Facilitators for the development and implementation of health promoting policy and programs - a scoping review at the local community level

[Implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC) : vers l'optimisation de la mise en œuvre de cette approche novatrice visant la participation sociale des aînés]

La présente étude visait à documenter l'implantation de l'Accompagnement-citoyen personnalisé d'intégration communautaire (APIC), lors duquel des bénévoles soutiennent la participation sociale d'aînés, dans des organismes communautaires en identifiant les facteurs favorables et défavorables ainsi que ses conditions essentielles. Soutenu par un devis qualitatif descriptif de type recherche clinique, une rencontre et six entretiens semi-dirigés ont été réalisés afin de documenter cette implantation dans six organismes communautaires œuvrant en milieu urbain au Québec (Canada). Selon les six coordonnatrices de l'APIC, les cinq directeurs généraux et l'agente de recherche, le principal facteur favorable est la conviction des responsables de l'implantation en la valeur ajoutée de l'intervention, incluant sa concordance avec la mission et les valeurs des organismes et les besoins de la population qu'ils desservent. Les facteurs défavorables sont principalement la répartition aléatoire et le temps accordé pour l'implantation. Ces résultats permettront de mieux guider l'implantation de l'APIC à plus grande échelle.

Segmenting citizens according to their self-sufficiency: A tool for local government

Identifying subgroups of citizens with varying levels of self-sufficiency in a large local or regional population provides local government with essential input for providing matching services and well-grounded spending of health and well-being expenditures. This paper identifies self-sufficiency levels of citizens by segmenting a broad adult population. We used data from a citizen survey based on a randomly selected response group containing questions on a wide range of topics, including finances, health and living conditions, and complemented these data with registration data, including information on housing type and household composition. We conducted a latent class cluster analysis using six indicators: perception of making ends meet, perceived health, quality of life, self-efficacy, access to socialsupport and social network. High scores on the indicators translate to high levels of self-sufficiency. We used a biased-adjusted, three-step approach to characterise the segments. Six meaningful segments were identified and labelled as 'highly self-sufficient,' 'self-sufficient - medium access to social support,' 'self-sufficient - medium self-efficacy,' 'moderately self-sufficient - low self-efficacy & high social network,' 'moderately self-sufficient - low access to social support/social network & high perceived health' and 'not self-sufficient.' At a macro level, perception of making ends meet and quality of life have discriminating value in assessing self-sufficiency. For a more detailed differentiation between groups with similar levels of self-sufficiency, perceived health, self-efficacy, access to socialsupport, and social network are valuable indicators. Overall, this study introduces a comprehensive tool to assess self-sufficiency in larger groups of citizens by using a parsimonious number of indicators. Local and regional governments can apply this tool to effectively assess the self-sufficiency levels of their population and signal potentially vulnerable groups. In this way, the tool makes the identification of self-sufficiency levels of larger populations more feasible and more efficient and can be widely adopted in different contexts.

Natural experiments for the evaluation of place-based public health interventions: a methodology scoping review

Introduction

Place-based public health evaluations are increasingly making use of natural experiments. This scoping review aimed to provide an overview of the design and use of natural experiment evaluations (NEEs), and an assessment of the plausibility of the as-if randomization assumption.

Methods

A systematic search of three bibliographic databases (Pubmed, Web of Science and Ovid-Medline) was conducted in January 2020 to capture publications that reported a natural experiment of a place-based public health intervention or outcome. For each, study design elements were extracted. An additional evaluation of as-if randomization was conducted by 12 of this paper's authors who evaluated the same set of 20 randomly selected studies and assessed 'as-if ' randomization for each.

Results

366 NEE studies of place-based public health interventions were identified. The most commonly used NEE approach was a Difference-in-Differences study design (25%), followed by before-after studies (23%) and regression analysis studies. 42% of NEEs had likely or probable as-if randomization of exposure (the intervention), while for 25% this was implausible. An inter-rater agreement exercise indicated poor reliability of as-if randomization assignment. Only about half of NEEs reported some form of sensitivity or falsification analysis to support inferences.

Conclusion

NEEs are conducted using many different designs and statistical methods and encompass various definitions of a natural experiment, while it is questionable whether all evaluations reported as natural experiments should be considered as such. The likelihood of as-if randomization should be specifically reported, and primary analyses should be supported by sensitivity analyses and/or falsification tests. Transparent reporting of NEE designs and evaluation methods will contribute to the optimum use of place-based NEEs.

Can co-created knowledge mobilisation interventions alter and enhance mindlines to improve childhood eczema care? A UK-based Social Impact Framework evaluation

OBJECTIVE

To evaluate the impact of using knowledge mobilisation interventions to alter and enhance mindlines and improve childhood eczema care.

DESIGN

The eczema mindlines study involved three stages: (1) mapping and confirming eczema mindlines, (2) intervention development and delivery and (3) analysis of intervention impact. The focus of this paper is on stage 3. Data analysis was guided by the Social Impact Framework to address the questions: (1) what is the impact of this study on individuals and groups? (2) what changes in behaviour and practice have occurred due to their involvement? (3) what mechanisms have enabled these impacts or changes to occur? and (4) what are the recommendations and questions arising from this research?

SETTINGS

A deprived inner-city neighbourhood in central England and national/international settings.

PARTICIPANTS

Patients, practitioners and wider community members exposed to the interventions locally, nationally and internationally.

RESULTS

Data revealed tangible multi-level, relational and intellectual impacts. Mechanisms supporting impact included: simplicity and consistency of messages adapted to audience, flexibility, opportunism and perseverance, personal interconnectivity and acknowledgement of emotion. Co-created knowledge mobilisation strategies to alter and enhance mindlines mediated through knowledge brokering were effective in producing tangible changes in eczema care practice and self-management and in 'mainstreaming' childhood eczema in positive way across communities. These changes cannot be directly attributed to the knowledge mobilisation interventions, however, the evidence points to the significant contribution made.

CONCLUSION

Co-created knowledge mobilisation interventions offer a valuable method of altering and enhancing eczema mindlines across lay-practitioner-wider society boundaries. The Social Impact Framework provides comprehensive method of understanding and documenting the complex web of impact occurring as a result of knowledge mobilisation. This approach is transferable to managing other long-term conditions.

Work Ability and Well-Being Management and Its Barriers and Facilitators in Multinational Organizations: A Scoping Review

The aim of this scoping review was to identify effective workplace programs for work ability and well-being management and its barriers and facilitators in multinational organizations. The PubMed, Embase, and Web of Science databases were searched from 1974 through February 2023 to identify quantitative and qualitative studies on the management of work ability and well-being, and related outcomes including presenteeism, absenteeism, productivity loss, and healthy practices, conducted in a multinational organization or company. The titles and abstracts of over 11,000 publications were screened, and 10 studies fulfilling the inclusion criteria were included in the review. The management of work ability and well-being in multinational companies requires leadership support and commitment, effective communication, employee health awareness and engagement, comprehensive personalized health risk and condition assessments, and the management of risk factors and occupational and non-occupational health conditions. Financial constraints, high workloads, competing priorities, a lack of effective communication, a lack of worksite managers’ motivation, employees’ language barriers, high worksite managers’ turnover, and a decline in the support of senior managers are considered as barriers, and the presence of existing participatory practices is considered as a facilitator of participation in workplace health and well-being interventions in multinational companies. This review suggests that the management of work ability and well-being in multinational companies should go beyond health promotion and include comprehensive personalized health risk and health condition assessments and management.

A qualitative study on multisector activities to prevent childhood obesity in the municipality of Seinäjoki, Finland

Background

Multisector activities are needed to prevent childhood obesity due to its multifactorial background. The first aim was to identify the activities that had been undertaken for obesity prevention and deduce their main targets. Second, we analyzed the public health policy approaches (upstream, midstream, and downstream) which were followed. Finally, we studied the perception of interviewees regarding their sectors’ roles in implementing the local obesity program.

Methods

Deductive content analysis was used to analyze semi-structured interviews with 34 key professionals (from seven administrative sectors) who had participated in multisector health promotion during 2009–2016 and five representatives of other core parties.

Results

Several midstream and upstream activities were targeted at making physical activity (PA) and healthy eating (HE) integral parts of children’s lifestyle. One long-term strategy was to create environments for PA accessible to every inhabitant and build and renovate the interiors and yards of schools and day-care centers. The healthiness of meals was increased progressively. In addition to midstream and upstream activities, as a downstream activity, an intervention targeting children at risk of obesity was implemented. The impact of management on the activities was considerable; childhood obesity prevention was included in the city strategy and systematically coordinated at the highest managerial level. Altogether, various sectors operated efficiently to promote obesity-preventing lifestyles; however, not all (important) sectors recognized their role in the multisector process.

Conclusion

Most of the activities to guide children towards obesity-preventing lifestyles were either at the midstream or upstream level. Among the latter, considerable work is aimed at creating opportunities to practice PA and making it a natural part of the daily life. The aim of familiarizing children with lifestyles that include PA and HE was shared across sectors, including sectors that had not yet acknowledged their role in obesity prevention. Strong support from city management and systematic coordination of the activity are important factors that contribute to the engagement of several administrative sectors in working towards a shared aim, such as the prevention of childhood obesity.

Evaluating ‘Health in All Policies’ in Norwegian Municipalities

The Health in All Policies (HiAP) approach has emerged as a central strategy for promoting health at local, regional, and state levels in different countries. Representing a complex and complicated strategy, evaluations of HIAP at the local level are scarce, and scholars call for more knowledge and critical discussions regarding how to evaluate at this level. In this conceptual paper, I discuss how summative and formative evaluation approaches might supplement each other when evaluating HiAP at the local level. First, I discuss the possibilities of using summative and formative evaluation of HiAP. Further, I discuss how formative-dialogue research might represent possibilities for evaluation by combining the two approaches. Finally, I ask if there has been a shift in the Norwegian evaluation discourse, from the promotion of summative evaluation alone to a combination of both summative and formative methods.

Needs to Create Healthy Living Environments-A Two-Stage Delphi Survey in Europe to Identify Facilitating Factors and Barriers in Municipal Health Promotion

(1) In the field of health promotion, municipalities offer opportunities to reduce SES-based health inequalities by addressing vulnerable communities. This research project aims to identify facilitating and inhibiting factors for the creation of healthy living environments. (2) After preliminary literature and qualitative research work, an online-based Delphi survey was conducted (December 2020–March 2021). This included the rating and commentating of 22 theses at two times, whereby the results of the first round of rating were visible to the participants the second time. (3) Twelve experts from seven European countries participated in the Delphi survey across both rounds (1st round: n = 37; 12 countries). The consensus was particularly clear with regard to providing resources, which, in turn, are especially necessary for involving target groups in health promotion. (4) The results illustrate the relevance of further cross-national exchange. Certain aspects however, such as the HiAP approach or strategies to reach disadvantaged groups, are still challenging in practice. In order to develop concrete recommendations, the theses need to be further operationalised. The Delphi method offers a suitable possibility to map international expertise in this field and with a focus on health equity.

Theory-based capacity building intervention for intersectoral action for health at local governments: An exploratory pilot study

Aim

To design, implement and evaluate a nurse‐led capacity building intervention (PromoGOB) for intersectoral action for health at local governments.

Design

The programme was based on theories of the policy process and organizational change and facilitated by a nurse developing a health broker role. A complex intervention perspective was adopted in carrying out the study. The intervention was evaluated using a mixed method embedded design.

Methods

Quantitative component relied on a specific questionnaire. This tool, designed and piloted ad hoc, measured the capacity in terms of knowledge, awareness, resources, skills, and commitment, both at sectoral and government levels. For the qualitative component, semi‐structured interviews were conducted. These explored the perceived capacity and feasibility and acceptability issues. The programme was initiated at the end of October 2019, and it lasted a total of 5 weeks. Nineteen individuals representing various sectors at a local government in northern Spain participated in the study. The data analysis was concluded by the end of March 2020.

Findings

PromoGOB positively influenced participants' capacity for addressing health promotion. Awareness component, intersectoral work and the nurse as health broker were essential in the programme. The necessity of political participation was identified as an issue to be prioritized in future studies.

Conclusion

This study highlights the relevance of capacity building at local governments and the role that nurses can play in it. Further work should be undertaken to continue developing Health in All Policies approach at local level.

Impact

This study offers a starting point for nurses to get involved in the policy process of health promotion, performing a specific role as health brokers, building capacity at local governments for addressing social determinants of health, and delving into theories and concepts of the Health in All Policies field.

Can the Theory of Salutogenesis Offer a Framework to Enhance Policy Coherence during Policy Development and Implementation in Municipalities?

Health promotion efforts in municipalities demands extensive collaboration, between sectors (multi-sector) as well as between levels (multi-level). To develop, adopt and implement policies that contribute to reduce health inequity demands for policy coherence: consistent approaches across sectors and levels. In this conceptual paper, we discuss how the theory of Salutogenesis, and its inherent concept of coherence, can contribute to structure such collaboration processes in coherent ways, and contribute to experiences of policy coherence for both collaborators (practitioners and stakeholders) and inhabitants. We discuss how challenges with fragmented knowledge as well as lack of resources and motivation might be met through an explicit application of Salutogenesis core concepts. First, we argue that framing HP-efforts in terms of positive goals that can be achieved can contribute to motivation for change. Next, we discuss how the concepts of comprehensibility, manageability and meaningfulness can be applied to describe challenges, and plan for coherent policies and processes vertically (between levels) and horizontally (between sectors). Last, we discuss limitations and challenges with this approach, including the need to further develop the theoretical foundation of Salutogenesis, and how it can be applied at a setting- and/or policy-level.

Revisitando definições e naturezas da intersetorialidade: um ensaio teórico

Resumo Este ensaio teórico aborda definições e características centrais das ações intersetoriais para a saúde. Tem como objetivo, portanto, refletir sobre o conhecimento produzido a respeito das concepções e da natureza das ações intersetoriais para a saúde. Para a construção das análises, realizou-se uma revisão integrativa a partir de publicações referentes ao período de 2000 a 2019 identificadas nas bases de dados Lilacs, SciELO, Web of Science e Science Direct. O corpus contemplou 12 artigos, sendo analisados os aspectos relacionados com a finalidade, o propósito ou o método da ação intersetorial, sendo possível traçar similaridades e contrastes entre as definições. Diante da opacidade na construção de definições, coube situar que existe uma construção sócio-histórica dos conceitos, mas as definições provisórias expressam certo borramento ou apagamento que se encontram em disputa no interior do campo da saúde e que podem direcionar a distintos pontos de vista e constituir barreiras para incluir a implementação das ações intersetoriais relacionadas à promoção da saúde nas práticas cotidianas. De tais reflexões derivaram um conjunto de proposições acerca das naturezas das ações intersetoriais para a saúde, com vistas a contribuir para o debate sobre a temática.

Families and Collective Futures: Developing a Program Logic Model for Arts-Based Psychosocial Practice With South African Rural Communities

Aim: This aim of this study is to describe the development of a program logic model to guide arts-based psychosocial practice delivered in rural South African farming communities affected by transgenerational traumas. Background: The rationale for developing a program logic model for arts-based psychosocial practice in South Africa was based on the lack of evidence for effective community arts-based psychosocial interventions for collective trauma, unknown consensus about best practices and the need for developing cogent collective psychosocial practices. Further to this, the aims and benefits of the practice required clarity given the psychosocial complexity of the environment within which the practices for this population are being offered. The logic model offers a valuable resource for practitioners, participants and funders to understand the problem being addressed, how practice is defined, as well as the impact of practice and on intermediate and longer term goals. Methods: The authors used a systematic iterative approach to describe the operationalization of arts-based psychosocial practice. This resulted in the design of the logic model being informed by data from focus groups, an overview of the literature regarding transgerenational trauma in this population, operational policies and organizational documents. The development of the logic model involved actively investigating with practitioners their work with remote farming communities. We thematised practitioners practice constructs to identify salient practice elements and their relationship to perceived benefits and lastly feedback from practitioners and participants following implementation to make adjustments to the logic model. Results: The results were clearly identified in the form of visual mapping using the design of a program logic model. The logic model was divided into 5 parts and was verified by practitioners following implementation. The parts of the program logic model are (Part 1) main presenting problem, (Part 2) operational processes, (Part 3) practice elements, (Part 4) benefits, and impact and (Part 5) review.

Involvement and Multi-Sectoral Collaboration: Applying Principles of Health Promotion during the Implementation of Local Policies and Measures—A Case Study

Five principles for health promotion (HP) stand out in various forms, providing guidance for HP measures and policy implementation: (1) a broad and positive health concept, (2) participation and involvement of key stakeholders, (3) build action and action competence by involving and empowering target groups, (4) a setting perspective, and (5) equity in health. The purpose of this study is to describe, and critically discuss, how the five HP principles can be applied to structure collaboration processes for implementing HP measures in local communities. A case study methodology was applied when investigating how the HP principles guided actions and focus-of-attention throughout the process of implementing a local community HP measure. Of special importance was the broad involvement of stakeholders and the anchoring of overarching, as well as specific, HP goals in the municipal strategic documents to ensure political commitment, ownership, and adequate resources. Direction on how to apply or achieve the HP principles should be further explored, described, and brought into systematic day-to-day work for a better society-development.

Experiences from cross-cultural collaboration in health campaigns in Tanzania: a qualitative study

Background

Health campaigns are an important aspect of preventive health work. They can aim to improve health literacy in rural areas where residents lack access to health information and knowledge, and to improve both local and global health through cross-cultural collaboration. In Tanga District, Tanzania, exchange students and local youths participate together with Tanga International Competence Centre (TICC) to plan and accomplish health campaigns in local communities. The aim of this study was to explore the participants’ experiences with the cross-cultural collaboration in the planning and delivery of TICC’s health campaigns.

Methods

This study used a focused ethnographic approach. Five weeks of fieldwork included four observations of health campaigns and nine interviews: three individual interviews with employees at TICC (all Tanzanians), two group interviews with nine Norwegian nursing students, two group interviews with five local youths enrolled in TICC’s Youth Program, one interview with a local village leader, and one interview with a local primary school teacher. The interview material was analyzed using systematic text condensation.

Results

All participants experienced the cross-cultural collaboration as successful. Having enough time, adapting to local conditions, and understanding the needs of the target groups were perceived as essential to the campaigns’ success. Music and role-play, which are dominant within Tanzanian culture but not common among the Norwegian students, created excitement and motivation among the audiences. The interviewees identified changes in people’s health behavior in the aftermath of the campaigns.

Conclusion

All participants in this study identified positive outcomes from the cross-cultural collaboration within TICC’s health campaigns. The health campaigns were considered beneficial because of the poor access to health information among residents in the local communities.

Perceived determinants of implementation success of the neglected tropical diseases programme in Ghana: a qualitative study among programme officers

Background

The importance of health policy implementation cannot be overemphasized in contemporary public health. Neglected Tropical Diseases (NTDs) have negatively impacted society, affect quality of life and make the poor societies poorer. Several policies and strategies have been put in place across the world including the neglected tropical diseases programme in Ghana. Though chalked many successes, the programme continues to lag behind in the full attainment of various objectives. Several factors exist that determine how effective a programme is implemented. Identification of these factors on every programme is essential to determine where more programme resources need to be channelled. This study assessed the determinants of successful implementation of the neglected tropical diseases programme in Ghana.

Methods

A qualitative approach with the case study design was employed. Purposive and snowball sampling techniques were used to identify key programme officers at the national, regional and district levels of programme implementation. Eighteen (18) Key informant interviews were conducted at all the three levels of the Ghana Health Service NTDs programme. Data were thematically analysed and presented.

Results

Findings from the study revealed that determinants that influenced the successful implementation of the NTDs programme include donor support, education and training, partnerships, reliability of the health structure, integrative nature of the programme and management commitment. These determining factors cut across the inner settings of the implementing agency and the external environment.

Conclusion

Neglected tropical diseases continuously affect Ghanaians, especially the poor. It is important for both policy makers and implementers to identify the factors that ensure the success of the programme in the Ghanaian context. Though the factors are independently sufficient, they synergistically lead to improved programme implementation. Empowering all units involved (local to national level) and maximizing the enabling factors identified to would improve upon implementation and ensure sustainability.

Being and doing in the outdoors brings something extra! Evaluating the Danish Healthy in Nature Project

Purpose

Little is known of the potential of using nature and outdoor activities in relation to community-based health promotion programmes. This study seeks a better understanding of how people with mental or chronic physical health problems experience a local outdoor health promotion or rehabilitation programmes and a better understanding of how these programs contribute to the participant’s health and well-being.

Methods

The study is based on data from the Healthy in Nature project targeting adults with chronic physical health problems and adults with mental health problems. Data was collected using a qualitative multiple case study design involving five selected cases with both qualitative interviews and observation. Data was analysed using Braun et al.’s 6-phase guide to qualitative reflexive thematic analysis, employing Self-Determination Theory as a theoretical framework. Results: Overall, the participants in the two groups experienced increased competence, autonomy, and relatedness, and the participants expressed the importance of both being in a natural environment and doing outdoor activities (friluftsliv).

Conclusions

The study makes a valuable contribution to the field of health promotion and rehabilitation pointing to nature and friluftsliv as important elements that offer great potential to community-based health promotion.

Associations between density and quality of health promotion programmes and built environment features across Jerusalem

BACKGROUND

Health promotion programmes (HPPs) have the potential to influence individual health, depending on their quality and characteristics. Little is known about how they interact with built environment features and neighbourhood demographics in cities with substantial health disparities.

METHODS

Using the European Quality Instrument for Health Promotion (EQUIHP), we assessed the quality of HPPs, operating between 2016 and 2017, among adults aged 18-75 in Jerusalem. Areas were characterized by ethnicity and area socioeconomic level. Health information (body mass index, physical activity level) was obtained from the city profile survey. Geospatial information on the location and length of walking paths and bicycle lanes was obtained. Spearman correlations were used to assess associations among variables.

RESULTS

Ninety-three HPPs operating in 349 locations in Jerusalem were identified. Programmes were unevenly distributed across urban planning areas (UPAs), with the highest density observed in the southwest, areas populated mainly by non-orthodox Jewish residents. However, the best performing HPPs based on EQUIHP score were in the north and east UPAs, inhabited primarily by Arab residents. At a neighbourhood level, characteristics of the built environment positively correlated with higher total EQUIHP scores: the ratio between walking lane length to the neighbourhood's population size (r = 0.413, P < 0.001) and length of bicycle lane per population (r = 0.309, P = 0.5). Median EQUIHP score negatively correlated with the number of programmes per neighbourhood size (m2) (r = -0.327, P = 0.006) and neighbourhood average socioeconomic status (SES; r = -0.266, P = 0.027).

CONCLUSIONS

Our findings suggest that higher quality HPPs were preferentially located in areas of lower SES and served minority populations in Jerusalem.

Does partnership diversity in intersectoral policymaking matter for health promoting intervention packages' composition? A multiple-case study in the Netherlands

Intersectoral policymaking to improve public health includes integrated health promotion (HP) intervention packages that address a variety of health behavior determinants. The involvement of different partners is assumed to be necessary to implement such integrated packages. We examined how partnership diversity was associated with the composition of intervention packages implemented in Dutch municipalities. In a longitudinal multiple-case study (2012-14), we collected questionnaire data among 31 project leaders and 152 intervention implementers in 31 (alliances of) municipalities. Package composition was assessed in terms of intervention strategies, implementation settings and targeted behavioral determinants. Partnership diversity during the adoption and implementation phases was assessed in terms of the actors and sectors, as well as private partners and citizens involved. The association between partnership diversity and package composition was examined using crosstabs. Almost all packages integrated multiple strategies, but mostly education, facilitation and case finding, in multiple, but mostly health and public settings, such as schools. The packages targeted diverse behavioral determinants, although mainly personal and social environmental factors. A variety of partners from multiple sectors was involved, during both adoption and implementation of the packages. However, partners from the health, welfare and education sectors were mostly involved. More partnership diversity, especially during implementation, was associated with more integrated intervention packages. In intersectoral policymaking, investment in diversely composed partnerships seems worthwhile for implementing integrated intervention packages. However, investments in other conditions, like framing health issues and network management, are also needed to make environmental determinants of health behavior the object of HP.

A Systematic Review to Examine the Evidence in Developing Social Prescribing Interventions That Apply a Co-Productive, Co-Designed Approach to Improve Well-Being Outcomes in a Community Setting

This systematic review aims to investigate the evidence in applying a co-design, co-productive approach to develop social prescribing interventions. A growing body of evidence suggests that co-production and co-design are methods that can be applied to engage service users as knowledgeable assets who can contribute to developing sustainable health services. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Peer-reviewed articles were sought using electronic databases, experts and grey literature. The review search concluded with eight observational studies. Quality appraisal methods were influenced by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Framework approach. A narrative thematic synthesis of the results was conducted. The evidence suggests that a co-design and co-productive social prescribing can lead to positive well-being outcomes among communities. Barriers and facilitators of co-production and co-design approach were also highlighted within the evidence. The evidence within this review confirms that a co-production and co-design would be an effective approach to engage stakeholders in the development and implementation of a SP intervention within a community setting. The evidence also implies that SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design a service that improves health and well-being outcomes for community members.

Community Action Package in Iran's Comprehensive Mental and Social Health Services (the SERAJ Program)

Objective: The social component of health plays a significant role in improving the mental health of the people of a district. A national program on providing comprehensive social and mental health services, entitled ‎‎"SERAJ", was developed and piloted in three districts of Iran. The present study aims to determine its model for improving the indicators of the social component of mental health. Method : This study is a system design for which a literature review, interviews with experts, and focused group discussions with stakeholders were used. Results: Community action in promoting the mental health of the districts has three main components: strengthening intersectoral collaboration through the memorandum of understandings (MoU), increasing people's participation by establishing People's Participation House (PPH) with the presence of the representative of current People's network, and social protection of people suffering from mental disorders by establishing the Social Support Unit (SSU) for self-reliance activity. All three components are controlled by the governor and with supervision and technical consult of the health network of the district and stakeholder participation. Conclusion: The model uses the inner capacities of the city instead of creating new structures. The prerequisites for the effective function of the main three components are educating departments, educating members of the PPH, and hiring a social worker at the SSU. The effective measures taken by the departments to reduce the risk factors for mental disorders are dependent on the technical and financial support of relevant organizations at the provincial and national levels.

Partnerships, Processes, and Outcomes: A Health Equity-Focused Scoping Meta-Review of Community-Engaged Scholarship

In recent decades, there has been remarkable growth in scholarship examining the usefulness of community-engaged research (CEnR) and community-based participatory research (CBPR) for eliminating health inequities.This article seeks to synthesize the extant literature of systematic reviews, scoping reviews, and other related reviews regarding the context, processes, and research designs and interventions underlying CEnR that optimize its effectiveness. Through a scoping review, we have utilized an empirically derived framework of CBPR to map this literature and identify key findings and priorities for future research. Our study found 100 reviews of CEnR that largely support the CBPR conceptual framework.

A Proposal for Public Health Information System-Based Health Promotion Services

This study aims to examine the current status and utilization of 22 health promotion projects that use the health care information system. We investigate the health promotion examination results for a counseling project held at health centers, which use information connected with the Health Insurance Corporation. First, we review the status of 22 health promotion projects, including 13 integrated health promotion projects and 9 other health promotion projects. Next, we examine the linkages between the 22 projects and other health promotion systems. Consequently, despite accumulating vast amounts of data, only 10 places could be linked to health promotion data in the health and medical information system; the Social Security Information Service was the only exception to this trend. The Public Health Information System (PHIS) had the lowest data utilization rate in the project. The study results show that it is necessary to utilize data from local health and medical institutions in order to provide information system-based health promotion services. In particular, it seems to be effective when health and medical institutions provided various counseling services and other linked services to local residents in connection with the Korea Health Insurance Corporation’s health examination results.

Evaluation of the promising neighbourhoods community program to reduce health inequalities in youth: a protocol of a mixed-methods study

BACKGROUND

Reducing socioeconomic health inequalities among youth is a major challenge for governments around the world and reports on successful attempts are scarce. Socioecological and integral approaches with collaborative partnerships and community engagement are recommended but knowledge about the effectiveness and effective and ineffective elements is limited. The Promising Neighbourhoods program employs such an approach aiming to reduce socioeconomic inequalities in health, safety and talent development in youth. We will evaluate the process-implementation, and effectiveness of the Promising Neighbourhoods program.

METHODS/DESIGN

Core elements of Promising Neighbourhoods are a collaborative community programming approach with stakeholders, data-based priority setting, knowledge-, and theory-based policies and evidence-based interventions. Community stakeholders and key-leaders from the neighbourhoods are engaged in the program. For this evaluation study the program will be implemented in three intervention neighbourhoods. These neighbourhoods will be compared to three control neighbourhoods at baseline in 2018/2019 and at follow-up in 2020/2021 after full implementation of the Promising Neighbourhoods program. Intervention neighbourhoods receive a tailored intervention-package including evidence-based interventions and additional measures by community stakeholders. In control neighbourhoods, no special planning will take place thus interventions are offered as usual. A mixed-methods approach following the stages of the logic model from program is applied for this evaluation. Questionnaires, focus groups, and registration data will be collected among community stakeholders, key-leaders, and youth to evaluate the process-implementation of the program. Indicators of intermediate and ultimate outcomes will be studied among N = 818 children and N = 818 youngsters using difference-in-difference regression analysis to evaluate the effectiveness of the Promising Neighbourhoods program.

DISCUSSION

Hypotheses are that a collaborative community approach with stakeholders leads to clear priority-setting and better tailored interventions of better quality. We further hypothesise a decline in socioeconomic inequalities in intermediate and ultimate outcomes for health, safety and talent development in the intervention neighbourhoods in comparison to control neighbourhoods. The results add knowledge about effective and ineffective elements of collaborative community programming approaches to reduce health inequalities in youth and thus are relevant for local and national public health authorities.

TRIAL REGISTRATION

Netherlands National Trial Register number NL7279 . Date of registration: 26-Sept-2018.

Identification of starting points to promote health and wellbeing at the community level - a qualitative study

Background

As health is influenced by the social, economic and environmental conditions in which individuals live, local communities are an ideal setting to promote health and wellbeing. However, up to now various health promotion interventions at the community level have had limited success, perhaps related to an incomplete understanding of local contexts and priorities. We therefore aimed to develop a broader and deeper understanding of topics or issues that were most salient to residents of a South-West German community by exploring their perceptions of needs, challenges, barriers and existing resources related to health and well-being.

Methods

As an initial step of a multi-year community-based participatory research project, we conducted semi-structured interviews with key informants (n = 30) from various community settings (e.g., child care, elderly care, businesses, non-profit organizations, village councils, and local government). The terms “health” and “wellbeing” were included in the stem of each question in the semi-structured interview guide to enable a focus on related perceived needs, challenges, barriers and existing resources. Interviews were audiotaped, transcribed verbatim and analyzed using qualitative content analysis techniques.

Results

Themes emerging from our interviews appeared to center primarily in three distinct areas: natural resources and built environment, access to services, and social cohesion including subthemes on the importance of social engagement and volunteerism, sense of community, and shared identity.

Conclusions

That health and wellbeing were not identified explicitly as a priority by key informants suggests that these should not be presented as the primary focus of a community-wide initiative. Instead themes with a higher priority should be addressed in ways that can lead to better health and wellbeing as a secondary goal.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6425-x) contains supplementary material, which is available to authorized users.

Towards local implementation of Dutch health policy guidelines: a concept-mapping approach

To develop a targeted implementation strategy for a municipal health policy guideline, implementation targets of two guideline users [Regional Health Services (RHSs)] and guideline developers of leading national health institutes were made explicit. Therefore, characteristics of successful implementation of the guideline were identified. Differences and similarities in perceptions of these characteristics between RHSs and developers were explored. Separate concept mapping procedures were executed in two RHSs, one with representatives from partner local health organizations and municipalities, the second with RHS members only. A third map was conducted with the developers of the guideline. All mapping procedures followed the same design of generating statements up to interpretation of results with participants. Concept mapping, as a practical implementation tool, will be discussed in the context of international research literature on guideline implementation in public health. Guideline developers consider implementation successful when substantive components (health issues) of the guidelines, content are visible in local policy practice. RHSs, local organizations and municipalities view the implementation process itself within and between organizations as more relevant, and state that usability of the guideline for municipal policy and commitment by officials and municipal managers are critical targets for successful implementation. Between the RHSs, differences in implementation targets were smaller than between RHSs and guideline developers. For successful implementation, RHSs tend to focus on process targets while developers focus more on the thematic contents of the guideline. Implications of these different orientations for implementation strategies are dealt with in the discussion.

Determinants of an integrated public health approach: the implementation process of Greenland's second public health program

Background

Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined.

Methods

Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II’s implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination.

Results

Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee.

Conclusion

Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II’s integrated approach does not harmonise with the government’s inflexible organisational structure resulting in insufficient implementation.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6253-4) contains supplementary material, which is available to authorized users.

Local Organizations Supporting Implementation of Graphic Health Warnings for Tobacco in Underserved Communities: A Qualitative Inquiry

Background: Graphic health warnings (GHWs) on cigarette packages offer the potential to support tobacco cessation and prevention of initiation. Guidance for supporting implementation at the local level is limited, which can lead to missed opportunities to amplify the health impact of GHWs. This study examines the potential for local organizations engaged in tobacco control in underserved communities to support GHW implementation. Materials and Methods: Key informant interviews were conducted with 20 leaders in the three partner communities of Boston, Lawrence, and Worcester, Massachusetts. Data were analyzed using a combination of inductive and deductive methods, grounded in a framework analysis approach. Results: First, participants expected local organizations to play a diverse range of roles to support GHW policy implementation, ranging from convening local actors to offering complementary health education activities. Second, there is a need for external agencies to actively support local organizations during the pre-implementation and implementation phases, e.g., by engaging local organizations and providing resources and technical assistance. Finally, participants noted concerns about potential disconnects between the GHWs and the needs of underserved populations. Discussion: With the necessary supports, local community organizations can be important implementation partners to maximize the impact of GHWs and ensure that benefits accrue to members of underserved communities.

Intersectoral Planning for Public Health: Dilemmas and Challenges

BACKGROUND

Intersectoral action is often presented as essential in the promotion of population health and health equity. In Norway, national public health policies are based on the Health in All Policies (HiAP) approach that promotes whole-of-government responsibility. As part of the promotion of this intersectoral responsibility, planning is presented as a tool that every Norwegian municipality should use to integrate public health policies into their planning and management systems. Although research on implementing the HiAP approach is increasing, few studies apply a planning perspective. To address this gap in the literature, our study investigates how three Norwegian municipalities experience the use of planning as a tool when implementing the HiAP approach.

METHODS

To investigate planning practices in three Norwegian municipalities, we used a qualitative multiple case study design based on face-to-face interviews. When analysing and discussing the results, we used the dichotomy of instrumental and communicative planning approaches, in addition to a collaborative planning approach, as the theoretical framework.

RESULTS

The municipalities encounter several dilemmas when using planning as a tool for implementing the HiAP approach. Balancing the use of qualitative and quantitative knowledge and balancing the use of structural and processual procedures are two such dilemmas. Other dilemmas include balancing the use of power and balancing action and understanding in different municipal contexts. They are also faced with the dilemma of whether to place public health issues at the forefront or to present these issues in more general terms.

CONCLUSION

We argue that the dilemmas experienced by the municipalities might be explained by the difficult task of combining instrumental and communicative planning approaches because the balance between them is seldom fixed.

Promoção da saúde na Atenção Primária à Saúde: sistematização de desafios e estratégias intersetoriais

RESUMO Foi realizada revisão da literatura com o intuito de sistematizar o conhecimento produzido no campo da promoção da saúde com ênfase nos desafios e estratégias para implementação da intersetorialidade. As bases de dados consultadas foram Lilacs, SciELO, Web of Science e Science Direct; e identificadas publicações referentes ao período compreendido entre 2006 e 2017. O corpus contou com 28 artigos, sendo analisados os aspectos relacionados com os resultados dos estudos. Verificou-se que eles têm destacado a discussão de fragilidades contextuais relacionadas com aspectos gerenciais e operacionais das intervenções para promoção da saúde, assim como com estratégias adotadas para fomentar a implementação e gestão de ações intersetoriais. Conclui-se que são necessários investimentos em estudos de caso que permitam analisar intervenções concretas direcionadas à promoção da saúde, agregar novas explicações e estabelecer coerência com a complexidade dos distintos contextos no âmbito da Atenção Primária à Saúde.

The development and implementation of a new import duty on palm oil to reduce non-communicable disease in Fiji

BACKGROUND

Non communicable diseases (NCD) place a significant health burden on Pacific Island countries including Fiji. Policy interventions to curb NCDs have been implemented in Fiji including a 32% increase in the import duty on palm oil. This study aims to analyse the development and implementation of the increase in palm oil import duty in Fiji. Also, to document the policy process, identify barriers and facilitators during implementation and to examine the impact of the new import duty on import volumes.

METHODS

Data were collected through key informant interviews with private stakeholders, government officials and supermarket managers. Transcripts were analysed thematically. Import volumes were analysed for the 2010-2015 period.

RESULTS

Facilitators of policy development and implementation included stakeholder awareness of the health implications of palm oil, preparation of a comprehensive policy briefing paper, and inter-sectoral support and leadership. This decrease in the availability of palm oil was encouraging however, it may have been counteracted to some extent by industry relabelling the product as vegetable oil.

CONCLUSIONS

Barriers to policy changes need to be anticipated during the policy development process. Whilst the decline in imports probably reduced population consumption, further research is needed to determine if this translated to a population wide reduction in saturated fat.

Self-assessment of health promoting Hospital's activities in the largest heart Hospital of Northwest Iran

BACKGROUND

Health Promoting Hospitals are among the major health promoters of the society. To acquire Health Promoting Hospital (HPH) status, a hospital must self-assess to know their inadequacies and then lay the foundation for improvements. This study has been performed with the aim of assessing readiness of the largest heart hospital of northwestern Iran regarding the HPH standards.

METHODS

This cross-sectional study was conducted through the participation of 270 administrative and clinical staff of the largest heart hospital of northwestern Iran. Data were gathered using self-assessment tool for health promoting hospitals including demographics and the HPH standards. HPH standards' dimensions were Management policy, Patient assessment, Patient information and intervention, Promoting a healthy workplace, and Continuity and cooperation. Analysis was performed by SPSS v. 16 with a significance level of 0.05.

RESULTS

The participants included clinical (67.4%) and administrative (32.6%) staff. Among the HPH standards, the lowest score belonged to the management policy (1.44 ± 0.53) and the highest one to the patient information and intervention (1.72 ± 0.47). The average score of compliance with the HPH standards was 1.60 ± 0.40 which shows moderate progress of the hospital towards the HPH standards.

CONCLUSION

Regarding the moderate situation of the hospital in HPH standards and the low score of the management policy, the studied hospital should enforce the standards, especially in the management policy. Also, there is a need for health promotion programs in all three levels of prevention with the participation of the staff and the patients as much as possible.

Towards environmental health equity in health impact assessment: innovations and opportunities

OBJECTIVES

As global environmental change drives inequitable health outcomes, novel health equity assessment methodologies are increasingly required. We review literatures on equity-focused HIA to clarify how equity is informing HIA practice, and to surface innovations for assessing health equity in relation to a range of exposures across geographic and temporal scales.

METHODS

A narrative review of the health equity and HIA literatures analysed English articles published between 2003 and 2017 across PubMed, PubMed Central, Biomed Central and Ovid Medline. Title and abstract reviews of 849 search results yielded 89 articles receiving full text review.

RESULTS

Considerations of equity in HIA increased over the last 5 years, but equity continues to be conflated with health disparities rather than their root causes (i.e. inequities). Lessons from six literatures to inform future HIA practice are described: HIA for healthy cities, climate change vulnerability assessment, cumulative health risk assessment, intersectionality-based policy analysis, corporate health impact assessment and global health impact assessment.

CONCLUSIONS

Academic reporting on incorporating equity in HIA practice has been limited. Nonetheless, significant methodological advancements are being made to examine the health equity implications of multiple environmental exposures.

How to apply the evidence-based recommendations for greater health equity into policymaking and action at the local level?

In 2014, the regional commission for equity in health in the Swedish region of Östergötland, the Östgötacommission, presented their scientific report on health inequities and possible explanatory factors in the region as well as evidence-based recommendations to reduce health disparities. The final report with its 66 recommendations was officially approved by politicians across parties in the region. In the next step, out of the 66 recommendations, 10 areas of action were politically prioritized and declared in a common letter of intent signed by representatives from the municipalities and the Region of Östergötland. Now, these evidence-based recommendations and political areas of action are to be applied into policymaking and action at the local level. In this paper, this transferral process is reflected upon with the local example of the Norrköping municipality and their work with social investments. It is suggested to start with follow-up and evaluation of local action from the perspective of proportionate universalism, followed by local processes based on the organization model described here and earlier used at the regional level.

Governance for public health and health equity: The Tröndelag model for public health work

Background: Multi-sectoral governance of population health is linked to the realization that health is the property of many societal systems. This study aims to contribute knowledge and methods that can strengthen the capacities of municipalities regarding how to work more systematically, knowledge-based and multi-sectoral in promoting health and health equity in the population. Methods: Process evaluation was conducted, applying a mixed-methods research design, combining qualitative and quantitative data collection methods. Results: Processes strengthening systematic and multi-sectoral development, implementation and evaluation of research-based measures to promote health, quality of life, and health equity in, for and with municipalities were revealed. A step-by-step model, that emphasizes the promotion of knowledge-based, systematic, multi-sectoral public health work, as well as joint ownership of local resources, initiatives and policies has been developed. Conclusions: Implementation of systematic, knowledge-based and multi-sectoral governance of public health measures in municipalities demand shared understanding of the challenges, updated overview of the population health and impact factors, anchoring in plans, new skills and methods for selection and implementation of measures, as well as development of trust, ownership, shared ethics and goals among those involved.

Time to dismiss the idea of a structural fix within government? An analysis of intersectoral action for health in Danish municipalities

Aims: This paper examines the role of organizational structure within government(s) in attempts to implement intersectoral action for health in Danish municipalities. We discuss the implications of structural reorganization and the governance structures that are established in order to ensure coordination and integration between policy sectors. Methods: The paper is based on 49 interviews with civil servants from health and non-health sectors of 10 municipalities. Based on participants’ experiences, cases have been described and analyzed in an iterative process consulting the literature on Health in All Policies and joined-up government. Results: Continuous and frequent processes of reorganizing were widespread in the municipalities. However, they appeared to have little effect on policy change. The two most common governance structures established to transcend organizational boundaries were the central unit and the intersectoral committee. According to the experiences of participants, paradoxically both of these organizational solutions tend to reproduce the organizational problems they are intended to overcome. Even if structural reorganization may succeed in dissolving some sector boundaries, it will inevitably create new ones. Conclusions: It is time to dismiss the idea that intersectoral action for health can be achieved by means of a structural fix. Rather than rearranging organizational boundaries it may be more useful to seek to manage the silos which exist in any organization, e.g. by promoting awareness of their implications for public health action and by enhancing the boundary spanning skills of public health officers.

Implementation of a web-based national child health-care programme in a local context: A complex facilitator role

Aim: The aim of this study was to investigate child health-care coordinators’ experiences of being a facilitator for the implementation of a new national child health-care programme in the form of a web-based national guide. Methods: The study was based on eight remote, online focus groups, using Skype for Business. A qualitative content analysis was performed. Results: The analysis generated three categories: adapt to a local context, transition challenges and led by strong incentives. There were eight subcategories. In the latent analysis, the theme ‘Being a facilitator: a complex role’ was formed to express the child health-care coordinators’ experiences. Conclusions: Facilitating a national guideline or decision support in a local context is a complex task that requires an advocating and mediating role. For successful implementation, guidelines and decision support, such as a web-based guide and the new child health-care programme, must match professional consensus and needs and be seen as relevant by all. Participation in the development and a strong bottom-up approach was important, making the web-based guide and the programme relevant to whom it is intended to serve, and for successful implementation. The study contributes valuable knowledge when planning to implement a national web-based decision support and policy programme in a local health-care context.

Exploring drivers and challenges in implementation of health promotion in community mental health services: a qualitative multi-site case study using Normalization Process Theory

Background

There is an increased interest in improving the physical health of people with mental illness. Little is known about implementing health promotion interventions in adult mental health organisations where many users also have physical health problems. The literature suggests that contextual factors are important for implementation in community settings. This study focused on the change process and analysed the implementation of a structural health promotion intervention in community mental health organisations in different contexts in Denmark.

Methods

The study was based on a qualitative multiple-case design and included two municipal and two regional provider organisations. Data were various written sources and 13 semi-structured interviews with 22 key managers and frontline staff. The analysis was organised around the four main constructs of Normalization Process Theory: Coherence, Cognitive Participation, Collective Action, and Reflexive Monitoring.

Results

Coherence: Most respondents found the intervention to be meaningful in that the intervention fitted well into existing goals, practices and treatment approaches. Cognitive Participation: Management engagement varied across providers and low engagement impeded implementation. Engaging all staff was a general problem although some of the initial resistance was apparently overcome. Collective Action: Daily enactment depended on staff being attentive and flexible enough to manage the complex needs and varying capacities of users. Reflexive Monitoring: During implementation, staff evaluations of the progress and impact of the intervention were mostly informal and ad hoc and staff used these to make on-going adjustments to activities. Overall, characteristics of context common to all providers (work force and user groups) seemed to be more important for implementation than differences in the external political-administrative context.

Conclusions

In terms of research, future studies should adopt a more bottom-up, grounded description of context and pay closer attention to the interplay between different dimensions of implementation. In terms of practice, future interventions need to better facilitate the translation of the initial sense of general meaning into daily practice by active local management support that occurs throughout the implementation process and that systematically connects the intervention to existing practices.

Public health terminology: Hindrance to a Health in All Policies approach?

AIM

National public health policies in Norway are based on a Health in All Policies (HiAP) approach. At the local level, this means that public health, as a cross-sectional responsibility, should be implemented in all municipal sectors by integrating public health policies in municipal planning and management systems. The paper investigates these local processes, focusing on the use of public health terminology and how this terminology is translated from national to local contexts. We ask whether the terms 'public health' and 'public health work' are suitable when implementing an HiAP approach.

METHODS

A qualitative case study based on analyses of interviews and planning documents was performed in three Norwegian municipalities.

RESULTS

The results present dilemmas associated with using public health terminology when implementing an HiAP approach. On the one hand, the terms are experienced as wide, complex, advanced and unnecessary. On the other hand, the terms are experienced as important for a systematic approach towards understanding public health ideology and cross-sectional responsibility. One municipality used alternative terminology.

CONCLUSIONS

This paper promotes debate about the appropriateness of using the terms 'public health' and 'public health work' at the local level. It suggests that adaptation is suitable and necessary, unless it compromises knowledge, responsibility and a systematic approach. This study concludes that the use of terminology is a central factor when implementing the Norwegian Public Health Act at the local level.

Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale

The US tobacco industry spends $8.2 billion annually on marketing at the point of sale (POS), a practice known to increase tobacco use. Evidence-based policy interventions (EBPIs) are available to reduce exposure to POS marketing, and nationwide, states are funding community-based tobacco control partnerships to promote local enactment of these EBPIs. Little is known, however, about what implementation strategies best support community partnerships' success enacting EBPI. Guided by Kingdon's theory of policy change, Counter Tools provides tools, training, and other implementation strategies to support community partnerships' performance of five core policy change processes: document local problem, formulate policy solutions, engage partners, raise awareness of problems and solutions, and persuade decision makers to enact new policy. We assessed Counter Tools' impact at 1 year on (1) partnership coordinators' self-efficacy, (2) partnerships' performance of core policy change processes, (3) community progress toward EBPI enactment, and (4) salient contextual factors. Counter Tools provided implementation strategies to 30 partnerships. Data on self-efficacy were collected using a pre-post survey. Structured interviews assessed performance of core policy change processes. Data also were collected on progress toward EBPI enactment and contextual factors. Analysis included descriptive and bivariate statistics and content analysis. Following 1-year exposure to implementation strategies, coordinators' self-efficacy increased significantly. Partnerships completed the greatest proportion of activities within the "engage partners" and "document local problem" core processes. Communities made only limited progress toward policy enactment. Findings can inform delivery of implementation strategies and tests of their effects on community-level efforts to enact EBPIs.

The impact of neighborhood social capital on life satisfaction and self-rated health: A possible pathway for health promotion?

Neighborhood social capital has repeatedly been linked to favorable health-outcomes and life satisfaction. However, it has been questioned whether it's impact on health has been over-rated. We aim to investigate relationships between neighborhood social capital and self-rated health (SRH) and life satisfaction (LS) respectively, both directly and indirectly mediated via Sense of Coherence and self-esteem. Based on a cross-sectional population-survey (N=865) in a medium size Norwegian municipality, we specified a structural equation model (SEM) including the above-listed variables, while controlling for gender, age, education, income, and employment status. The applied model explains more variance in LS (46%) than in SRH (23%). Social capital has a stronger impact on life satisfaction than on health. The indirect pathway via SOC had the highest impact on life satisfaction, but no significant relationship to SRH. Self-rated health was more tightly linked to personal background variables. Enhancing social capital in the neighborhood might be a beneficial strategy to promote life satisfaction, as well as strengthening sense of coherence even in healthy communities.