social support. However, more embedded long-term process evaluations of these interventions are needed to establish maintenance of these observed benefits and to understand to what extent the findings apply to the UK context.

Physical Activity of Adolescents with and without Disabilities from a Complete Enumeration Study (n = 128,803): School Health Promotion Study 2017

Evidence suggests that adolescent males take part in more moderate-to-vigorous physical activity (MVPA) than females, and that adolescents with disabilities participate in even less. Public health data are typically based on the international physical activity (PA) recommendations of at least 60 minutes of MVPA daily. However, it appears that data are lost because a person who reports MVPA 0–6 days a week is grouped together and is considered as ‘inactive’. Therefore, the purposes of this study were to report differences among adolescents with and without disabilities who were ‘active’ and ‘inactive’ and to explore differences by sex. A complete enumeration study (2017 School Health Promotion Survey; n = 128,803) of Finnish adolescents aged between 14–19 years old was conducted. The single item self-report MVPA was used with items from the Washington Group on Disability Statistics. Data were grouped into physiological and cognitive disabilities and were split into active and inactive adolescents based on the PA recommendations; subsequently, binary logistic regression analyses were performed. Data from the inactive participants were analyzed with multivariate analysis of covariance and effect sizes were reported. Approximately 10% of males and 17% of females reported disabilities. There were fewer adolescents with disabilities who took part in daily PA (OR = 0.90, CI = 0.85–0.94), especially among those with cognitive disabilities (OR = 0.86, CI = 0.82–0.91). There were more active male than female adolescents (OR = 1.48, CI = 1.43–1.52). Of the inactive adolescents, females reported similar MVPA to males, with and without disabilities after controlling for age, school type, and family financial situation. Inactive adolescents with walking difficulties reported the least amount of MVPA (males; mean = 2.24, CI = 2.03–2.44, females; mean = 2.18, CI = 1.99–2.37). The difference in means with adolescents without disabilities according to Cohen’s d effect size was medium for males (0.56) and females (0.58). The effect sizes from all other groups of disabilities were small. The difference in PA between males and females has diminished among the inactive groups, yet there is still a need to improve the gap between males and females, especially for those who meet the PA recommendations. More strategies are needed to improve MVPA among adolescents with disabilities, especially those with cognitive disabilities.

Ownership and Use of Commercial Physical Activity Trackers Among Finnish Adolescents: Cross-Sectional Study

Background

Mobile phone apps for monitoring and promoting physical activity (PA) are extremely popular among adults. Devices, such as heart rate monitors or sports watches (HRMs/SWs) that work with these apps are at sufficiently low costs to be available through the commercial markets. Studies have reported an increase in PA levels among adults with devices; however, it is unknown whether the phenomena are similar during early adolescence. At a time when adolescents start to develop their own sense of independence and build friendship, the ease of smartphone availability in developed countries needs to be investigated in important health promoting behaviors such as PA.

Objective

The objective of this study was to investigate the ownership and usage of PA trackers (apps and HRM/SW) among adolescents in a national representative sample and to examine the association between use of devices and PA levels.

Methods

The Finnish school-aged physical activity (SPA) study consisted of 4575 adolescents, aged 11-, 13-, and 15-years, who took part in a web-based questionnaire during school time about PA behaviors between April and May 2016. Binary logistic regression analyses were used to test the associations between moderate to vigorous physical activity (MVPA) and devices, after controlling for gender, age, disability, and family affluence.

Results

PA tracking devices have been categorized into two types, which are accessible to adolescents: (1) apps and (2) HRM/SW. Half the adolescents (2351/4467; 52.63%) own apps for monitoring PA, yet 16.12% (720/4467) report using apps. Fewer adolescents (782/4413; 17.72%) own HRM/SW and 9.25% (408/4413) use HRM/SW. In this study, users of HRM/SW were 2.09 times (95% CI 1.64-2.67), whereas users of apps were 1.4 times (95% CI 1.15-1.74) more likely to meet PA recommendations of daily MVPA for at least 60 min compared with adolescents without HRM/SW or without apps.

Conclusions

To our knowledge, this is the first study that describes the situation in Finland with adolescents using PA trackers and its association with PA levels. Implications of the use of apps and HRM/SW by adolescents are discussed.