An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries

BACKGROUND

Perceived financial security impacts physical, mental, and social health and overall wellbeing at community and population levels. Public health action on this dynamic is even more critical now that the COVID-19 pandemic has exacerbated financial strain and reduced financial wellbeing. Yet, public health literature on this topic is limited. Initiatives targeting financial strain and financial wellbeing and their deterministic effects on equity in health and living conditions are missing. Our research-practice collaborative project addresses this gap in knowledge and intervention through an action-oriented public health framework for initiatives targeting financial strain and wellbeing.

METHODS

The Framework was developed using a multi-step methodology that involved review of theoretical and empirical evidence alongside input from a panel of experts from Australia and Canada. In an integrated knowledge translation approach, academics (n = 14) and a diverse group of experts from government and non-profit sectors (n = 22) were engaged throughout the project via workshops, one-on-one dialogues, and questionnaires.

RESULTS

The validated Framework provides organizations and governments with guidance for the design, implementation, and assessment of diverse financial wellbeing- and financial strain-related initiatives. It presents 17 priority actionable areas (i.e., entry points for action) likely to have long-lasting, positive effects on people's financial circumstances, contributing to improved financial wellbeing and health. The 17 entry points relate to five domains: Government (All Levels), Organizational & Political Culture, Socioeconomic & Political Context, Social & Cultural Circumstances, and Life Circumstances.

CONCLUSIONS

The Framework reveals the intersectionality of root causes and consequences of financial strain and poor financial wellbeing, while also reinforcing the need for tailored actions to promote socioeconomic and health equity for all people. The dynamic, systemic interplay of the entry points illustrated in the Framework suggest opportunities for multi-sectoral, collaborative action across government and organizations towards systems change and the prevention of unintended negative impacts of initiatives.

A Policy-Ready Public Health Guidebook of Strategies and Indicators to Promote Financial Well-Being and Address Financial Strain in Response to COVID-19

INTRODUCTION

The COVID-19 pandemic has adversely affected the financial well-being of populations globally, escalating concerns about links with health care and overall well-being. Governments and organizations need to act quickly to protect population health relative to exacerbated financial strain. However, limited practice- and policy-relevant resources are available to guide action, particularly from a public health perspective, that is, targeting equity, social determinants of health, and health-in-all policies. Our study aimed to create a public health guidebook of strategies and indicators for multisectoral action on financial well-being and financial strain by decision makers in high-income contexts.

METHODS

We used a multimethod approach to create the guidebook. We conducted a targeted review of existing theoretical and conceptual work on financial well-being and strain. By using rapid review methodology informed by principles of realist review, we collected data from academic and practice-based sources evaluating financial well-being or financial strain initiatives. We performed a critical review of these sources. We engaged our research-practice team and government and nongovernment partners and participants in Canada and Australia for guidance to strengthen the tool for policy and practice.

RESULTS

The guidebook presents 62 targets, 140 evidence-informed strategies, and a sample of process and outcome indicators.

CONCLUSION

The guidebook supports action on the root causes of poor financial well-being and financial strain. It addresses a gap in the academic literature around relevant public health strategies to promote financial well-being and reduce financial strain. Community organizations, nonprofit organizations, and governments in high-income countries can use the guidebook to direct initiative design, implementation, and assessment.

How perceptions of community environment influence health behaviours: using the Analysis Grid for Environments Linked to Obesity Framework as a mechanism for exploration

INTRODUCTION

Overweight and obesity are influenced by a complex interplay of individual and environmental factors that affect physical activity and healthy eating. Nevertheless, little has been reported on people's perceptions of those factors. Addressing this critical gap and community partner needs, this study explored how people perceived the influence of micro- and macroenvironmental factors on physical activity and healthy eating.

METHODS

Community partners wanted the study results in a format that would be readily and easily used by local decision makers. We used photovoice to engage 35 community members across four municipalities in Alberta, Canada, and to share their narratives about their physical activity and healthy eating. A combination of inductive and deductive analysis categorized data by environmental level (micro vs. macro) and type (physical, political, economic, and sociocultural), guided by the Analysis Grid for Environments Linked to Obesity Framework.

RESULTS

Participants conceptualized health-influencing factors more broadly than physical activity and healthy eating to include "community social health." Participants spoke most often about the influence of the microenvironment (n = 792 ANGELO Framework coding tallies) on their physical activity, healthy eating and community social health in comparison to the macroenvironment (n = 93). Photovoice results provided a visual narrative to community partners and decision makers about how people's ability to make healthy choices can be limited by macroenvironmental forces beyond their control.

CONCLUSION

Focussing future research on macro- and microenvironmental influences and localized community social health can inform practice by providing strategies on how to implement healthy changes within communities, while ensuring that research and interventions echo diverse people's perceptions.

Community Lenses Revealing the Role of Sociocultural Environment on Physical Activity

PURPOSE

To identify perceptions of how sociocultural environment enabled and hindered physical activity (PA) participation.

DESIGN

Community-based participatory research.

SETTING

Two semirural and two urban communities located in Alberta, Canada.

PARTICIPANTS

Thirty-five people (74.3% females, 71.4% aged 25-64 years) across the four communities.

METHOD

PhotoVoice activities occurred over 3 months during the spring of 2009. Participants were asked to document perceived environmental attributes that might foster or inhibit PA in their community. Photographs and narratives were shared in one-on-one interviews. Line-by-line coding of the transcripts was independently conducted by two researchers using an inductive approach. Codes were arranged into themes and subthemes, which were then organized into the Analysis Grid for Environments Linked to Obesity (ANGELO) framework.

RESULTS

Six main themes (accompanied by subthemes) emerged: sociocultural aesthetics, safety, social involvement, PA motivation, cultural ideas of recreation, and car culture. Representative quotes and photographs illustrate enablers and obstacles identified by participants.

CONCLUSION

This PhotoVoice study revealed how aspects of participants' sociocultural environments shaped their decisions to be physically active. Providing more PA resources is only one step in the promotion of supportive environments. Strategies should also account for the beautification and maintenance of communities, increasing feelings of safety, enhancement of social support among community members, popularization of PA, and mitigating car culture, among others.

Perceptions of Healthy Eating in Four Alberta Communities: A Photovoice Project

Peoples' perceptions of healthy eating are influenced by the cultural context in which they occur. Despite this general acceptance by health practitioners and social scientists, studies suggest that there remains a relative homogeneity around peoples' perceptions that informs a hegemonic discourse around healthy eating. People often describe healthy eating in terms of learned information from sources that reflect societies' norms and values, such as the Canada Food Guide and the ubiquitous phrase "fruits and vegetables". Past research has examined how built environments shape people's access to healthy living options, such as distribution of grocers versus convenience stores and fast food restaurants. Often overlooked is an in-depth understanding of how social contexts interact with built environments, molding peoples' perceptions of healthy eating. This paper reports on perceptions of healthy eating in four communities across Alberta, Canada. A photovoice methodology was employed to elicit perceptions of healthy eating with 35 participants. This study illustrates how participants' photographs and their stories convey multiple meanings about healthy eating within their own lives and communities. Findings suggest that a 'local' context is an important part of the discourse centered around the promotion of healthy eating practices in these and potential other communities.

Understanding key influencers' attitudes and beliefs about healthy public policy change for obesity prevention

OBJECTIVE

As overweight and obesity is a risk factor for chronic diseases, the development of environmental and healthy public policy interventions across multiple sectors has been identified as a key strategy to address this issue.

METHODS

In 2009, a survey was developed to assess the attitudes and beliefs regarding health promotion principles, and the priority and acceptability of policy actions to prevent obesity and chronic diseases, among key policy influencers in Alberta and Manitoba, Canada. Surveys were mailed to 1,765 key influencers from five settings: provincial government, municipal government, school boards, print media companies, and workplaces with greater than 500 employees. A total of 236 surveys were completed with a response rate of 15.0%.

RESULTS

Findings indicate nearly unanimous influencer support for individual-focused policy approaches and high support for some environmental policies. Restrictive environmental and economic policies received weakest support. Obesity was comparable to smoking with respect to perceptions as a societal responsibility versus a personal responsibility, boding well for the potential of environmental policy interventions for obesity prevention.

CONCLUSIONS

This level of influencer support provides a platform for more evidence to be brokered to policy influencers about the effectiveness of environmental policy approaches to obesity prevention.

How community environment shapes physical activity: perceptions revealed through the PhotoVoice method

A growing body of evidence shows that community environment plays an important role in individuals' physical activity engagement. However, while attributes of the physical environment are widely investigated, sociocultural, political, and economic aspects of the environment are often neglected. This article helps to fill these knowledge gaps by providing a more comprehensive understanding of multiple dimensions of the community environment relative to physical activity. The purpose of this study was to qualitatively explore how people's experiences and perceptions of their community environments affect their abilities to engage in physical activity. A PhotoVoice method was used to identify barriers to and opportunities for physical activity among residents in four communities in the province of Alberta, Canada, in 2009. After taking pictures, the thirty-five participants shared their perceptions of those opportunities and barriers in their community environments during individual interviews. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, themes emerging from these photo-elicited interviews were organized in four environment types: physical, sociocultural, economic, and political. The data show that themes linked to the physical (56.6%) and sociocultural (31.4%) environments were discussed more frequently than the themes of the economic (5.9%) and political (6.1%) environments. Participants identified nuanced barriers and opportunities for physical activity, which are illustrated by their quotes and photographs. The findings suggest that a myriad of factors from physical, sociocultural, economic, and political environments influence people's abilities to be physically active in their communities. Therefore, adoption of a broad, ecological perspective is needed to address the barriers and build upon the opportunities described by participants to make communities more healthy and active.

Understanding older adults' usage of community green spaces in Taipei, Taiwan

As the world's population ages, there is an increasing need for community environments to support physical activity and social connections for older adults. This exploratory study sought to better understand older adults' usage and perceptions of community green spaces in Taipei, Taiwan, through direct observations of seven green spaces and nineteen structured interviews. Descriptive statistics from observations using the System for Observing Play and Recreation in Communities (SOPARC) confirm that older adults use Taipei's parks extensively. Our analyses of interviews support the following recommendations for age-friendly active living initiatives for older adults: make green spaces accessible to older adults; organize a variety of structured activities that appeal to older adults particularly in the morning; equip green spaces for age-appropriate physical activity; and, promote the health advantages of green spaces to older adults.

Examining aspects of the built environment: an evaluation of a community walking map project

OBJECTIVE

Interventions that address the built environment present an opportunity to affect behaviours such as physical activity. The purpose of this study was to evaluate a community walking map developed for eight neighbourhoods in the City of Edmonton (COE).

METHOD

A walking map developed in partnership with the COE's Walkable Initiative was distributed to 11,994 households across eight neighbourhoods in July 2010. In total, 149 respondents completed an online follow-up survey that assessed the effectiveness of the walking maps in influencing physical activity.

RESULTS

Of the 149 respondents, 89 (59.7%) reported that they had received a copy of the map, and 60 (40.2%) reported that they had not. Of those who had a copy, 76.4% (n=68) indicated that the routes and destinations on the map encouraged them to walk more in the community, 64.0% (n=57) stated they would walk more often to get to destinations, and 55.1% (n=49) indicated they would walk more often for physical activity or exercise as a result of having a copy of the map. Finally, 91.0% (n=81) stated that they found the map to be useful, as it provided walking routes (60/81, 74.1%,) and places to go in the community (57/81, 70.4%). Of those who did not receive a copy, 95.0% (n=57) indicated that they would use a community walking map.

CONCLUSION

This evaluation demonstrated that a community walking map was a valuable tool for not only encouraging walking for physical activity but also motivating individuals to explore their communities and visit local community destinations.

Photovoice as a Method for Revealing Community Perceptions of the Built and Social Environment

Over the last number of years there has been growing interest in the use of community-based participatory research (CBPR) for preventing and controlling complex public health problems. Photovoice is one of several qualitative methods utilized in CBPR, as it is a participatory method that has community participants use photography, and stories about their photographs, to identify and represent issues of importance to them. Over the past several years photovoice methodology has been frequently used to explore community health and social issues. One emerging opportunity for the utilization of photovoice methodology is research on community built and social environments, particularly when looking at the context of the neighbourhood. What is missing from the current body of photovoice literature is a critique of the strengths and weaknesses of photovoice as a method for health promotion research (which traditionally emphasizes capacity-building, community-based approaches) and as a method for revealing residents' perceptions of community as a source of health opportunities or barriers. This paper will begin to address this gap by discussing the successes and challenges of using the photovoice methodology in a recent CBPR project to explore community perceptions of the built and social environment (with the ultimate goal of informing community-based chronic disease prevention initiatives). The paper concludes with methodological recommendations and directions for future research.