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Chowdhury HA, Joham AE, Kabir A, Rahman AKMF, Ali L, Harrison CL, Billah B. Exploring type 2 diabetes self-management practices in rural Bangladesh: facilitators, barriers and expectations-a qualitative study protocol. BMJ Open 2024; 14:e081385. [PMID: 38697759 PMCID: PMC11086285 DOI: 10.1136/bmjopen-2023-081385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a global public health crisis impacting low-income and middle-income countries such as Bangladesh. While self-management is encouraged for individuals with T2DM, there is a significant lack of knowledge regarding the factors of facilitators, barriers and expectations associated with T2DM self-management in Bangladesh. This research aims to investigate the potential elements that support, impede and are anticipated in the effective practice of self-management for T2DM in rural areas of Bangladesh. METHODS AND ANALYSIS This study will use an exploratory qualitative approach. 16 focus group discussions, 13 in-depth interviews and 9 key informant interviews will be conducted among multilevel stakeholders, including people with T2DM, their caregivers, healthcare providers, health managers/administrators and policy planners. Interviews will be audio-recorded, transcribed, translated and analysed using thematic analysis. ETHICS AND DISSEMINATION This research project has been approved by the Monash University Human Research Ethics Committee (project reference number: 39483) and the Ethical Review Committee of the Centre for Injury Prevention and Research, Bangladesh (Memo: CIPRB/ERC/2023/14). Research findings will be disseminated in peer-reviewed journals and conference presentations. Published reports will include group data. Individual data privacy will be strictly maintained.
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Affiliation(s)
- Hasina Akhter Chowdhury
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Anju E Joham
- Monash Centre for Health Research and Implementation-MCHRI, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
- Department of Diabetes, Monash University, Melbourne, Victoria, Australia
| | - Ashraful Kabir
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - A K M Fazlur Rahman
- Centre for Injury Prevention and Research Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Liaquat Ali
- Pothikrit Institute of Health Studies (PIHS), Dhaka, Bangladesh
| | - Cheryce L Harrison
- Monash Centre for Health Research and Implementation-MCHRI, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Wang RAH, Smittenaar P, Thomas T, Kamal Z, Kemp H, Sgaier SK. Geographical variation in perceptions, attitudes and barriers to mental health care-seeking across the UK: a cross-sectional study. BMJ Open 2024; 14:e073731. [PMID: 38503409 PMCID: PMC10952949 DOI: 10.1136/bmjopen-2023-073731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 02/27/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVES To examine the relative importance of the drivers of mental health care-seeking intention and how these, along with intention itself, are geographically distributed across integrated care systems (ICS) and health boards (HBs) in the UK. Also, to examine the degree of acceptance of virtual modes of care. DESIGN Community-based cross-sectional survey. PARTICIPANTS AND SETTING A national online survey of 17 309 adults between August and September 2021 recruited via a research technology company, Lucid. Sample size quotas were set to ensure coverage across the UK and match population distributions for gender, age and ethnicity. After exclusions, 16 835 participants remained (54% female, 89% white). MAIN OUTCOME MEASURES Care-seeking intention, using a continuous measure of likelihood and a categorical measure of estimated time to seek professional help for a future mental health difficulty. RESULTS 20.5% (95% CI 19.8% to 21.2%) reported that they would significantly delay or never seek mental healthcare, ranging from 8.3% to 25.7% across ICS/HBs. Multilevel regression analysis showed mental health knowledge was the most predictive of care-seeking intention, followed by attitudes towards others with mental illness and a combination of stigma, negative attitudes to treatment and instrumental barriers to accessing care. The model explained 17% of the variance. There was substantial geographical variation in prevalence of preclinical symptoms of depression and anxiety, attitudes to mental health, and barriers to care, leading to complex ICS/HB profiles. Remote and self-guided therapies did not pose as a major barrier to care with more than half of respondents likely or very likely to use them. CONCLUSIONS Our locally relevant and actionable findings suggest possible interventions that may improve care-seeking intention and indicate which of these interventions need to be geographically tailored to have maximal effect.
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Affiliation(s)
- Rui Adele H Wang
- Surgo Health, Washington, District of Columbia, USA
- Surgo Ventures Inc, Washington, District of Columbia, USA
| | - Peter Smittenaar
- Surgo Health, Washington, District of Columbia, USA
- Surgo Ventures Inc, Washington, District of Columbia, USA
| | - Tony Thomas
- Surgo Ventures Inc, Washington, District of Columbia, USA
| | - Zeast Kamal
- Surgo Ventures Inc, Washington, District of Columbia, USA
- University College London, London, London, UK
| | - Hannah Kemp
- Surgo Health, Washington, District of Columbia, USA
- Surgo Ventures Inc, Washington, District of Columbia, USA
| | - Sema K Sgaier
- Surgo Health, Washington, District of Columbia, USA
- Surgo Ventures Inc, Washington, District of Columbia, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Stanley RM, McKnight A, Probst Y, O'Flynn G, Tillott S. Strong culture, healthy lifestyles: a mixed methods feasibility study for a co-created afterschool cultural programme for Australian Aboriginal children. Pilot Feasibility Stud 2024; 10:31. [PMID: 38360808 PMCID: PMC10868114 DOI: 10.1186/s40814-023-01422-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/21/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Having a strong connection to culture and Country is fundamental to the health and wellbeing of Australian Aboriginal children. The aim of the research was to evaluate the feasibility of study methods and programme implementation of a co-created afterschool cultural programme, and identify areas for improvement. METHODS Aboriginal Relational Research Methodology and mixed methods were applied to evaluate the feasibility of the implementation of the programme and study methods using a non-randomised single-group study design. Australian Aboriginal children and their siblings aged 5-13 years were recruited within regional New South Wales, Australia. The primary outcomes for feasibility included recruitment rates of children and Aboriginal programme mentors, compliance rates of outcome data collection and of the planned programme activities, programme attendance, retention rates and mean enjoyment scores. Follow-up yarning circles were conducted with the children, their parents/caregivers, programme mentors and teachers to explore aspects of feasibility, and areas for improvement. RESULTS A total of 90 caregivers consented to their children (n = 111) being part of the research. Sixteen Aboriginal mentors were recruited to deliver the programmes across the communities. Overall, 74.4% of all health outcome measures were completed across baseline (86.5%) and follow-up (55.9%). Only 61.0% of the programme activities were delivered as originally planned. The average programme attendance rate was 70.0% with a 92.0% retention rate. Eighty-nine percent of children reported a high level of enjoyment with the programmes. Follow-up yarning identified the importance of relational methodologies and flexibility within the programme design and implementation to ensure programmes were adapted to the local community, conditions and differing age groups. Considerations for future programmes included the timing of the programme and identifying health outcome assessment tools and methods that acknowledge cultural protocols and experiences. CONCLUSIONS Engaging the communities in the development, implementation and evaluation of the programmes were key to community support of the programme and conducting the feasibility study. Future programmes and evaluations need to be built on strong partnerships and embrace flexible and culturally embedded methodologies in order to be adaptive and responsive to research approaches, communities and to Country. TRIAL REGISTRATION ACTRN12619001224112. Retrospectively registered on 05 September 2019.
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Affiliation(s)
- Rebecca M Stanley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia.
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2500, Australia.
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia.
| | - Anthony McKnight
- School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Yasmine Probst
- Illawarra Health and Medical Research Institute, Wollongong, NSW, 2500, Australia
- Faculty of Health, Southern Cross University, Gold Coast Campus, Bilinga, QLD, 4225, Australia
| | - Gabrielle O'Flynn
- School of Education, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Sarah Tillott
- Faculty of Health, Southern Cross University, Gold Coast Campus, Bilinga, QLD, 4225, Australia
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Pearson M, Dawson A, Raubenheimer J, Senerathna L, Conigrave K, Lee KSK, Rajapakse T, Pushpakumara PHGJ, Siribaddana S, Soerensen JB, Konradsen F, Jan S, Dawson AJ, Buckley N, Abeysinghe R, Siriwardhana P, Priyadarshana C, Haber PS, Dzidowska M, Abeykoon P, Glozier N. Community-based alcohol education intervention (THEATRE) study to reduce harmful effects of alcohol in rural Sri Lanka: design and adaptation of a mixed-methods stepped wedge cluster randomised control trial. BMJ Open 2023; 13:e064722. [PMID: 37321807 PMCID: PMC10276966 DOI: 10.1136/bmjopen-2022-064722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 04/19/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Alcohol consumption is a leading cause of mortality, morbidity and adverse social sequelae in Sri Lanka. Effective community-based, culturally adapted or context-specific interventions are required to minimise these harms. We designed a mixed-methods stepped wedge cluster randomised control trial of a complex alcohol intervention. This paper describes the initial trial protocol and subsequent modifications following COVID-19. METHODS AND ANALYSIS We aimed to recruit 20 villages (approximately n=4000) in rural Sri Lanka. The proposed intervention consisted of health screening clinics, alcohol brief intervention, participatory drama, film, and public health promotion materials to be delivered over 12 weeks.Following disruptions to the trial resulting from the Easter bombings in 2019, COVID-19 and a national financial crisis, we adapted the study in two main ways. First, the interventions were reconfigured for hybrid delivery. Second, a rolling pre-post study evaluating changes in alcohol use, mental health, social capital and financial stress as the primary outcome and implementation and ex-ante economic analysis as secondary outcomes. ETHICS AND DISSEMINATION The original study and amendments have been reviewed and granted ethical approval by Rajarata University of Sri Lanka (ERC/2018/21-July 2018 and February 2022) and the University of Sydney (2019/006). Findings will be disseminated locally in collaboration with the community and stakeholders.The new hybrid approach may be more adaptable, scalable and generalisable than the planned intervention. The changes will allow a closer assessment of individual interventions while enabling the evaluation of this discontinuous event through a naturalistic trial design. This may assist other researchers facing similar disruptions to community-based studies. TRIAL REGISTRATION The trial is registered with the Sri Lanka Clinical Trials Registry; https://slctr.lk/trials/slctr-2018-037.
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Affiliation(s)
- Melissa Pearson
- Centre for Pesticide Suicide Prevention, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Andrew Dawson
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Jacques Raubenheimer
- Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
| | - Lalith Senerathna
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Katherine Conigrave
- Sydney Medical School, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - K S Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Thilini Rajapakse
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Pahala Hangidi Gedara Janaka Pushpakumara
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Family Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Peradeniya, Sri Lanka
| | - Sisira Siribaddana
- Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Jane Brandt Soerensen
- Global Health Section, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Angela J Dawson
- Faculty of Health, World Health Collaborating Centre, University of Technology, Sydney, Sydney, New South Wales, Australia
| | - Nicholas Buckley
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Biomedical Informatics and Digital Health, University of Sydney, Sydney, New South Wales, Australia
| | - Ranil Abeysinghe
- Department of Psychiatry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Prabash Siriwardhana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Health Promotion, Faculty of Applied Sciences, Rajarata University of Sri Lanka, Mihintale, Sri Lanka
| | - Chamil Priyadarshana
- South Asian Clinical Toxicology Research Collaboration, University of Peradeniya, Peradeniya, Sri Lanka
| | - Paul S Haber
- Sydney Medical School, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Monika Dzidowska
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Nick Glozier
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
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Kohler S, Dippon L, Helsper N, Rütten A, Abu-Omar K, Birkholz L, Pfeifer K, Weber P, Semrau J. Population-based physical activity promotion with a focus on health equity: a review of reviews. Int J Equity Health 2023; 22:18. [PMID: 36703145 PMCID: PMC9878967 DOI: 10.1186/s12939-023-01834-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/16/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The extent to which people are physically active is dependent upon social gradients. Numerous studies have shown that especially people with social disadvantages do not meet the physical activity (PA) recommendations. A promising strategy to alleviate this issue are approaches that promote PA in the general population. In addition, several researchers have raised concerns that population-based health interventions may increase health inequities. The aim of the current review of reviews was therefore to identify successful population-based PA promotion approaches with a particular focus on health equity. METHODS Six electronic databases were examined for systematic reviews on population-based PA promotion for the period 2015 to 2021. A reference list and grey literature search were also conducted. Two independent reviewers used inclusion/exclusion criteria to screen titles and abstracts of the potentially relevant literature and conducted a quality assessment for each identified review. All included reviews of population-based approaches for PA promotion with a focus on disadvantaged populations and/or health equity were narratively summarized. RESULTS Our search resulted in 4,411 hits. After a systematic review process, six reviews met the inclusion criteria and were included after they were all rated as high quality. We identified that mass-media campaigns, point-of-decision prompts, environmental approaches, policy approaches, and community-based multi-component approaches can promote PA in the general population. Across populations with social disadvantages mass-media campaigns, point-of-decision prompts and policy approaches are likely to be effective as long as they are tailored. Regarding environmental approaches, the results are inconsistent. None of the reviews on community-based multi-component approaches provided evidence on health equity. CONCLUSION There are several effective approaches to promote PA in the general population but evidence regarding health equity is still sparse. Future studies should therefore pay more attention to this missing focus. Furthermore, there is a lack of evidence regarding the type of tailoring and the long-term impact of population-based approaches to PA promotion. However, this requires appropriate funding programmes, complex study designs and evaluation methods.
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Affiliation(s)
- Simone Kohler
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Lea Dippon
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Natalie Helsper
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Alfred Rütten
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Karim Abu-Omar
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Leonie Birkholz
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Klaus Pfeifer
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Philipp Weber
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
| | - Jana Semrau
- grid.5330.50000 0001 2107 3311Department of Sport Science and Sport, Friedrich-Alexander University Erlangen Nuremberg, Gebbertstr, 123B, 91058 Erlangen, Germany
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Lelie L, van der Molen HF, van den Berge M, van der Feltz S, van der Beek AJ, Hulshof CTJ, Proper KI. The process evaluation of a citizen science approach to design and implement workplace health promotion programs. BMC Public Health 2022; 22:1610. [PMID: 36002884 PMCID: PMC9399973 DOI: 10.1186/s12889-022-14009-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many workplace health promotion programs (WHPPs) do not reach blue-collar workers. To enhance the fit and reach, a Citizen Science (CS) approach was applied to co-create and implement WHPPs. This study aims to evaluate i) the process of this CS approach and ii) the resulting WHPPs. METHODS The study was performed in two companies: a construction company and a container terminal company. Data were collected by questionnaires, interviews and logbooks. Using the framework of Nielsen and Randall, process measures were categorized in the intervention, context and mental models. Interviews were transcribed and thematically coded using MaxQDA software. RESULTS The involvement in the CS approach and co-creating the WHPPs was positively experienced. Information provision, sustained engagement over time and alignment with the workplace's culture resulted in barriers in the CS process. As to the resulting WHPPs, involvement and interaction during the intervention sessions were particularly experienced in small groups. The reach was affected by the unfavorable planning off the WHPPs and external events of re-originations and the covid-19 pandemic. DISCUSSION Continuous information provision and engagement over time, better alignment with the workplace's culture and favorable planning are considered to be important factors for facilitating involvement, reach and satisfaction of the workers in a Citizen science approach to design and implement a WHPP. Further studies continuously monitoring the process of WHPPs using the CS approach could be helpful to anticipate on external factors and increase the adaptability. CONCLUSIONS Workers were satisfied with the involvement in WHPPs. Organizational and social cultural factors were barriers for the CS approach and its reach. Involvement and interaction in WHPPs were particularly experienced in small grouped sessions. Consequently, contextual and personal factors need be considered in the design and implementation of WHPPs with CS approach among blue-collar workers.
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Affiliation(s)
- Lisa Lelie
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands.
| | - Henk F van der Molen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam UMC location AMC, University of Amsterdam, 1100, DD, Amsterdam, The Netherlands
| | - Mandy van den Berge
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - Sophie van der Feltz
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - Allard J van der Beek
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands
| | - Carel T J Hulshof
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Coronel Institute of Occupational Health, Netherlands Center for Occupational Diseases, Amsterdam UMC location AMC, University of Amsterdam, 1100, DD, Amsterdam, The Netherlands
| | - Karin I Proper
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, 1007, MB, Amsterdam, The Netherlands. .,Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, 3721, MA, Bilthoven, The Netherlands.
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Tran SHN, Weaver RG, Manns BJ, Saunders-Smith T, Campbell T, Ivers N, Hemmelgarn BR, Tonelli M, Pannu R, Campbell DJT. Factors Affecting the Reception of Self-Management Health Education: A Cross-Sectional Survey Assessing Perspectives of Lower-Income Seniors with Cardiovascular Conditions. Patient Prefer Adherence 2022; 16:971-981. [PMID: 35422615 PMCID: PMC9005130 DOI: 10.2147/ppa.s351459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/11/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Self-management education and support (SMES) programs can prevent adverse chronic disease outcomes, but factors modifying their reception remain relatively unexplored. We examined how perceptions of an SMES program were influenced by the mode of delivery, and co-receipt of a paired financial benefit. METHODS AND PATIENTS Using a cross-sectional survey, we evaluated the perceived helpfulness of a SMES program among 446 low-income seniors at high risk for cardiovascular events in Alberta, Canada. Secondary outcomes included frequency of use, changes in perspectives on health, satisfaction with the program, and comprehensibility of the material. Participants received surveys after engaging with the program for at least 6 months. We used modified Poisson regression to calculate relative risks. Open-ended questions were analyzed inductively. RESULTS The majority of participants reported that the SMES program was helpful (>80%). Those who also received the financial benefit (elimination of medication copayments) were more likely to report that the SMES program was helpful (RR 1.24, 95% CI 1.11-1.39). Those who received the program electronically were more likely to use the program weekly (RR 1.51, 1.25-1.84). Both those who received the intervention electronically (RR 1.18, 1.06-1.33), and those who also received copayment elimination (RR 1.17, 1.05-1.31) were more likely to state that the program helped change their perspectives on health. CONCLUSION When designing SMES programs, providing the option for electronic delivery appears to promote greater use for seniors. The inclusion of online-delivery and co-receipt of tangible benefits when designing an SMES program for seniors results in favorable reception and could facilitate sustained adherence to health behavior recommendations. Participants also specifically expressed that what they enjoyed most was that the SMES program was informative, helpful, engaging, and supportive.
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Affiliation(s)
- Sophia H N Tran
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert G Weaver
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Women’s College Hospital, Toronto, ON, Canada
| | | | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Raj Pannu
- Emergence Creative, New York, NY, USA
| | - David J T Campbell
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
- Correspondence: David JT Campbell, Tel +1 403-210-9511, Email
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Burgemeister FC, Crawford SB, Hackworth NJ, Hokke S, Nicholson JM. Place-based approaches to improve health and development outcomes in young children: A scoping review. PLoS One 2021; 16:e0261643. [PMID: 34941941 PMCID: PMC8700019 DOI: 10.1371/journal.pone.0261643] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/08/2021] [Indexed: 11/24/2022] Open
Abstract
This scoping review examines the strength of evidence for the effectiveness of public policy-led place-based initiatives designed to improve outcomes for disadvantaged children, their families and the communities in which they live. Study designs and methods for evaluating such place-based initiatives were assessed, along with the contexts in which initiatives were implemented and evaluated. Thirty-two reports relating to 12 initiatives were included. Eleven initiatives used a quasi-experimental evaluation to assess impact, although there were considerable design variations within this. The remaining initiative used a pre- and post- evaluation design. Place-based initiatives by definition aim to improve multiple and interrelated outcomes. We examined initiatives to determine what outcomes were measured and coded them within the five domains of pregnancy and birth, child, parent, family and community. Across the 83 outcomes reported in the 11 studies with a comparison group, 30 (36.4%) demonstrated a positive outcome, and all but one initiative demonstrated a positive outcome in at least one outcome measure. Of the six studies that examined outcomes more than once post baseline, 10 from 38 outcomes (26.3%) demonstrated positive sustained results. Many initiatives were affected by external factors such as policy and funding changes, with unknown impact on their effectiveness. Despite the growth of place-based initiatives to improve outcomes for disadvantaged children, the evidence for their effectiveness remains inconclusive.
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Affiliation(s)
| | | | - Naomi J. Hackworth
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- Parenting Research Centre, East Melbourne, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
| | - Stacey Hokke
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Jan M. Nicholson
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, Australia
- Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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9
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Nickel S, von dem Knesebeck O. Do multiple community-based interventions on health promotion tackle health inequalities? Int J Equity Health 2020; 19:157. [PMID: 32912257 PMCID: PMC7488049 DOI: 10.1186/s12939-020-01271-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany
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10
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Hatcher AM, McBride RS, Rebombo D, Munshi S, Khumalo M, Christofides N. Process evaluation of a community mobilization intervention for preventing men's partner violence use in peri-urban South Africa. EVALUATION AND PROGRAM PLANNING 2020; 78:101727. [PMID: 31639542 PMCID: PMC7264430 DOI: 10.1016/j.evalprogplan.2019.101727] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 05/05/2023]
Abstract
Intimate partner violence (IPV) is experienced by one-third of women globally, yet few programs attempt to shift men's IPV perpetration. Community mobilization is a potential strategy for reducing men's IPV perpetration, but this has rarely been examined globally. We conducted a mixed-methods process evaluation alongside a trial testing community mobilization in peri-urban South Africa. We used in-depth interviews (n=114), participant observation (160 h), and monitoring and evaluation data to assess program delivery. Qualitative data (verbatim transcripts and observation notes) were managed in Dedoose using thematic coding and quantitative data were descriptively analyzed using Stata13. We learned that outreach elements of community mobilization were implemented with high fidelity, but that critical reflection and local advocacy were difficult to achieve. The context of a peri-urban settlement (characterized by poor infrastructure, migrancy, low education, social marginalization, and high levels of violence) severely limited intervention delivery, as did lack of institutional support for staff and activist volunteers. That community mobilization was poorly implemented may explain null trial findings; in the larger trial, the intervention failed to measurably reduce men's IPV perpetration. Designing community mobilization for resource-constrained settings may require additional financial, infrastructural, organizational, or political support to effectively engage community members and reduce IPV.
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Affiliation(s)
- Abigail M Hatcher
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa; Department of Medicine, University of California, San Francisco, United States.
| | - Ruari-Santiago McBride
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa
| | | | - Shehnaz Munshi
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa
| | | | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, Unviersity of the Witwatersrand, Johannesburg, South Africa
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11
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Improving the quality of foods available in a rural kibbutz cafeteria in Israel to align with a freshly prepared Mediterranean-style diet through a community culinary coaching programme. Public Health Nutr 2019; 22:3229-3237. [PMID: 31327325 DOI: 10.1017/s1368980019001721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the impact of a community culinary coaching programme (CCCP) on cafeteria food alignment with a freshly prepared Mediterranean-style diet, and diners' consumption habits and satisfaction. DESIGN A non-randomized, controlled, community-based participatory research programme. CCCP included eight 90 min coaching sessions with a community steering committee, 22 h of kitchen staff training, 12 h of pre-school staff training and 30 h of education for diners; control communities received no intervention. Outcomes, measured before and 12 months after programme initiation, included cafeteria food alignment with a freshly prepared Mediterranean-style diet through a food items list derived from the cafeteria food purchasing software, and adult diners' consumption habits and satisfaction through questionnaires. SETTING Communal cafeterias of rural kibbutzim. PARTICIPANTS Intervention: kibbutz with 493 adults and 214 children. Control: Two kibbutzim with a total of 487 adults and 206 children. RESULTS Intervention cafeteria food improved significantly in all Mediterranean index categories except nuts (legumes, wholegrain products, fish, MUFA/SFA P < 0·0001; fruits, vegetables P < 0·001; processed meats P = 0·004), and in the proportion of ultra-processed and unprocessed or minimally processed foods categories of the NOVA classification (-22 %, P < 0·001 and +7 %, P < 0·001, respectively), compared with the control community. The intervention group's satisfaction was significantly improved in twenty-five (83 %) out of the thirty satisfaction items, compared with twelve (40 %) in the control group. No changes were identified in diners' consumption habits in either intervention or control communities. CONCLUSIONS CCCP might be useful in improving alignment of cafeteria food with a freshly prepared Mediterranean-style diet.
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Enrique A, Mooney O, Salamanca-Sanabria A, Lee C, Farrell S, Richards D. Assessing the efficacy and acceptability of an internet-delivered intervention for resilience among college students: A pilot randomised control trial protocol. Internet Interv 2019; 17:100254. [PMID: 31304095 PMCID: PMC6603299 DOI: 10.1016/j.invent.2019.100254] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Exposure to new stressors places college students at increased risk for developing mental health problems. Preventive interventions aimed at enhancing resilience have the potential to improve mental health and well-being in college students and internet-delivery may improve access to these interventions. However, few studies have evaluated the efficacy of online interventions for resilience in college students. The present study seeks to assess the feasibility [initial efficacy and acceptability] of a newly developed internet-delivered intervention for resilience provided with human or automated support, in a sample of college students. METHOD A pilot randomised controlled trial including three groups: 1) an intervention group with human support; 2) an intervention group with automated support; and 3) a waiting list control group. The intervention, Space for Resilience, is based on positive psychology and consists of seven modules, delivered over a period of eight weeks. Primary outcomes measures will include the Connor-Davidson Resilience Scale (CD-RISC) and the Pemberton Happiness Index (PHI). Secondary outcomes measures will include the Brief Resilience Scale (BRS), the Patient Health Questionnaire - 4 items (PHQ-4), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale - 4 items (PSS-4). Acceptability will be examined using the Satisfaction with Treatment (SAT) questionnaire. Analysis will be conducted on an intention-to-treat basis. DISCUSSION The study seeks to establish the initial efficacy and acceptability of an internet-delivered intervention for resilience with human support and automated support. Apart from determining the impact of the intervention on acceptability and effectiveness, this study will be a first to explore more clearly the relative benefits of different support modes.
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Affiliation(s)
- A. Enrique
- E-Mental Research group, School of Psychology, Trinity College Dublin, Ireland,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - O. Mooney
- E-Mental Research group, School of Psychology, Trinity College Dublin, Ireland
| | - A. Salamanca-Sanabria
- E-Mental Research group, School of Psychology, Trinity College Dublin, Ireland,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - C.T. Lee
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - S. Farrell
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - D. Richards
- E-Mental Research group, School of Psychology, Trinity College Dublin, Ireland,Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland,Corresponding author at: E-Mental Research group, School of Psychology, Trinity College Dublin, Ireland.
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13
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Risica PM, Tovar A, Palomo V, Dionne L, Mena N, Magid K, Ward DS, Gans KM. Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the 'Healthy Start/Comienzos Sanos' cluster randomized trial. BMC Public Health 2019; 19:419. [PMID: 30999881 PMCID: PMC6472069 DOI: 10.1186/s12889-019-6704-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. METHODS This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2-5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers' need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children's diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. DISCUSSION Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. TRIAL REGISTRATION (# NCT02452645 ) ClinicalTrials.gov Trial registered on May 22, 2015.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Noereem Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Kate Magid
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Diane Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7461 USA
| | - Kim M. Gans
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269 USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269 USA
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14
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Jaworowska A, Rotaru G, Christides T. Nutritional Quality of Lunches Served in South East England Hospital Staff Canteens. Nutrients 2018; 10:nu10121843. [PMID: 30513708 PMCID: PMC6316249 DOI: 10.3390/nu10121843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/18/2018] [Accepted: 11/20/2018] [Indexed: 11/17/2022] Open
Abstract
Worksite canteens generally are characterized by obesogenic environments, which offer access to energy-dense foods and sugar-sweetened beverages rather than nutrient-rich food. This study assessed the nutritional quality of hot lunches offered in National Health Service (NHS) hospital staff canteens: 35 side dishes and 112 meals were purchased from 8 NHS hospital staff canteens. The meals were analyzed for portion size, energy, protein, total fat, saturated fatty acids (SFAs), salt, and the sodium to potassium ratio. The vegetarian and meat-based lunch meals served in the hospital staff canteens tended to be high in energy, total fat, saturated fatty acids, and salt: 40%, 59% and 67% of meat meals and 34%, 43%, and 80% of vegetarian meals were assigned the red traffic light label for total fat, salt, and SFAs per portion, respectively. Similar types of meals, but served in different hospitals, varied considerably in their nutritional quality. The consumption of some lunch meals could provide more than 50% of recommended total fat, SFAs, and salt for both men and women and daily energy for women. The majority of analyzed lunch meals were characterized by an unfavorable nutrient profile, and regular consumption of such meals may increase the risk of noncommunicable diseases.
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Affiliation(s)
- Agnieszka Jaworowska
- School of Science, Faculty of Engineering and Science, University of Greenwich, Central Avenue, Chatham ME4 4TB, UK.
| | - Gabriela Rotaru
- School of Science, Faculty of Engineering and Science, University of Greenwich, Central Avenue, Chatham ME4 4TB, UK.
| | - Tatiana Christides
- Leicester Medical School, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester LE1 7RH, UK.
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15
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Waterworth P, Pescud M, Chappell S, Davies C, Roche D, Shilton T, Ledger M, Slevin T, Rosenberg M. Culture, management and finances as key aspects for healthy workplace initiatives. Health Promot Int 2018; 33:162-172. [PMID: 27543456 DOI: 10.1093/heapro/daw068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to qualitatively explore the barriers and enablers to implementing healthy workplace initiatives in a sample of workplaces based in Perth, Western Australia. In-depth interviews were conducted with representatives from 31 organizations representing small, medium and large businesses in the Perth metropolitan area which reported having healthy workplace initiatives. In total, 43 factors were mentioned as influencing the implementation of healthy workplace initiatives. Factors appearing to exert the most influence on the implementation of health promoting initiatives in this sample were culture; support from managers and staff; collaboration with industry providers; financial resources circumstances and the physical environment. These factors appeared to be mutually reinforcing and interconnected. Findings suggest there may be merit in applying an organizational development lens to the implementation of workplace health promotion initiatives as this could assist in leveraging enablers and minimizing barriers.
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Affiliation(s)
- Pippa Waterworth
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Melanie Pescud
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.,School of Regulation and Global Governance (RegNet), ANU College of Asia & The Pacific, The Australian National University, Fellows Road, Canberra, ACT 2601, Australia.,The Australian Prevention Partnership Centre, Sax Institute, Ultimo, NSW 2007, Australia
| | - Stacie Chappell
- College of Business, Western New England University, 1215 Wilbraham Road, Springfield, MA 01119, USA
| | | | - Dee Roche
- UWA Business School, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Trevor Shilton
- National Heart Foundation (WA Branch), 334 Rokeby Road, Subiaco, WA 6008, Australia
| | - Melissa Ledger
- Cancer Council WA, 420 Bagot Road, Subiaco, WA 6008, Australia
| | - Terry Slevin
- Cancer Council WA, 420 Bagot Road, Subiaco, WA 6008, Australia
| | - Michael Rosenberg
- School of Sport Science, Exercise and Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.,Health Promotion Evaluation Unit, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
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16
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Finney Rutten LJ, Radecki Breitkopf C, St Sauver JL, Croghan IT, Jacobson DJ, Wilson PM, Herrin J, Jacobson RM. Evaluating the impact of multilevel evidence-based implementation strategies to enhance provider recommendation on human papillomavirus vaccination rates among an empaneled primary care patient population: a study protocol for a stepped-wedge cluster randomized trial. Implement Sci 2018; 13:96. [PMID: 30001723 PMCID: PMC6043954 DOI: 10.1186/s13012-018-0778-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Each year, human papillomavirus (HPV) causes 30,000 cancers in the USA despite the availability of effective and safe vaccines. Uptake of HPV vaccine has been low and lags behind other adolescent vaccines. This protocol describes a multilevel intervention to improve HPV vaccination rates. Methods Using a cluster randomized trial, we will evaluate the independent and combined impact of two evidence-based implementation strategies with innovative enhancements on HPV vaccination rates for female and male patients. The clusters are six primary care sites providing care to pediatric populations. We will use a stepped-wedge cluster randomized design, including process evaluation, to test the hypothesis that compared with the current course of care and a practice-level intervention using reminder-recall interventions coupled with provider-level audit and feedback with education increases HPV vaccination rates in exposed clusters. The factorial design allows us to use a single trial to test these two interventions and to assess each individually and in combination. Our design has four 12-month steps. The first step will be a baseline period; data collected during it will provide a within-practice control group for each cluster. Second, two clusters will be randomly assigned to receive intervention 1 (reminder and recall), and two clusters will be randomly selected to receive intervention 2 (audit and feedback with education). Third, the other two clusters will be randomly allocated to intervention 1 or 2. Clusters initially with intervention 1 will be randomly allocated to 1 + 2 or 1; clusters initially with intervention 2 will be randomly allocated to 1 + 2 or 2. Fourth, all clusters will receive both interventions. To ensure balance of patient numbers across interventions, we will use block randomization at the first step, with the six clusters grouped into three pairs according to volume. Our primary outcome will be vaccination rates. Discussion Results of our clinical trial and process evaluation will provide evidence showing whether practice- and provider-level interventions improve HPV vaccination rates and will offer insight into contextual factors associated with direction and magnitude of trial outcomes. Trial registration ClinicalTrials.gov, NCT03501992, registered April 18, 2018. Electronic supplementary material The online version of this article (10.1186/s13012-018-0778-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lila J Finney Rutten
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.,Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Robert M Jacobson
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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17
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Risica PM, Gorham G, Dionne L, Nardi W, Ng D, Middler R, Mello J, Akpolat R, Gettens K, Gans KM. A multi-level intervention in worksites to increase fruit and vegetable access and intake: Rationale, design and methods of the 'Good to Go' cluster randomized trial. Contemp Clin Trials 2018; 65:87-98. [PMID: 29242108 PMCID: PMC5912165 DOI: 10.1016/j.cct.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Fruit and vegetable (F&V) consumption is an important contributor to chronic disease prevention. However, most Americans do not eat adequate amounts. The worksite is an advantageous setting to reach large, diverse segments of the population with interventions to increase F&V intake, but research gaps exist. No studies have evaluated the implementation of mobile F&V markets at worksites nor compared the effectiveness of such markets with or without nutrition education. METHODS This paper describes the protocol for Good to Go (GTG), a cluster randomized trial to evaluate F&V intake change in employees from worksites randomized into three experimental arms: discount, fresh F&V markets (Access Only arm); markets plus educational components including campaigns, cooking demonstrations, videos, newsletters, and a web site (Access Plus arm); and an attention placebo comparison intervention on physical activity and stress reduction (Comparison). Secondary aims include: 1) Process evaluation to determine costs, reach, fidelity, and dose as well as the relationship of these variables with changes in F&V intake; 2) Applying a mediating variable framework to examine relationships of psychosocial factors/determinants with changes in F&V consumption; and 3) Cost effectiveness analysis of the different intervention arms. DISCUSSION The GTG study will fill important research gaps in the field by implementing a rigorous cluster randomized trial to evaluate the efficacy of an innovative environmental intervention providing access and availability to F&V at the worksite and whether this access intervention is further enhanced by accompanying educational interventions. GTG will provide an important contribution to public health research and practice. Trial registration number NCT02729675, ClinicalTrials.gov.
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Affiliation(s)
- Patricia M Risica
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI 02912, USA; Department of Epidemiology, Brown School of Public Health, Providence, RI 02912, USA.
| | - Gemma Gorham
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA
| | - Laura Dionne
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA
| | - William Nardi
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA
| | - Doug Ng
- Currently with Department of Surgery, Columbia University Medical Center, NY, New York 10032, USA
| | - Reese Middler
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA
| | - Jennifer Mello
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA
| | - Rahmet Akpolat
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269, USA
| | - Katelyn Gettens
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
| | - Kim M Gans
- Center for Health Equity Research, Brown School of Public Health, Providence, RI 02912, USA; Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI 02912, USA; Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269, USA; Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT 06269, USA
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18
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Abstract
UWALK is a multi-strategy, multi-sector, theory-informed, community-wide approach using e and mHealth to promote physical activity in Alberta, Canada. The aim of UWALK is to promote physical activity, primarily via the accumulation of steps and flights of stairs, through a single over-arching brand. This paper describes the development of the UWALK program. A social ecological model and the social cognitive theory guided the development of key strategies, including the marketing and communication activities, establishing partnerships with key stakeholders, and e and mHealth programs. The program promotes the use of physical activity monitoring devices to self-monitor physical activity. This includes pedometers, electronic devices, and smartphone applications. In addition to entering physical activity data manually, the e and mHealth program provides the function for objective data to be automatically uploaded from select electronic devices (Fitbit®, Garmin and the smartphone application Moves) The RE-AIM framework is used to guide the evaluation of UWALK. Funding for the program commenced in February 2013. The UWALK brand was introduced on April 12, 2013 with the official launch, including the UWALK website on September 20, 2013. This paper describes the development and evaluation framework of a physical activity promotion program. This program has the potential for population level dissemination and uptake of an ecologically valid physical activity promotion program that is evidence-based and theoretically framed.
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19
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Quiroz Saavedra R, Brunson L, Bigras N. Transforming Social Regularities in a Multicomponent Community-Based Intervention: A Case Study of Professionals' Adaptability to Better Support Parents to Meet Their Children's Needs. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 59:316-332. [PMID: 28580598 DOI: 10.1002/ajcp.12145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper presents an in-depth case study of the dynamic processes of mutual adjustment that occurred between two professional teams participating in a multicomponent community-based intervention (CBI). Drawing on the concept of social regularities, we focus on patterns of social interaction within and across the two microsystems involved in delivering the intervention. Two research strategies, narrative analysis and structural network analysis, were used to reveal the social regularities linking the two microsystems. Results document strategies and actions undertaken by the professionals responsible for the intervention to modify intersetting social regularities to deal with a problem situation that arose during the course of one intervention cycle. The results illustrate how key social regularities were modified in order to resolve the problem situation and allow the intervention to continue to function smoothly. We propose that these changes represent a transition to a new state of the ecological intervention system. This transformation appeared to be the result of certain key intervening mechanisms: changing key role relationships, boundary spanning, and synergy. The transformation also appeared to be linked to positive setting-level and individual-level outcomes: confidence of key team members, joint planning, decision-making and intervention activities, and the achievement of desired intervention objectives.
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Affiliation(s)
- Rodrigo Quiroz Saavedra
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
- Département de didactique, Université du Québec à Montréal, Montréal, QC, Canada
| | - Liesette Brunson
- Département de psychologie, Université du Québec à Montréal, Montréal, QC, Canada
| | - Nathalie Bigras
- Département de didactique, Université du Québec à Montréal, Montréal, QC, Canada
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20
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Sushames A, van Uffelen JG, Gebel K. Do physical activity interventions in Indigenous people in Australia and New Zealand improve activity levels and health outcomes? A systematic review. Int J Behav Nutr Phys Act 2016; 13:129. [PMID: 28003015 PMCID: PMC5178072 DOI: 10.1186/s12966-016-0455-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/25/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Indigenous Australians and New Zealanders have a significantly shorter life expectancy than non-Indigenous people, mainly due to differences in prevalence of chronic diseases. Physical activity helps in the prevention and management of chronic diseases, however, activity levels are lower in Indigenous than in non-Indigenous people. OBJECTIVE To synthesise the literature on the effects of physical activity interventions for Indigenous people in Australia and New Zealand on activity levels and health outcomes. METHODS The Cochrane Library, MEDLINE, SPORTSDiscus and PsycINFO were searched for peer-reviewed articles and grey literature was searched. Interventions targeted Indigenous people in Australia or New Zealand aged 18+ years and their primary or secondary aim was to increase activity levels. Data were extracted by one author and verified by another. Risk of bias was assessed independently by two authors. Data were synthesised narratively. RESULTS 407 records were screened and 13 studies included. Interventions included individual and group based exercise programs and community lifestyle interventions of four weeks to two years. Six studies assessed physical activity via subjective (n = 4) or objective (n = 2) measures, with significant improvements in one study. Weight and BMI were assessed in all but one study, with significant reductions reported in seven of 12 studies. All five studies that used fitness tests reported improvements, as did four out of eight measuring blood pressure and seven out of nine in clinical markers. CONCLUSIONS There was no clear evidence for an effect of physical activity interventions on activity levels, however, there were positive effects on activity related fitness and health outcomes. TRIAL REGISTRATION The review protocol was registered with PROSPERO (registration number: CRD42015016915 ).
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Affiliation(s)
- Ashleigh Sushames
- College of Healthcare Sciences, James Cook University, Cairns, QLD Australia
- Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, 14-88 McGregor Road, Smithfield, Cairns, QLD 4878 Australia
| | - Jannique G.Z. van Uffelen
- Institute of Sport, Exercise and Active Living, Victoria University, Footscray Park Campus, Melbourne, VIC 3000 Australia
- Department of Kinesiology, Physical Activity, Sports and Health Research Group, KU Leuven - University of Leuven, Leuven, B-3000 Belgium
| | - Klaus Gebel
- Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences, James Cook University, 14-88 McGregor Road, Smithfield, Cairns, QLD 4878 Australia
- School of Allied Health, Faculty of Health Sciences, Australian Catholic University, North Sydney, NSW Australia
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, NSW Australia
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21
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Kesztyüs D, Lauer R, Traub M, Kesztyüs T, Steinacker JM. Effects of statewide health promotion in primary schools on children's sick days, visits to a physician and parental absence from work: a cluster-randomized trial. BMC Public Health 2016; 16:1244. [PMID: 27955648 PMCID: PMC5153907 DOI: 10.1186/s12889-016-3903-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/03/2016] [Indexed: 11/23/2022] Open
Abstract
Background Based on the World Health Organization’s global school health initiative we investigate intervention effects of statewide health promotion in schools on the numbers of children’s sick days and visits to a physician, and parental days off work due to child illness. Methods Cluster-randomized trial with 1-year follow-up in primary schools in the state of Baden-Württemberg, Germany. Anthropometric measurements of first and second grade school children were taken by trained staff. Parents filled in questionnaires for information about socio-demographics, health-related variables, numbers of children’s sick days, visits to a physician, and days parents had to stay off work to care for a sick child. Longitudinal differences in the outcome variables were calculated between baseline and follow-up. Intraclass correlation coefficients were determined to quantify a possible clustering of data in schools. Accordingly, linear models and linear mixed models were applied to identify relationships and ascertain significances. Results Data from 1943 children (1st grade n = 1024, 6.6 ± 0.4 years old; 2nd grade n = 919, 7.6 ± 0.4 years old) were available at baseline. Unadjusted differences regarding both grades were found between mean longitudinal changes in intervention and control group in children’s sick days (−3.2 ± 7.1 vs. -2.3 ± 5.6, p = 0.013), and maternal days off work (−0.9 ± 2.4 vs. -0.5 ± 2.8, p = 0.019). The intervention effect on sick days was adjusted in a linear regression for baseline values, gender and migration background and confirmed for first grade children (B = −0.83, p = 0.003). The intervention effect on maternal days off work lost its significance after adjusting for baseline values. No significant differences were detected in the numbers of children’s visits to a physician and paternal days off work. Conclusions School-based health promotion slightly reduces sick days in first grade children. Subsequently, parents may not need to stay off work themselves. Small individual effects add up to larger benefits in a statewide implementation of health promotion. Additionally, health promotion may also positively contribute to school success. Trial Registration The study was registered on the German Clinical Trials Register (DRKS), Freiburg University, Germany, under the DRKS-ID: DRKS00000494. Registered: 25 August 2010.
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Affiliation(s)
- Dorothea Kesztyüs
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, 89075, Ulm, Germany. .,Ulm University, Institute of General Medicine, Helmholtzstraße 20, D-89081, Ulm, Germany.
| | - Romy Lauer
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, 89075, Ulm, Germany
| | - Meike Traub
- Division of Sport and Rehabilitation Medicine, Ulm University Medical Center, 89075, Ulm, Germany
| | - Tibor Kesztyüs
- Department of Computer Science, Ulm University of Applied Sciences, 89081, Ulm, Germany
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Abstract
Policies to reduce inequalities in health are needed in many different settings, one of which is the healthcare setting. This paper, drawing on the conclusions of the Copenhagen conference, explores the contribution that such policies can make within the healthcare system. In doing so it examines four themes. It begins by exploring the contribution that healthcare makes to health. It challenges the widely held view that this contribution is small, arguing that there have been major advances in the effectiveness of medical care and the use of evidence-based healthcare, so that interventions of proven effectiveness are increasingly delivered to those who will benefi t. Unfortunately, there is growing evidence that the benefi ts of modern healthcare do not benefi t all groups equally. Thus, there is an unfi nished agenda in many countries to enhance the equitable distribution of access to effective healthcare. Second, it explores the dynamic relationship between illness and poverty and, specifi cally, the impoverishing nature of illness in the absence of effective mechanisms to ensure solidarity and to provide social safety nets. It identifi es how all elements within a healthcare system have a part to play. Those responsible for healthcare fi nancing should ensure that funds are obtained in an equitable manner. Those who provide healthcare can do much to promote access for the disadvantaged and to use their facilities to promote health as well as cure disease. Third, it considers the specifi c needs of disadvantaged populations, and especially those whose needs are least visible, such as illegal migrants. It concludes by reviewing the need for better information to document the scale of inequalities, to evaluate interventions designed to reduce them, and to disseminate evidence of good practice.
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Affiliation(s)
- Martin McKee
- London School of Hygiene and Tropical Medicine/European
Observatory on Health Care Systems, London, UK,
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23
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Allender S, Millar L, Hovmand P, Bell C, Moodie M, Carter R, Swinburn B, Strugnell C, Lowe J, de la Haye K, Orellana L, Morgan S. Whole of Systems Trial of Prevention Strategies for Childhood Obesity: WHO STOPS Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1143. [PMID: 27854354 PMCID: PMC5129353 DOI: 10.3390/ijerph13111143] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 12/18/2022]
Abstract
Background: Community-based initiatives show promise for preventing childhood obesity. They are characterized by community leaders and members working together to address complex local drivers of energy balance. Objectives: To present a protocol for a stepped wedge cluster randomized trial in ten communities in the Great South Coast Region of Victoria, Australia to test whether it is possible to: (1) strengthen community action for childhood obesity prevention, and (2) measure the impact of increased action on risk factors for childhood obesity. Methods: The WHO STOPS intervention involves a facilitated community engagement process that: creates an agreed systems map of childhood obesity causes for a community; identifies intervention opportunities through leveraging the dynamic aspects of the system; and, converts these understandings into community-built, systems-oriented action plans. Ten communities will be randomized (1:1) to intervention or control in year one and all communities will be included by year three. The primary outcome is childhood obesity prevalence among grade two (ages 7-8 y), grade four (9-10 y) and grade six (11-12 y) students measured using our established community-led monitoring system (69% school and 93% student participation rate in government and independent schools). An additional group of 13 external communities from other regions of Victoria with no specific interventions will provide an external comparison. These communities will also allow us to assess diffusion of the intervention to control communities during the first three years of the trial. Conclusion: This trial will test effectiveness, over a five-year period, of community-owned, -supported and -led strategies designed to address complex and dynamic causes of childhood obesity.
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Affiliation(s)
- Steven Allender
- Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Lynne Millar
- Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Peter Hovmand
- Brown School's Social System Design Lab, Washington University, St Louis, MO 63130, USA.
| | - Colin Bell
- Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia.
- School of Medicine, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Marj Moodie
- Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia.
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Rob Carter
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia.
- Population Nutrition and Global Health, University of Auckland, Auckland, NZ 1142, USA.
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), World Health Organization Collaborating Centre for Obesity Prevention, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Janette Lowe
- Southern Grampians and Glenelg Primary Care Partnership, Hamilton, NZ 3300, USA.
| | - Kayla de la Haye
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA 90033, USA.
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Melbourne 3125, Australia.
| | - Sue Morgan
- Victorian Department of Health and Human Services, Geelong 3220, Australia.
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Hills MD, Carroll S, O'Neill M. Vers un modèle d'évaluation de l'efficacité des interventions communautaires en promotion de la santé : compte-rendu de quelques développements Nord-américains récents1. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/10253823040110010105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marcia D. Hills
- University of Victoria Human and Social Development
PO Box 3060 STN CSC Victoria BC V8W 3R4 Canada,
| | - Simon Carroll
- University of Victoria Human and Social Development
PO Box 3060 STN CSC Victoria BC V8W 3R4 Canada
| | - Michel O'Neill
- Faculté des Sciences infirmières 4108-J Pavillon Paul-Comtois,
Université Laval Québec, Qc, Canada, G1K 7P4
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25
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Best A, Stokols D, Green LW, Leischow S, Holmes B, Buchholz K. An Integrative Framework for Community Partnering to Translate Theory into Effective Health Promotion Strategy. Am J Health Promot 2016; 18:168-76. [PMID: 14621414 DOI: 10.4278/0890-1171-18.2.168] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework—with several health promotion models that could integrate existing theories—and applying it to comprehensive health promotion strategy. An Integrative Framework. We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation–Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. Integrating the Models: The Need for Systems Theory and Thinking. Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. Vision for Healthy Communities. (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion “best practices” guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. Conclusions and Recommendations. We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.
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Affiliation(s)
- Allan Best
- Centre for Clinical Epidemiology and Evaluation, Vancouver Hospital and Health Sciences Centre, Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada
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26
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Johnsen TL, Indahl A, Baste V, Eriksen HR, Tveito TH. Protocol for the atWork trial: a randomised controlled trial of a workplace intervention targeting subjective health complaints. BMC Public Health 2016; 16:844. [PMID: 27542921 PMCID: PMC4992332 DOI: 10.1186/s12889-016-3515-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/13/2016] [Indexed: 11/13/2022] Open
Abstract
Background Subjective health complaints, such as musculoskeletal and mental health complaints, have a high prevalence in the general population, and account for a large proportion of sick leave in Norway. It may be difficult to prevent the occurrence of subjective health complaints, but it may be possible to influence employees’ perception and management of these complaints, which in turn may have impact on sick leave and return to work after sick leave. Long term sick leave has many negative health and social consequences, and it is important to gain knowledge about effective interventions to prevent and reduce long term sick leave. Methods/Design This study is a cluster randomised controlled trial to evaluate the effect of the modified atWork intervention, targeting non-specific musculoskeletal complaints and mental health complaints. This intervention will be compared to the original atWork intervention targeting only non-specific musculoskeletal complaints. Kindergartens in Norway are invited to participate in the study and will be randomly assigned to one of the two interventions. Estimated sample size is 100 kindergartens, with a total of approximately 1100 employees. Primary outcome is sick leave at unit level, measured using register data from the Norwegian Labour and Welfare Administration. One kindergarten equals one unit, regardless of number of employees. Secondary outcomes will be measured at the individual level and include coping, health, job satisfaction, social support, and workplace inclusion, collected through questionnaires distributed at baseline and at 12 months follow up. All employees in the included kindergartens are eligible for participating in the survey. Discussion The effect evaluation of the modified atWork intervention is a large and comprehensive project, providing evidence-based information on prevention of long-term sick leave, which may be of considerable benefit both from a societal, organisational, and individual perspective. Trial registration Clinicaltrials.gov: NCT02396797. Registered March 23th, 2015.
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Affiliation(s)
- Tone Langjordet Johnsen
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, POB 2168, NO, 3103, Tønsberg, Norway.,Department of Health Promotion, University College of Southeast Norway, Horten, Norway
| | - Aage Indahl
- Division of Physical Medicine and Rehabilitation, Vestfold Hospital Trust, POB 2168, NO, 3103, Tønsberg, Norway
| | - Valborg Baste
- Uni Research Health, POB 7810, NO, 5020, Bergen, Norway
| | - Hege Randi Eriksen
- Uni Research Health, POB 7810, NO, 5020, Bergen, Norway.,Department of Sport and Physical Activity, Bergen University College, Bergen, Norway
| | - Torill Helene Tveito
- Uni Research Health, POB 7810, NO, 5020, Bergen, Norway. .,Department of Health Promotion, University College of Southeast Norway, Horten, Norway.
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27
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Community-Based Prevention Programs in the War on Drugs: Findings from the “Fighting Back” Demonstration. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260603600202] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Illegal drug use remains one of the United States' most serious health problems, and the “War on Drugs” continues without an end in sight. Antidrug programs, which offer the potential to reduce substance abuse problems, are a component of efforts to deal with the problem, but they operate absent adequate scientific analysis. Although policy has shifted from a focus on supply control to one that includes prevention and treatment, research and theory lag behind program implementation. Thus, for example, community-based programs designed to change norms and systems of substance use have been widely promoted despite the lack of data to support their use. The present paper summarizes findings from an evaluation of a large national demonstration program, “Fighting Back.” Results of the evaluation of broad-based community initiatives in a dozen communities show that the programs failed to reduce rates of substance use and associated harms. These findings, along with other evidence, place reliance on community-based programs at odds with public rhetoric. To deal more effectively with substance abuse, there is a need to move from “grading” programs to understanding why and how interventions function.
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28
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Pérez D, Van der Stuyft P, Zabala MC, Castro M, Lefèvre P. A modified theoretical framework to assess implementation fidelity of adaptive public health interventions. Implement Sci 2016; 11:91. [PMID: 27391959 PMCID: PMC4939032 DOI: 10.1186/s13012-016-0457-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 05/14/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND One of the major debates in implementation research turns around fidelity and adaptation. Fidelity is the degree to which an intervention is implemented as intended by its developers. It is meant to ensure that the intervention maintains its intended effects. Adaptation is the process of implementers or users bringing changes to the original design of an intervention. Depending on the nature of the modifications brought, adaptation could either be potentially positive or could carry the risk of threatening the theoretical basis of the intervention, resulting in a negative effect on expected outcomes. Adaptive interventions are those for which adaptation is allowed or even encouraged. Classical fidelity dimensions and conceptual frameworks do not address the issue of how to adapt an intervention while still maintaining its effectiveness. DISCUSSION We support the idea that fidelity and adaptation co-exist and that adaptations can impact either positively or negatively on the intervention's effectiveness. For adaptive interventions, research should answer the question how an adequate fidelity-adaptation balance can be reached. One way to address this issue is by looking systematically at the aspects of an intervention that are being adapted. We conducted fidelity research on the implementation of an empowerment strategy for dengue prevention in Cuba. In view of the adaptive nature of the strategy, we anticipated that the classical fidelity dimensions would be of limited use for assessing adaptations. The typology we used in the assessment-implemented, not-implemented, modified, or added components of the strategy-also had limitations. It did not allow us to answer the question which of the modifications introduced in the strategy contributed to or distracted from outcomes. We confronted our empirical research with existing literature on fidelity, and as a result, considered that the framework for implementation fidelity proposed by Carroll et al. in 2007 could potentially meet our concerns. We propose modifications to the framework to assess both fidelity and adaptation. The modified Carroll et al.'s framework we propose may permit a comprehensive assessment of the implementation fidelity-adaptation balance required when implementing adaptive interventions, but more empirical research is needed to validate it.
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Affiliation(s)
- Dennis Pérez
- Epidemiology Division, Tropical Medicine Institute “Pedro Kouri”, Autopista Novia del Mediodía, Km. 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Patrick Van der Stuyft
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Marta Castro
- Epidemiology Division, Tropical Medicine Institute “Pedro Kouri”, Autopista Novia del Mediodía, Km. 6 ½, La Lisa, Marianao 13, PO Box 601, Havana City, Cuba
| | - Pierre Lefèvre
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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29
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Richard L, Potvin L, Denis JL, Kishchuk N. Integration of the Ecological Approach in Tobacco Programs for Youth: A Survey of Canadian Public Health Organizations. Health Promot Pract 2016. [DOI: 10.1177/152483990200300309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed the level of integration of the ecological approach in Canadian public health organizations’ tobacco control programs for youth. The study used a model that identified intervention settings, targets, and strategies as key dimensions of an ecological approach to programs. An inventory of the tobacco youth programs implemented by regional public health organizations identified 148 organizations conducting such programs, 129 of which agreed to participate. Program descriptions were obtained through telephone interviews. The mean number of settings in which programs were implemented was 3 (SD = 1.3), with schools and communities being the most often-used settings. The mean number of different intervention strategies was 3.6 (SD = 1.7). Most frequently, programs directly targeted youths themselves, followed by interpersonal and organizational environment. Overall, the level of integration of the ecological approach was deemed high. Canadian public health organizations’ tobacco control programs aimed at youth are evolving toward a more comprehensive agenda.
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Affiliation(s)
| | - Louise Potvin
- Department of Social and Preventive Medicine and GRIS (Interdisciplinary Health Research Group) at the Université de Montréal in Quebec, Canada
| | - Jean-Louis Denis
- Department of Health Administration and GRIS (Interdisciplinary Health Research Group) at the Université de Montréal in Quebec, Canada
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30
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Kegler MC, Miner K. Environmental Health Promotion Interventions: Considerations for Preparation and Practice. HEALTH EDUCATION & BEHAVIOR 2016; 31:510-25. [PMID: 15296632 DOI: 10.1177/1090198104265602] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interventions to address current, future, and potential public health dilemmas, such as air pollution, urban sprawl, brown field reclamation, and threats of intentional toxic exposures would benefit from a synergy between the disciplines of environmental health and health education. A comparison between the Protocol for Assessing Community Excellence in Environmental Health and the PRECEDE-PROCEED model used in health education illustrates some similarities and differences in terminology, assessment procedures, intervention design, and types of evidence used by the two disciplines. Promising intervention strategies draw on the expertise of both fields and include social action, policy and media advocacy, coalition building, organizational change, lay health advisers, risk communication, and tailored educational messages. Appropriate targets of change can range from the equitable distribution of resources to individual behavior change. Significant interdisciplinary evaluation research is necessary to accelerate the identification of successful models for reducing the burden of environmental health problems in communities.
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Affiliation(s)
- Michelle Crozier Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia 30033, USA.
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31
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Conditions for valid estimation of causal effects on prevalence in cross-sectional and other studies. Ann Epidemiol 2016; 26:389-394.e2. [PMID: 27287301 DOI: 10.1016/j.annepidem.2016.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 03/25/2016] [Accepted: 04/04/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE Causal effects in epidemiology are almost invariably studied by considering disease incidence even when prevalence data are used to estimate the causal effect. For example, if certain conditions are met, a prevalence odds ratio can provide a valid estimate of an incidence rate ratio. Our purpose and main result are conditions that assure causal effects on prevalence can be estimated in cross-sectional studies, even when the prevalence odds ratio does not estimate incidence. METHODS Using a general causal effect definition in a multivariate counterfactual framework, we define causal contrasts that compare prevalences among survivors from a target population had all been exposed at baseline with that prevalence had all been unexposed. Although prevalence is a measure reflecting a moment in time, we consider the time sequence to study causal effects. RESULTS Effects defined using a contrast of counterfactual prevalences can be estimated in an experiment and, with conditions provided, in cross-sectional studies. Proper interpretation of the effect includes recognition that the target is the baseline population, defined at the age or time of exposure. CONCLUSIONS Prevalences are widely reported, readily available measures for assessing disabilities and disease burden. Effects on prevalence are estimable in cross-sectional studies but only if appropriate conditions hold.
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32
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Lytvyak E, Olstad DL, Schopflocher DP, Plotnikoff RC, Storey KE, Nykiforuk CIJ, Raine KD. Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: the Healthy Alberta Communities study. BMC Public Health 2016; 16:344. [PMID: 27090293 PMCID: PMC4835846 DOI: 10.1186/s12889-016-3021-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/10/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends. METHODS Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention. RESULTS Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities. CONCLUSIONS Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.
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Affiliation(s)
- Ellina Lytvyak
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Dana Lee Olstad
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
- />Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Donald P. Schopflocher
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Ronald C. Plotnikoff
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
- />Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle Callaghan, Callaghan, NSW 2308 Australia
| | - Kate E. Storey
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Candace I. J. Nykiforuk
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Kim D. Raine
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
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Affiliation(s)
- Jonathan M Mond
- a Department of Psychology , Macquarie University , Sydney , New South Wales , Australia.,b Research School of Psychology , The Australian National University , Canberra , Australian Capital Territory , Australia.,c School of Medicine , Western Sydney University , Campbelltown , New South Wales , Australia
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Stoutenberg M, Stanzilis K, Falcon A. Translation of lifestyle modification programs focused on physical activity and dietary habits delivered in community settings. Int J Behav Med 2015; 22:312-27. [PMID: 25200447 DOI: 10.1007/s12529-014-9438-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Lifestyle modification programs (LMPs) can provide individuals with behavioral skills to sustain long-term changes to their physical activity (PA) levels and dietary habits. Yet, there is much work to be done in the translation of these programs to community settings. PURPOSE This review identified LMPs that focused on changing both PA and dietary behaviors and examined common features and barriers faced in their translation to community settings. METHODS A search of multiple online databases was conducted to identify LMPs that included participants over the age of 18 who enrolled in LMPs, offered in community settings, and had the goal of improving both PA and dietary behaviors. Data were extracted on participant demographics, study design characteristics, and study outcome variables including changes in PA, dietary habits, body weight, and clinical outcomes. RESULTS We identified 27 studies that met inclusion criteria. Despite high levels of retention and adherence to the interventions, varying levels of success were observed in increasing PA levels, improving dietary habits, reducing body weight, and improving clinic outcomes. CONCLUSION LMPs addressing issues of PA and dietary habits can be successfully implemented in a community setting. However, inconsistent reporting of key components in the translation of these studies (participant recruitment, utilization of behavioral strategies) may limit their replication and advancement of future programs. Future efforts should better address issues such as identifying barriers to participation and program implementation, utilization of community resources, and evaluating changes across multiple health behaviors.
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Affiliation(s)
- Mark Stoutenberg
- Department of Public Health Sciences, University of Miami, 1120 NW 14th Street, Suite 1008, Miami, FL, 33136, USA,
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Characteristics of Employees of Small Manufacturing Businesses by Occupation: Informing Evidence-Based Intervention Planning. J Occup Environ Med 2015; 57:1185-91. [PMID: 26539766 DOI: 10.1097/jom.0000000000000536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We examined characteristics of employees in six occupational categories in small manufacturing businesses (20-150 employees). METHODS We analyzed survey data from 47 businesses (n = 2577 employees; 86% response rate) and examined relationships between job type and sociodemographic, health, and organizational support characteristics. Analyses were adjusted for age and sex, and company as a random effect. RESULTS Smoking rates were highest for production workers (33%), production managers (27%), and support staff (28%) and lowest for managers (11%) (P <0.001). Job stress was higher for production workers and support staff than managers (P < 0.0001). Managers perceived social capital (P<0.001), safety climate (P < 0.0001) and support for smoking cessation (P < 0.001) higher than production managers, production workers, and support staff. CONCLUSIONS Differences in characteristics by occupation call for integrated interventions that target working class employees, leverage the influence of production managers, and enhance organizational support.
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Pescud M, Teal R, Shilton T, Slevin T, Ledger M, Waterworth P, Rosenberg M. Employers' views on the promotion of workplace health and wellbeing: a qualitative study. BMC Public Health 2015; 15:642. [PMID: 26162910 PMCID: PMC4499225 DOI: 10.1186/s12889-015-2029-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 07/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background The evidence surrounding the value of workplace health promotion in positively influencing employees’ health and wellbeing via changes to their health behaviours is growing. The aim of the study was to explore employers’ views on the promotion of workplace health and wellbeing and the factors affecting these views. Methods Using a qualitative phenomenological approach, 10 focus groups were conducted with employers selected from a range of industries and geographical locations within Western Australia. The total sample size was 79. Results Three factors were identified: employers’ conceptualization of workplace health and wellbeing; employers’ descriptions of (un)healthy workers and perceptions surrounding the importance of healthy workers; and employers’ beliefs around the role the workplace should play in influencing health. Conclusions Progress may be viable in promoting health and wellbeing if a multifaceted approach is employed taking into account the complex factors influencing employers’ views. This could include an education campaign providing information about what constitutes health and wellbeing beyond the scope of occupational health and safety paradigms along with information on the benefits of workplace health and wellbeing aligned with perceptions relating to healthy and unhealthy workers.
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Affiliation(s)
- Melanie Pescud
- Health Promotion Evaluation Unit, 35 Stirling Highway, Crawley, 6009, Australia. .,Regulatory Institutions Network (RegNet), The Australian National University, Acton, Australia.
| | - Renee Teal
- Health Promotion Evaluation Unit, 35 Stirling Highway, Crawley, 6009, Australia.
| | | | | | | | - Pippa Waterworth
- Health Promotion Evaluation Unit, 35 Stirling Highway, Crawley, 6009, Australia.
| | - Michael Rosenberg
- Health Promotion Evaluation Unit, 35 Stirling Highway, Crawley, 6009, Australia.
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Vanhove AJ, Herian MN, Perez ALU, Harms PD, Lester PB. Can resilience be developed at work? A meta-analytic review of resilience-building programme effectiveness. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2015. [DOI: 10.1111/joop.12123] [Citation(s) in RCA: 208] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Alycia L. U. Perez
- Army Analytics Group/Research Facilitation Team; Monterrey California USA
| | | | - Paul B. Lester
- Army Analytics Group/Research Facilitation Team; Monterrey California USA
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Degenhardt BF, Johnson JC, Gross SR, Hagan C, Lund G, Curry WJ. Preliminary findings on the use of osteopathic manipulative treatment: outcomes during the formation of the practice-based research network, DO-Touch.NET. J Osteopath Med 2015; 114:154-70. [PMID: 24567269 DOI: 10.7556/jaoa.2014.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT Few studies have assessed the use of osteopathic manipulative treatment (OMT) and subsequent patient-reported outcomes. OBJECTIVE To assess the current use of OMT and associated patient-reported outcomes. DESIGN A retrospective medical record review and a prospective observational study. SETTING Two university-based sites and their clinics associated with the practice-based research network DO-Touch.NET. PARTICIPANTS Patients aged 18 years or older who received OMT. MAIN OUTCOME MEASURES Medical records from 2007 were retrospectively reviewed to identify conditions being managed with OMT. From 2008 to 2010, patients were recruited before seeing their physicians. Questionnaires were distributed to patients and physicians, and information including demographics, chief complaints, symptom severity, current and past treatments, interference of symptoms with quality of life, physical examination findings, diagnoses, OMT performed, and immediate patient response to OMT was collected. A subset of patients provided data on symptom severity and frequency and other treatments daily for the 7 days after OMT. On day 7, symptom interference with quality of life was reassessed. RESULTS Retrospective data were collected from 2569 office visits, and prospective data were collected from 299 office visits (patient age range, 18-93 years). In the medical record review, 17 of the top 25 diagnoses (68%) were related to musculoskeletal conditions. In the prospective study, 18 of the top 24 medical diagnoses (75%) were related to musculoskeletal conditions. Immediately after OMT, patients at 271 of 296 office visits (92%) felt better or much better; those at 5 (<2%) felt worse. After 7 days, patients at 126 of 175 office visits (72%) felt better or much better, and those at 10 (6%) felt worse. Average and worst symptom severity decreased until post-OMT days 4 and 5, respectively, when severity leveled off. There was decreased interference of symptoms with quality of life from before OMT to 7 days after OMT in usual/general activities, sleep, mood, and relationships (all P≤.05). CONCLUSION These preliminary results suggest that for adults, OMT is predominantly used for managing musculoskeletal pain conditions and is effective for short-term symptom relief. Continued surveillance of DO-Touch.NET member practice outcomes may help identify priorities for osteopathic research and define evidence-based standards for OMT practice and training.
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Affiliation(s)
- Brian F Degenhardt
- A.T. Still Research Institute, A.T. Still University, 800 W Jefferson St, Kirksville, MO 63501-1443.
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Oldenburg B, Taylor CB, O'Neil A, Cocker F, Cameron LD. Using new technologies to improve the prevention and management of chronic conditions in populations. Annu Rev Public Health 2015; 36:483-505. [PMID: 25581147 DOI: 10.1146/annurev-publhealth-031914-122848] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Lifestyle factors are important in the development of chronic diseases, such as heart disease, respiratory disease, and diabetes, and chronic disease risk can be reduced by changes in lifestyle behaviors linked to these conditions. The use of mass media and community-wide strategies targeting these behaviors has been extensively evaluated since the 1970s. This review summarizes some examples of interventions and their use of media conducted within the old communications landscape of the 1970s and 1980s and the key lessons learned from their design, implementation, and evaluation. We then consider the potential and evidence base for using contemporary technology applications and platforms-within the new communications landscape-to improve the prevention and management of lifestyle-related chronic diseases in the future. We discuss the implications and adaptation of lessons derived from the ways in which new technologies are being used in commercial and political contexts and their relevance for public health. Finally, we consider some recent examples of applying new technologies to public health issues and consider some of the challenges in this rapidly developing field.
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Affiliation(s)
- Brian Oldenburg
- School of Population and Global Health, University of Melbourne, Parkville, Victoria 3010, Australia;
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Hurley KS, Lyle RM, Hyner GC. Physical activity attitudes, beliefs, and practices among adults 50 and older: baseline community assessment. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2014; 34:235-54. [PMID: 25030104 DOI: 10.2190/iq.34.3.c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study aligned with the National Blueprint, a coalition of national organizations to identify the principal barriers to physical activity participation in older adults and to outline strategies for increasing physical activity levels. A community coalition took the initiative to conduct a baseline assessment of health attitudes, perceptions, and behaviors among community adults in order to understand the immediate needs of the adult community. Adults 50 and older (N = 309) completed surveys of health and physical activity (PA) behaviors. Individuals reported below average physical activity levels. Motives and barriers to PA differed by gender and race/ethnicity. Age and health perceptions significantly predicted PA levels. Findings support previous research with this age group, thus discussion of the utility of multi-level approaches (e.g., social ecological model) to health betterment in communities is forwarded. Providing multi-level resources (personal, social, environmental, policy) can increase opportunities for adoption and maintenance of health behaviors.
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Oldenburg NC, Duval S, Luepker RV, Finnegan JR, LaMarre H, Peterson KA, Zantek ND, Jacobs G, Straka RJ, Miller KH, Hirsch AT. A 16-month community-based intervention to increase aspirin use for primary prevention of cardiovascular disease. Prev Chronic Dis 2014; 11:E83. [PMID: 24831287 PMCID: PMC4023687 DOI: 10.5888/pcd11.130378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Cardiovascular diseases are the leading causes of disability and death in the United States. Primary prevention of these events may be achieved through aspirin use. The ability of a community-based intervention to increase aspirin use has not been evaluated. The objective of this study was to evaluate an educational intervention implemented to increase aspirin use for primary prevention of cardiovascular disease in a small city in Minnesota. METHODS A community-based intervention was implemented during 16 months in a medium-sized community in Minnesota. Messages for aspirin use were disseminated to individuals, health care professionals, and the general population. Independent cross-sectional samples of residents (men aged 45-79, women aged 55-79) were surveyed by telephone to identify candidates for primary prevention aspirin use, examine their characteristics, and determine regular aspirin use at baseline and after the campaign at 4 months and 16 months. RESULTS In primary prevention candidates, regular aspirin use rates increased from 36% at baseline to 54% at 4 months (odds ratio = 2.05; 95% confidence interval, 1.09-3.88); the increase was sustained at 52% at 16 months (odds ratio = 1.89; 95% confidence interval, 1.02-3.49). The difference in aspirin use rates at 4 months and 16 months was not significant (P = .77). CONCLUSION Aspirin use rates for primary prevention remain low. A combined public health and primary care approach can increase and sustain primary prevention aspirin use in a community setting.
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Affiliation(s)
- Niki C Oldenburg
- Cardiovascular Division, University of Minnesota Medical School, MMC 508, 420 Delaware St SE, Minneapolis, MN 55455. E-mail:
| | - Sue Duval
- University of Minnesota, Minneapolis, Minnesota
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Lindström M. Social capital, social class and tobacco smoking. Expert Rev Pharmacoecon Outcomes Res 2014; 8:81-9. [DOI: 10.1586/14737167.8.1.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Impact of community capacity on the health status of residents: understanding with the contextual multilevel model. Health Care Manag (Frederick) 2013; 32:77-86. [PMID: 23364421 DOI: 10.1097/hcm.0b013e31827edaa7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There has been little conceptual understanding as to how community capacity works, although it allows for an important, population-based health promotional strategy. In this study, the mechanism of community capacity was studied through literature reviews to suggest a comprehensive conceptual model. The research results found that the key to community capacity prevailed in how actively the capacities of individuals and their communities are able to interact with one another. Under active interactions, community-based organizations, which are a type of voluntary association, were created within the community, and cohesion among residents was enhanced. In addition, people were more willing to address community issues. During the process, many services were initiated to meet the people's health needs and strengthen their social and psychological ties. The characteristics of community capacity were named as the contextual multilevel effects. Because an increase in community capacity contributes to a boosted health status, encourages health behaviors, and eventually leads to the overall prosperity of the community, more public health-related attention is required.
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Gupta J, Falb KL, Lehmann H, Kpebo D, Xuan Z, Hossain M, Zimmerman C, Watts C, Annan J. Gender norms and economic empowerment intervention to reduce intimate partner violence against women in rural Côte d'Ivoire: a randomized controlled pilot study. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:46. [PMID: 24176132 PMCID: PMC3816202 DOI: 10.1186/1472-698x-13-46] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 10/24/2013] [Indexed: 11/12/2022]
Abstract
Background Gender-based violence against women, including intimate partner violence (IPV), is a pervasive health and human rights concern. However, relatively little intervention research has been conducted on how to reduce IPV in settings impacted by conflict. The current study reports on the evaluation of the incremental impact of adding “gender dialogue groups” to an economic empowerment group savings program on levels of IPV. This study took place in north and northwestern rural Côte d’Ivoire. Methods Between 2010 and 2012, we conducted a two-armed, non-blinded randomized-controlled trial (RCT) comparing group savings only (control) to “gender dialogue groups” added to group savings (treatment). The gender dialogue group consisted of eight sessions that targeted women and their male partner. Eligible Ivorian women (18+ years, no prior experience with group savings) were invited to participate. 934 out of 981 (95.2%) partnered women completed baseline and endline data collection. The primary trial outcome measure was an overall measure of past-year physical and/or sexual IPV. Past year physical IPV, sexual IPV, and economic abuse were also separately assessed, as were attitudes towards justification of wife beating and a woman’s ability to refuse sex with her husband. Results Intent to treat analyses revealed that compared to groups savings alone, the addition of gender dialogue groups resulted in a slightly lower odds of reporting past year physical and/or sexual IPV (OR: 0.92; 95% CI: 0.58, 1.47; not statistically significant). Reductions in reporting of physical IPV and sexual IPV were also observed (not statistically significant). Women in the treatment group were significantly less likely to report economic abuse than control group counterparts (OR = 0.39; 95% CI: 0.25, 0.60, p < .0001). Acceptance of wife beating was significantly reduced among the treatment group (β = -0.97; 95% CI: -1.67, -0.28, p = 0.006), while attitudes towards refusal of sex did not significantly change Per protocol analysis suggests that compared to control women, treatment women attending more than 75% of intervention sessions with their male partner were less likely to report physical IPV (a OR: 0.45; 95% CI: 0.21, 0.94; p = .04) and report fewer justifications for wife beating (adjusted β = -1.14; 95% CI: -2.01, -0.28, p = 0.01) ; and both low and high adherent women reported significantly decreased economic abuse (a OR: 0.31; 95% CI: 0.18, 0.52, p < 0.0001; a OR: 0.47; 95% CI: 0.27, 0.81, p = 01, respectively). No significant reductions were observed for physical and/or sexual IPV, or sexual IPV alone. Conclusions Results from this pilot RCT suggest the importance of addressing household gender inequities alongside economic programming, because this type of combined intervention has potential to reduce levels of IPV. Additional large-scale intervention research is needed to replicate these findings. Trial registration Registration Number: NCT01629472.
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Affiliation(s)
- Jhumka Gupta
- Department of Chronic Disease Epidemiology, Division of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06520, USA.
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Navarro HJ, Shakeshaft A, Doran CM, Petrie DJ. Does increasing community and liquor licensees' awareness, police activity, and feedback reduce alcohol-related violent crime? A benefit-cost analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5490-506. [PMID: 24169411 PMCID: PMC3863856 DOI: 10.3390/ijerph10115490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 09/24/2013] [Accepted: 09/29/2013] [Indexed: 11/16/2022]
Abstract
Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions.
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Affiliation(s)
- Héctor José Navarro
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Kensington, NSW 2052, Australia; E-Mail:
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Kensington, NSW 2052, Australia; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-2-9385-0333; Fax: +61-2-9385-0222
| | - Christopher M. Doran
- Hunter Medical Research Institute and the University of Newcastle, Room 3016, HMRI Building, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia; E-Mail:
| | - Dennis J. Petrie
- Centre for Health Policy, Programs & Economics, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie Street, Carlton, VIC 3010, Australia; E-Mail:
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Elisabeth Nyström M, Höög E, Garvare R, Weinehall L, Ivarsson A. Change and learning strategies in large scale change programs. JOURNAL OF ORGANIZATIONAL CHANGE MANAGEMENT 2013. [DOI: 10.1108/jocm-08-2012-0132] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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The impact of a depression awareness campaign on mental health literacy and mental morbidity among gay men. J Affect Disord 2013; 150:306-12. [PMID: 23683994 DOI: 10.1016/j.jad.2013.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND High prevalences of depression and suicidality have been found among gay men. This paper assesses the possible impact of Blues-out, a depression awareness campaign based on the European Alliance Against Depression targeting the gay/lesbian community in Geneva, Switzerland. METHODS In 2007 and 2011, pre- and post-intervention surveys were conducted among two distinct samples of gay men in Geneva, recruited by probability-based time-space sampling. Effect sizes and net percent changes are reported for mental health literacy and mental health outcomes in 2007 and 2011 as well as among men aware and unaware of Blues-out in 2011. RESULTS 43% of the respondents correctly recognized depression in 2011 with no change vis-à-vis 2007. Despite small effect sizes, significant net decreases (from -18% to -28%) were seen in lifetime suicide plans, 12-month suicidal ideation, lifetime depression, and 4-week psychological distress between 2007 and 2011. These decreases were not accompanied by changes in any of the numerous items on attitudes/knowledge, found only when comparing men aware and unaware of Blues-out in 2011. More men aware of Blues-out found specialists and psychological therapies helpful than their counterparts and correctly identified depression and gay men's greater risk for depression. LIMITATIONS Community-level assessment with no control. CONCLUSIONS Although improvement in depression recognition and decrease in suicide attempts could not be replicated unequivocally in this adapted intervention among gay men, there are indications that this evidence-based depression awareness campaign may have lessened suicidality and mental morbidity and improved mental health literacy and help-seeking.
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Kohl LFM, Crutzen R, de Vries NK. Online prevention aimed at lifestyle behaviors: a systematic review of reviews. J Med Internet Res 2013; 15:e146. [PMID: 23859884 PMCID: PMC3714003 DOI: 10.2196/jmir.2665] [Citation(s) in RCA: 260] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/28/2013] [Accepted: 07/04/2013] [Indexed: 12/21/2022] Open
Abstract
Background Interventions aimed at behavior change are increasingly being delivered over the Internet. Although research on intervention effectiveness has been widely conducted, their true public health impact as indicated by reach, effectiveness, and use is unclear. Objective The aim of this paper is to (1) review the current literature on online prevention aimed at lifestyle behaviors, and (2) identify research gaps regarding reach, effectiveness, and use. Methods A systematic search in PubMed revealed relevant literature published between 2005 and 2012 on Internet-delivered behavior change interventions aimed at dietary behaviors, physical activity, alcohol use, smoking, and condom use. Our search yielded 41 eligible reviews, which were analyzed in terms of reach, effectiveness, and use according to the RE-AIM framework. Results According to health priorities, interventions are largely targeted at weight-related behaviors, such as physical activity and dietary behavior. Evaluations are predominantly effect-focused and overall effects are small, variable, and not sustainable. Determinants of effectiveness are unclear; effectiveness cannot yet be unambiguously attributed to isolated elements. Actual reach of interventions is undiversified, mostly reaching participants who are female, highly educated, white, and living in high-income countries. One of the most substantial problems in online prevention is the low use of the interventions, a phenomenon seen across all behavior domains. Conclusions More research is needed on effective elements instead of effective interventions, with special attention to long-term effectiveness. The reach and use of interventions need more scientific input to increase the public health impact of Internet-delivered interventions.
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Affiliation(s)
- Leonie F M Kohl
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
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Ekberg J, Timpka T, Angbratt M, Frank L, Norén AM, Hedin L, Andersen E, Gursky EA, Gäre BA. Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities. BMC Health Serv Res 2013; 13:258. [PMID: 23826944 PMCID: PMC3708753 DOI: 10.1186/1472-6963-13-258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Methods Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. Results The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. Conclusions OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.
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Affiliation(s)
- Joakim Ekberg
- Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
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