1
|
Sharma A, Chanda S, Porwal A, Wadhwa N, Santhanam D, Ranjan R, Shah H, Adyanthaya S, Meena R. Effect of social and behavioral change interventions on minimum dietary diversity among pregnant women and associated socio-economic inequality in Rajasthan, India. BMC Nutr 2024; 10:82. [PMID: 38845052 PMCID: PMC11154971 DOI: 10.1186/s40795-024-00887-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Maternal dietary diversity is a key to improving the birth and child health outcomes. Besides socio-economic factors, the nutrition specific program- Social and Behavioural Change Communication (SBCC) interventions aimed to improve maternal dietary diversity has varied levels of impact on the socio-economic groups in poor resource setups. OBJECTIVE To measure the factors associated with the minimum dietary diversity (MDD) among pregnant women in selected districts of Rajasthan with special emphasis on the SBCC components. Additionally, it measures the socio-economic gaps in the behaviour of consumption of diversified diet during pregnancy. METHODS Data from a cross sectional survey of 6848 pregnant women, who have received a continuous SBCC counselling and registered under a state introduced conditional cash transfer program, during May to June, 2023, in five intervention districts -Banswara, Baran, Dunagrpur, Pratapgarh and Udaipur in Rajasthan was used. A 24 h recall based food consumption behaviour has been gathered to measure the MDD of pregnant women. Study has used descriptive statistics, multivariate regressions, and multivariate decomposition analysis to address the research objectives. RESULTS Study finds that only 55.2% of pregnant women are consuming diverse diet in the study duration with mean dietary diversity score is 4.8 (+/- 1.5). Logistic regression finds that SBCC components such as frontline workers (aOR = 1.3, CI: 1.1-1.4), community motivators (aOR = 1.9, CI: 1.7-2.1), and participation in MCHND (aOR = 1.0, CI: 0.9-1.2) have significant and higher likelihood on consumption of MDD food on previous day. A higher education and belonging from richer wealth quintile also show higher association for consumption of MDD. Multivariate decomposition shows, among richest and poorest wealth categories there is 19% point difference (58% difference due to coefficient vs. 42% difference due to composition) in MDD consumption. This is positively contributed by the caste and educational categories of women. CONCLUSION Despite a predominant vegetarian diet consuming population, better maternal dietary diversity was observed among those exposed to higher dose of SBCC intervention package. Educational status and caste of the respondent were significantly associated with minimum dietary diversity and contributed to the socio-economic inequality highlighting the importance of tailored and sustained SBCC interventions.
Collapse
Affiliation(s)
- Anshita Sharma
- Social and Economic Empowerment, IPE Global Limited, IPE Global Limited, Delhi, India.
| | - Srei Chanda
- Social and Economic Empowerment, IPE Global Limited, IPE Global Limited, Delhi, India
| | - Akash Porwal
- Social and Economic Empowerment, IPE Global Limited, IPE Global Limited, Delhi, India
| | - Namita Wadhwa
- Social and Economic Empowerment, IPE Global Limited, IPE Global Limited, Delhi, India
| | - Divya Santhanam
- Social and Economic Empowerment, IPE Global Limited, IPE Global Limited, Delhi, India
| | - Raghwesh Ranjan
- Social and Economic Empowerment, IPE Global Limited, IPE Global Limited, Delhi, India
| | - Hemang Shah
- Child Health and Development, Children's Investment Fund Foundation, Delhi, India
| | - Shachi Adyanthaya
- Child Health and Development, Children's Investment Fund Foundation, Delhi, India
| | - Ramavatar Meena
- Directorate of Integrated Child Development Services, Jaipur, Rajasthan, India
| |
Collapse
|
2
|
Alter DA, Austin PC, Rosenfeld A. The Dynamic Nature of the Socioeconomic Determinants of Cardiovascular Health: A Narrative Review. Can J Cardiol 2024; 40:989-999. [PMID: 38309464 DOI: 10.1016/j.cjca.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/05/2024] Open
Abstract
Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which has often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at 2 or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrhythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighbourhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. Seven percent of socioeconomic cardiovascular outcome studies have measured socioeconomic status at 2 or more points in time throughout the follow-up period, hypothesized mechanisms by which dynamic socioeconomic measures affected outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data can be better used methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root causes, interventions, and health-system designs if health equity is to be improved.
Collapse
Affiliation(s)
- David A Alter
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Peter C Austin
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Rosenfeld
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Jeong DH, Lee SK, Ahn ME, Kim SM, Ryu OH, Park KS, Shin SG, Han JH. An empirical study on social network analysis for small residential communities in Gangwon State, South Korea. Sci Rep 2024; 14:11648. [PMID: 38773232 PMCID: PMC11109222 DOI: 10.1038/s41598-024-62371-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/16/2024] [Indexed: 05/23/2024] Open
Abstract
Social Network Analysis (SNA) provides a dynamic framework for examining interactions and connections within networks, elucidating how these relationships impact behaviors and outcomes. This study targeted small residential communities in Gangwon State, South Korea, to explore network formation theories and derive strategies for enhancing health promotion services in rural communities. Conducted in 12 small residential areas, the survey led to a network categorization model distinguishing networks as formal, informal, or non-existent. Key findings demonstrated that demographic and socio-economic factors, specifically age, income, living environment, leisure activities, and education level, significantly influence network formation. Importantly, age, environmental conditions, satisfaction with public transportation, and walking frequency were closely associated with the evolution of formal networks. These results highlight the importance of early community network assessments, which must consider distinct network traits to develop effective health promotion models. Utilizing SNA early in the assessment process can improve understanding of network dynamics and optimize the effectiveness of health interventions.
Collapse
Affiliation(s)
| | - Sang-Kyu Lee
- Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Moo-Eob Ahn
- Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea
| | - Sang Mi Kim
- Department of AI Health Information Management, Yonsei University, Wonju, Republic of Korea
| | - Ohk-Hyun Ryu
- Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, 77 Sakju-ro, Chuncheon, 24253, Republic of Korea.
| | - Kyung Suk Park
- Industry Academic Cooperation Foundation, Hallym University, Chuncheon, Republic of Korea
| | - Se Gye Shin
- Industry Academic Cooperation Foundation, Hallym University, Chuncheon, Republic of Korea
| | - Jae Hyun Han
- Gangwon Technopark, Chuncheon, Gangwon-do, Republic of Korea
| |
Collapse
|
4
|
Weber P, Birkholz L, Straub R, Kohler S, Helsper N, Dippon L, Pfeifer K, Rütten A, Semrau J. The Limitations and Potentials of Evaluating Economic Aspects of Community-Based Health Promotion: A Critical Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024; 22:165-179. [PMID: 38190019 PMCID: PMC10864521 DOI: 10.1007/s40258-023-00864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/09/2024]
Abstract
Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.
Collapse
Affiliation(s)
- Philipp Weber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany.
| | - Leonie Birkholz
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Riccarda Straub
- School of Business, Economics and Society, Chair of Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, 90403, Nuremberg, Germany
| | - Simone Kohler
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Natalie Helsper
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Lea Dippon
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Alfred Rütten
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| | - Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr. 123b, 91058, Erlangen, Germany
| |
Collapse
|
5
|
Tinner L, Kelly C, Caldwell D, Campbell R. Community mobilisation approaches to preventing adolescent multiple risk behaviour: a realist review. Syst Rev 2024; 13:75. [PMID: 38409098 PMCID: PMC10895861 DOI: 10.1186/s13643-024-02450-2] [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: 05/23/2023] [Accepted: 01/03/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Adolescent multiple risk behaviour (MRB) is a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, with systematic reviews reporting mixed evidence of effectiveness. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. There are gaps in the current literature, theory and implementation that would benefit from a realist approach. We use a theory-driven evidence synthesis to assess how and why community mobilisation interventions work/do not work to prevent adolescent MRB and in what contexts. METHODS This realist review used a six-stage iterative process, guided by the RAMESES framework. We systematically searched PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies were screened for relevance to the programme theory, assessed for rigour and included based on a priori criteria. Two independent reviewers selected, screened and extracted data from included studies. A realist logic of analysis was used to develop context-mechanism-outcome configurations that contributed to our programme theory. FINDINGS We reviewed 35 documents describing 22 separate community mobilisation intervention studies. Most studies (n = 17) had a quality assessment score of three or four (out of four). We analysed the studies in relation to three middle range theories. To uphold our theory that these interventions work by creating a social environment where adolescents are less likely to engage in MRB, interventions should: (1) embed a framework of guiding principles throughout the community, (2) establish community readiness with population data and (3) ensure a diverse coalition with the support of intervention champions. Mechanisms such as empowerment through coalition ownership over the delivery of the intervention, cohesion across the community and motivation to work collaboratively to improve adolescent health are triggered to achieve social environment shifts. However, certain contexts (e.g. limited funding) restrict intervention success as these mechanisms are not fired. CONCLUSIONS For community mobilisation interventions to reduce adolescent MRB, the coalitions within them must seek to alter the social environment in which these behaviours occur. Mechanisms including empowerment, cohesion and motivation lead to this shift, but only under certain contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020205342.
Collapse
Affiliation(s)
- Laura Tinner
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK.
| | - Claire Kelly
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK
| | - Deborah Caldwell
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL, UK
| |
Collapse
|
6
|
Voss S, Bauer J, Jung-Sievers C, Moore G, Rehfuess E, Rhein VZ, Coenen M. Process evaluation of an integrated community-based intervention for promoting health equity in children in a new residential development area. Arch Public Health 2024; 82:19. [PMID: 38317198 PMCID: PMC10845767 DOI: 10.1186/s13690-024-01246-z] [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: 09/13/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators. METHODS Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members. RESULTS At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network. CONCLUSIONS The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas.
Collapse
Affiliation(s)
- Stephan Voss
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany.
- Pettenkofer School of Public Health, Munich, Germany.
| | - Julia Bauer
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Caroline Jung-Sievers
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, Cardiff, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
| | - Eva Rehfuess
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Valerie Zu Rhein
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Michaela Coenen
- Chair of Public Health and Health Services Research, Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Elisabeth-Winterhalter-Weg 6, Munich, 81377, Germany
- Pettenkofer School of Public Health, Munich, Germany
| |
Collapse
|
7
|
Prieto L. Exploring the Influence of Social Class and Sex on Self-Reported Health: Insights from a Representative Population-Based Study. Life (Basel) 2024; 14:184. [PMID: 38398693 PMCID: PMC10890034 DOI: 10.3390/life14020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
This study investigates the intricate interplay between social class, sex, and self-reported health (SRH) using data from the European Health Survey of Spain 2020 (EESE2020). Employing a cross-sectional design and a representative sample of 22,072 individuals, the analysis explores the persistence of disparities after adjusting for covariates, focusing on health-related variables. The study employs logistic regression models and directed acyclic graphs (DAGs) to delineate the direct effects of social class and sex on SRH, identifying a minimum adjustment set to control for confounding variables. Results reveal a gradient effect of social class on SRH, emphasizing the enduring impact of socioeconomic factors. Sex-based disparities in SRH diminish after considering additional health-related variables, highlighting the importance of a holistic approach. DAGs serve as transparent tools in disentangling complex relationships, guiding the identification of essential covariates. The study concludes that addressing health inequalities requires comprehensive strategies considering both individual health behaviours and socio-economic contexts. While recognizing limitations, such as the cross-sectional design, the findings contribute to a nuanced understanding of health disparities, informing evidence-based interventions and policies for a more equitable healthcare system.
Collapse
Affiliation(s)
- Luis Prieto
- Distance Learning, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| |
Collapse
|
8
|
Banaschak H, Bartolini F, Salman R, Bethge M. Increasing the use of medical rehabilitation by children and adolescents with migrant background through a multimodal information campaign: protocol of a trend study and accompanying process evaluation (MiMi-Reha-Kids, DRKS00019090). Front Public Health 2023; 11:1089685. [PMID: 37522008 PMCID: PMC10379645 DOI: 10.3389/fpubh.2023.1089685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Background Chronic illnesses can have an unfavorable impact on the participation opportunities of children and adolescents. The German health care system offers medical rehabilitation in order to prevent negative effects, however, migrant children and adolescents make use of this option less frequently than their peers without a migrant background. A multimodal information campaign was developed to increase the use of medical rehabilitation by children and adolescents with a migrant background, and to reduce disparities in health care. Methods The process evaluation will examine the implementation of a multimodal information campaign intended to increase the use of medical rehabilitation by migrant children and adolescents. The information campaign follows a low-threshold participatory approach. In a first step, persons from different migrant communities in Berlin and Hamburg are trained to become transcultural health mediators. These mediators then share their knowledge about chronic illnesses and medical rehabilitation with other families at information events held in their native language. The transcultural mediators also support migrant families in applying for medical rehabilitation. The effectiveness of the intervention will be tested by a trend study with repeated cross-sectional surveys. For this purpose, all families in the project regions of Berlin and Hamburg whose child has received medical rehabilitation are surveyed annually in order to be able to map changes in the proportions of children and adolescents with a migrant background over the course of the project. Discussion The study protocol describes a complex intervention to increase the use of medical rehabilitation by migrant children and adolescents, and the accompanying process evaluation and trend study. The intervention is intended to contribute to reducing health inequalities in Germany. Conclusion The study described in this protocol will provide extensive data on the multimodal information campaign and can thus help organizations and institutions adapt or further develop similar measures for other regions. Clinical trial registration German Clinical Trials Register (DRKS00019090).
Collapse
Affiliation(s)
- Hannes Banaschak
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | | | - Matthias Bethge
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| |
Collapse
|
9
|
Birkholz L, Weber P, Helsper N, Kohler S, Dippon L, Rütten A, Pfeifer K, Semrau J. Multi-level stakeholders' perspectives on implementation and scaling up community-based health promotion in Germany. Health Promot Int 2023; 38:7151550. [PMID: 37140350 DOI: 10.1093/heapro/daad045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Community-based health promotion has the potential to address existing health inequities, although such approaches are scarcely scaled up. For a successful scale up, various stakeholders at different levels and sectors need to be involved. The article's aims are to assess what kind of external support communities need for implementation and to identify facilitators and barriers for scaling up community-based health promotion. Two national digital workshops were conducted in Germany with stakeholders at the community level (n = 161) and with stakeholders at the federal and state levels (n = 84). Protocols were compiled and coded using qualitative content analysis. During the first workshop, we revealed 11 themes for external support needs ('Strategic approach', 'Define & compare indicators', 'International human resource', 'Tools & Aids', 'External conduction of the assessment', 'Involvement of people in difficult life situations', 'Overview of actors', 'Moderation', 'Obtain funding', 'Quality assurance/evaluation' and 'External support'). Eleven facilitators and barriers were identified for scaling up ('Assessment and evaluation', 'Intersectoral collaboration and partnerships', 'Communication', 'Characteristics of the program', 'Political and legal conditions', 'Political support', 'Local coordinator', 'Resources', 'Participation', 'Strategic planning/methods' and 'Intermediary organization'). The identified results provide practice-based evidence on support needed for scaling up, facilitators that promote scaling up and barriers that might hinder scaling up community-based health promotion in Germany. In a next step, this practice-based evidence needs to be systematically integrated with scientific-based evidence on key components for scaling up such approaches for the development of an effective scaling-up concept.
Collapse
Affiliation(s)
- Leonie Birkholz
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Philipp Weber
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Natalie Helsper
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Simone Kohler
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Lea Dippon
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Alfred Rütten
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Klaus Pfeifer
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| | - Jana Semrau
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstr.123b, D-91058 Erlangen, Germany
| |
Collapse
|
10
|
Termansen T, Bloch P, Tørslev MK, Vardinghus-Nielsen H. Tingbjerg Changing Diabetes: experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighbourhood in Copenhagen, Denmark. BMC Public Health 2023; 23:392. [PMID: 36841764 PMCID: PMC9958318 DOI: 10.1186/s12889-023-15291-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/20/2023] [Indexed: 02/27/2023] Open
Abstract
As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study provides important insights on the role of context and how it contributes complexity in community-based health promotion.The study is based on 18 months of ethnographic fieldwork in the local community including participant observations and 9 in-depth interviews with key partner representatives. Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners' navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness. The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.
Collapse
Affiliation(s)
- Tina Termansen
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark. .,Department of Health Sciences and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark.
| | - Paul Bloch
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | - Mette Kirstine Tørslev
- Department of Health Promotion Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730, Herlev, Denmark
| | - Henrik Vardinghus-Nielsen
- Department of Health Sciences and Technology, Aalborg University, Selma Lagerløfs Vej 249, 9260, Gistrup, Denmark
| |
Collapse
|
11
|
Purwaningsih E, Nurmala I, Fatah MZ. Systematic review of health promotion policies or regulations with CCAT theory. J Public Health Res 2023; 12:22799036231153479. [PMID: 36779075 PMCID: PMC9912565 DOI: 10.1177/22799036231153479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
One of the five Ottawa Charter's means of action is the concept of "healthy public policy," which is an approach to health promotion that is integrated with public policy. This concept can be used as an approach/method in solving health problems at the broader policy level and involving all sectors comprehensively, not just health promotion at the community level and the partial health sector, so that public health problems can be resolved properly. We conducted a systematic review of health promotion policies or regulations using CCAT theory. The purpose of this study is to find the state of the art of research related to stakeholder synergy in online game addiction prevention policies in adolescents. References and literature for this systematic review were collected from the Proquest, ScienceDirect, Pubmed, and Google Scholar databases. The search uses the boolean phrases "OR" and "AND." Keywords: policy or regulation, health promotion, and community coalition action theory. The results of the systematic review conducted by the researchers showed that of the twenty selected articles, three articles used the coalition/partnership dimension from the CCAT theory, four articles used the stakeholder dimension, two articles used the collaboration dimension, five articles discussed school health policies, policies related to gaming disorders. One article on the analysis of the juvenile contraceptive law, one article on the prevention of mental health disorders, one article on health promotion interventions, and two articles on risk factors and self-regulation focus on online gaming addiction in adolescents. This study concludes that in the future, further research is needed regarding health promotion policies to prevent online game addiction in adolescents to develop specific policy recommendations related to preventing online game addiction in adolescents.
Collapse
Affiliation(s)
| | - Ira Nurmala
- Ira Nurmala, Department Epidemiology,
Population Biostatistics and Health Promotion, Universitas Airlangga, Jl. Dr.
Ir. H. Soekarno, Mulyorejo, Kec. Mulyorejo, Kota SBY, Surabaya, Jawa Timur
60115, Indonesia.
| | | |
Collapse
|
12
|
Trojan A, Lorentz C, Süß W, Nickel S. [Comparing Community Capacities by Local Actors and External Experts: An Audit of Health Promotion Activities in Lenzsiedlung, Hamburg]. DAS GESUNDHEITSWESEN 2023; 85:83-90. [PMID: 34560800 PMCID: PMC11248458 DOI: 10.1055/a-1532-1911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The questionnaire "Capacity building in Neighbourhoods (KEQ)" has five dimensions which are regarded as intermediary outcome results of community health promotion. The questionnaire was to be completed by local actors and thus has some features of self-evaluation. We wanted to find out whether external experts make similar or more critical assessments. METHODS We conducted an audit of the health promotion activities in our intervention area (Hamburg neighbourhood Lenzsiedlung) in two steps. Five external health promotion experts functioned as auditors with experience in evaluating good practice projects of health promotion. The first part of the audit was a document-based evaluation, the second part a visit-based one during a two-day stay in the intervention area. RESULTS In the comparison of local actors' assessments (KEQ questionnaire results) with those of external experts in the document-based audit, the judgements of external experts were more positive on all five dimensions of the questionnaire (deviations from +0.1 to +0.9 on a scale from 1 to 5). In the visit-based audit, there was convergence in the assessments of the local actors and the external experts. They were partly identical; only the dimension "local leadership" was viewed slightly more critically by the external experts. CONCLUSIONS Based on our discussion of the four methodical problems of the comparison, we conclude that, on the whole, local actors do not tend to evaluate their activities too positively. However, if resources are available, one should try to confirm local views of outcomes by external assessments.
Collapse
Affiliation(s)
- Alf Trojan
- Institut für Medizinische Soziologie,
Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| | - Christian Lorentz
- Institut für Medizinische Soziologie,
Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| | - Waldemar Süß
- Institut für Medizinische Soziologie,
Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| | - Stefan Nickel
- Institut für Medizinische Soziologie,
Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| |
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Voss S, Coenen M, Hummel J, Jung-Sievers C, Zu Rhein V, Rehfuess E. Einflussfaktoren beim Aufbau von Präventionsketten in Neubaugebieten am Beispiel des Münchner Stadtteils Freiham – eine qualitative Studie. PRA¨VENTION UND GESUNDHEITSFO¨RDERUNG 2022. [PMCID: PMC9744050 DOI: 10.1007/s11553-022-01001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Einleitung Präventionsketten sind integrierte kommunale Strategien zur Förderung von Gesundheit und sozialer Teilhabe von Kindern, Jugendlichen und Familien sowie zur Vermeidung der Folgen von Kinderarmut. Sie sind als intersektorale Netzwerke in mehreren Kommunen in Deutschland etabliert. Der Aufbau von Präventionsketten in Neubaugebieten wurde bislang noch nicht systematisch erforscht. Im Rahmen der Prozessevaluation zur Präventionskette Freiham, die in dem sich derzeit im Bau befindlichen gleichnamigen Münchner Stadtteil implementiert wird, wurde eine qualitative Interview- und Fokusgruppenstudie durchgeführt. Das Ziel war, relevante Einflussfaktoren für den Aufbau von Präventionsketten in einem neu entstehenden Stadtteil zu identifizieren. Methoden Für die Studie wurden wiederholt Interviews mit dem Netzwerkwerkmanagement der Präventionskette Freiham durchgeführt sowie eine Fokusgruppe mit Vertreter*innen der beteiligten städtischen Referate. Zudem fanden Interviews mit 12 lokalen Fachkräften aus den Sektoren Bildung, Soziales und Gesundheit statt. Die Auswertung erfolgte mit der Methode der qualitativen Inhaltsanalyse in Anlehnung an Mayring. Ergebnisse Wichtige Einflussfaktoren für eine gelingende Implementierung stellten aus Sicht der Teilnehmer*innen die Ausstattung mit finanziellen und personellen Ressourcen sowie die Unterstützung durch die kommunale Politik und Verwaltungsspitzen dar. Für eine erfolgreiche Arbeit im Netzwerk waren die zentrale Netzwerkkoordination, eine transparente Kommunikation, die Integration der unterschiedlichen Interessen der Akteur*innen und die Vermittlung eines Mehrwerts des Engagements entscheidend. Eine spezifische Herausforderung für das Setting eines Neubaugebiets war der Aufbau von bedarfs- und zielgruppenorientierten Netzwerkstrukturen angesichts einer zunächst geringen Anzahl an Bewohner*innen und noch nicht etablierter Unterstützungsstrukturen. Schlussfolgerung Ausreichende Finanzierung und Rückhalt in Politik und Verwaltung sind zentrale Einflussfaktoren für die Implementierung einer Präventionskette in Kommunen. Insbesondere in Neubaugebieten ohne gewachsene Infrastruktur erfordert der Aufbauprozess eine langfristig angelegte Unterstützung.
Collapse
Affiliation(s)
- Stephan Voss
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Deutschland ,Pettenkofer School of Public Health, München, Deutschland
| | - Michaela Coenen
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Deutschland ,Pettenkofer School of Public Health, München, Deutschland
| | - Julia Hummel
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Deutschland ,Pettenkofer School of Public Health, München, Deutschland
| | - Caroline Jung-Sievers
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Deutschland ,Pettenkofer School of Public Health, München, Deutschland
| | - Valerie Zu Rhein
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Deutschland ,Pettenkofer School of Public Health, München, Deutschland
| | - Eva Rehfuess
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie – IBE, Lehrstuhl für Public Health und Versorgungsforschung, Ludwig-Maximilians-Universität München, Elisabeth-Winterhalter-Weg 6, 81377 München, Deutschland ,Pettenkofer School of Public Health, München, Deutschland
| |
Collapse
|
15
|
Hickman AC, Johnson RL, Lawler SP. Health-promoting pedagogy: Using reflexivity to support learning and action in planetary health education. Health Promot J Austr 2022; 33 Suppl 1:22-26. [PMID: 35922693 PMCID: PMC9826018 DOI: 10.1002/hpja.648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023] Open
Abstract
ISSUE ADDRESSED International competencies for health promotion education require ethical practice that is supported by reflexive health promotion practitioners, yet professional bodies do not codify how health promotion curriculum should support students' skill development in reflexive practice. METHODS Reflexivity in teaching and learning was scaffolded through short, progressive reflective blogs assessments, supportive feedback/feedforward mechanisms, and nested assessment design. RESULTS Student feedback is offered to demonstrate the impact of reflexive pedagogy in health promotion education. CONCLUSION Reflexivity in teaching and learning supports students in learning the role of health promotion in planetary health and developing skills in planetary health advocacy. SO WHAT Explicitly teaching the practice and process of critical reflexivity can help students develop personal insight, support professional practice, and promote positive change in the health of people and our planet.
Collapse
|
16
|
Kadel R, Allen J, Darlington O, Masters R, Collins B, Charles JM, Asaria M, Dyakova M, Bellis M, Cookson R. Cost of health inequality to the NHS in Wales. Front Public Health 2022; 10:959283. [PMID: 36187677 PMCID: PMC9523137 DOI: 10.3389/fpubh.2022.959283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023] Open
Abstract
Background Forty years from the seminal work of Welsh GP Julian Tudor Hart on the Inverse Care Law, inequalities in health and healthcare remain deeply embedded in Wales. There is a wider gap (over 17 years) in healthy life expectancy between people living in the most and least deprived neighborhoods in Wales. This health inequality is reflected in additional healthcare use. In this study we estimate the cost of inequality associated with this additional healthcare use to the publicly funded National Health Service (NHS) in Wales. Methods We retrieved administrative data on all NHS inpatient admissions, outpatient and accident and emergency attendances in Wales between April 2018 and March 2019 from Digital Health and Care Wales (DHCW). Hospital service use data were translated to costs using Healthcare Resource Group (HRG) and health service specific unit cost data and linked with area level mid-year population and deprivation indices in order to calculate the healthcare costs associated with socioeconomics deprivation. Results Inequality in healthcare use between people from more and less deprived neighborhoods was associated with an additional cost of £322 million per year to the NHS in Wales, accounting for 8.7% of total NHS hospital expenditure in the country. Emergency inpatient admissions made up by far the largest component of this additional cost contributing £247.4 million, 77% of the total. There are also substantial costs of inequality for A&E attendances and outpatient visits, though not maternity services. Elective admissions overall have a negative cost of inequality, since among men aged 50-75 and women aged 60-70, elective utilization is actually negatively associated with deprivation. Conclusion There are wide inequalities in health and healthcare use between people living in more deprived neighborhoods and those living in less deprived neighborhoods in Wales. Tackling health inequality through a combination of health promotion and early intervention policies targeted toward deprived communities could yield substantial improvement in health and wellbeing, as well as savings for the Welsh NHS through reduced use of emergency hospital care.
Collapse
Affiliation(s)
- Rajendra Kadel
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom,*Correspondence: Rajendra Kadel
| | - James Allen
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Oliver Darlington
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Rebecca Masters
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Brendan Collins
- Health and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United Kingdom
| | - Joanna M. Charles
- Health and Social Services Group, Finance Directorate, Welsh Government, Cardiff, United Kingdom
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Mariana Dyakova
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Mark Bellis
- WHO CC on Investment for Health and Wellbeing, Public Health Wales, Cardiff, United Kingdom
| | - Richard Cookson
- Centre for Health Economics, University of York, York, United Kingdom
| |
Collapse
|
17
|
Weber P, Birkholz L, Kohler S, Helsper N, Dippon L, Ruetten A, Pfeifer K, Semrau J. Development of a Framework for Scaling Up Community-Based Health Promotion: A Best Fit Framework Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084773. [PMID: 35457644 PMCID: PMC9032469 DOI: 10.3390/ijerph19084773] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/28/2022] [Accepted: 04/11/2022] [Indexed: 11/20/2022]
Abstract
Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this qualitative review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion. First, we conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework. From 80 articles, a total of 12 frameworks were eligible, and 5 were included for data extraction. The analysis yielded 10 a priori defined key components: “innovation characteristics”; “clarify and coordinate roles and responsibilities”; “build up skills, knowledge, and capacity”; “mobilize and sustain resources”; “initiate and maintain regular communication”; “plan, conduct, and apply assessment, monitoring, and evaluation”; “develop political commitment and advocacy”; “build and foster collaboration”; “encourage participation and ownership”; and “plan and follow strategic approaches”. We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework. We further identified “encourage participation and ownership” as a crucial component regarding health equity.
Collapse
|
18
|
Forde K, Costello L, Devine A, Sambell R, Wallace R. A multifaceted approach increased staff confidence to develop outside of school hours care as a health promoting setting. BMC Public Health 2021; 21:2286. [PMID: 34911511 PMCID: PMC8672543 DOI: 10.1186/s12889-021-12360-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Outside-of-school-hours-care (OSHC) services are well positioned to influence the health behaviours of 489, 800 Australian children, and are an important setting for health promotion given the current rates of childhood overweight and obesity and associated health risks. OSHC Professionals are ideally placed to become positive influencers in this setting, although they may require training and support to confidently perform this role. This study piloted a multifaceted intervention strategy to increase OSHC Professional's confidence and competencies, to support a health promoting OSHC environment with a nutrition and physical activity focus. METHODS A mixed methods approach was used. Nineteen OSHC Professionals participated in the study, including a face-to-face workshop, supported by a closed Facebook group and website. Role adequacy (self-confidence) and legitimacy (professional responsibility) were measured pre and post workshop and evaluated using non-parametric statistics. Facebook interactions were monitored, and four participants undertook qualitative exit interviews to discuss their experiences with the intervention. RESULTS Pre-workshop 68% of participants had not received any OSHC-specific health promotion training. Post-workshop significant improvements in confidence about menu planning, accessing nutrition information, activities and recipes was observed (P < 0.05 for all). A significant improvement was observed in role support and role related training (P < 0.05). A high level of support and interaction was observed between participants on Facebook and the website was reported a useful repository of information. CONCLUSIONS Health promotion training, combined with positive social connections, shared learning experiences, and a website improved OSHC Professionals confidence and capacity to provide a health promoting OSHC environment. Health promotion professional development for OSHC professionals should be mandated as a minimum requirement, and such learning opportunities should be scaffolded with support available through social media interactions and website access.
Collapse
Affiliation(s)
- Karen Forde
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
- Telethon Kids Institute, Nedlands, Australia
| | - Leesa Costello
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
| | - Amanda Devine
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
| | - Ros Sambell
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia
| | - Ruth Wallace
- School of Medical & Health Science, Edith Cowan University, Joondalup, Australia.
| |
Collapse
|
19
|
Audiger C, Bovagnet T, Deghaye M, Kaufmanis A, Pelisson C, Bochaton A, Menvielle G. Factors associated with participation in the organized cervical cancer screening program in the greater Paris area (France): An analysis among more than 200,000 women. Prev Med 2021; 153:106831. [PMID: 34624389 DOI: 10.1016/j.ypmed.2021.106831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
We aimed to identify the contextual factors associated with participation in the organized Cervical Cancer Screening (CCS) pilot program, which includes specific interventions to reach vulnerable women, in the Greater Paris region. Study population consisted of 231,712 women aged 25-65 years, who were not up to date to their smear test and had been invited to take part in the program from July 2014 to September 2017. Using a multilevel mixed logistic regression with random effects, we investigated the effect of grassroots interventions targeting vulnerable women, healthcare provider accessibility, social environment and municipal policy-related factors. The CCS rate was two times higher in women who had received their first invitation to the program during the study period (32·9%) compared to those who were already invited before the study period (15·3%). In both populations, there were no significant trends in participation with regards to the type of grassroots interventions, level of accessibility of healthcare services or municipal commitment to healthcare. Among women invited previously and aged above 35 increased participation was seen in neighborhoods with low proportion of single women or in less deprived neighborhoods. Our results identified groups of women who participated less in the organized CCS program and suggested that additional interventions targeting the barriers faced by vulnerable women, especially those aged 35-45 years old, are needed.
Collapse
Affiliation(s)
- Céline Audiger
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 27 rue Chaligny, F75012 Paris, France; Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France.
| | - Thomas Bovagnet
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 27 rue Chaligny, F75012 Paris, France
| | - Michel Deghaye
- Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France
| | - Aldis Kaufmanis
- Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France
| | - Caroline Pelisson
- Le Centre Régional de Coordination des Dépistages des Cancers- CRCDC-Région Ile de France, 8 place Adolphe Cherioux, 75015 Paris, France
| | - Audrey Bochaton
- Université Paris Nanterre, UMR CNRS 7533 LADYSS, 200 Avenue de la République, 92000 Nanterre, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), 27 rue Chaligny, F75012 Paris, France
| |
Collapse
|
20
|
Röding D, Walter U, Dreier M. Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data. J Urban Health 2021; 98:791-800. [PMID: 34799821 PMCID: PMC8688653 DOI: 10.1007/s11524-021-00590-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/28/2022]
Abstract
Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998-2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = - 2.48 (95% CI - 3.45 to - 1.51) for IG vs. CG and b = - 0.30 (95% CI - 0.46 to - 0.14) for ISCHP duration (0-16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.
Collapse
Affiliation(s)
- Dominik Röding
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
| | - Ulla Walter
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| | - Maren Dreier
- Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg Str. 1, 30625, Hannover, Germany
| |
Collapse
|
21
|
Bucher Della Torre S, Fabbi S, Carrard I. Healthy Snacks in School: How Do Regulations Work? A Mixed-Design Study. THE JOURNAL OF SCHOOL HEALTH 2021; 91:697-705. [PMID: 34240432 DOI: 10.1111/josh.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND School is an important setting to promote healthy eating habits for children. We compared the effects of 4 conditions on the nutritional quality of snacks brought to school. We also investigated teachers' opinions regarding the process, barriers, and facilitators in regulation implementation. METHODS We compared the nutritional quality of morning snacks based on 1958 photographs from schools divided into 4 conditions: regulation based on a list of permitted foods and beverages; regulation banning sweets, chips, and sugary drinks; information without regulation; or no intervention. Based on 5 focus groups (N = 18 participants), we investigated factors influencing regulation implementation. RESULTS In schools with a list of permitted foods and beverages, 76% of the children had a healthy snack, compared to 52% to 54% in the 3 other conditions (p < .01). They also brought less sweet foods compared to those in the other conditions (41% vs. 68% to 71%, p < .01). In focus groups, most teachers supported regulation but also expressed ambivalence about their legitimacy. CONCLUSIONS In this study, a regulation based on a list of permitted foods and beverages showed the best results. All actors should be involved in a progressive implementation process to increase acceptance of such regulation.
Collapse
Affiliation(s)
- Sophie Bucher Della Torre
- Assistant Professor UAS, Department of Nutrition and Dietetics, , Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, Carouge, CH-1227, Switzerland
| | - Sidonie Fabbi
- Lecturer UAS, , Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, CH-1227 Carouge, Switzerland; Dietitian, School Health Service, Department of Public Instruction, 11 Glacis de Rive, CH-1211, Genève, Switzerland
| | - Isabelle Carrard
- Associate Professor UAS, Department of Nutrition and Dietetics, , Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, CH-1227, Carouge, Switzerland
| |
Collapse
|
22
|
Laura T, Deborah C, Rona C. Community mobilisation approaches to preventing and reducing adolescent multiple risk behaviour: a realist review protocol. Syst Rev 2021; 10:147. [PMID: 33980307 PMCID: PMC8117311 DOI: 10.1186/s13643-021-01696-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/30/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Adolescent multiple risk behaviour (MRB) continues to be a global health issue. Most interventions have focused on the proximal causes of adolescent MRB such as peer or family influence, rather than targeting the wider environmental or structural context. There is increasing recognition that community mobilisation approaches could be beneficial for adolescent health. Despite this, there are gaps in the current literature, theory and implementation that would benefit from a realist approach due to the suitability of this methodology to analysing complex interventions. The objective of this study is to understand 'how, why, for whom and in what circumstances and time periods' do community mobilisation interventions work to prevent and/or reduce adolescent multiple risk behaviour. METHODS This is a protocol for a realist review. The review will use a six-stage iterative process, guided by the RAMESES framework. We will systematically search PubMed, MEDLINE, PsycINFO, Web of Science, CINAHL and Sociological Abstracts, from their inception to 2021. Studies will be screened for relevance to the programme theory and included based on a priori eligibility criteria including (1) reporting a community mobilisation intervention (2) targeting two health risk behaviors (3) for adolescent populations. Two independent reviewers will select, screen and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome configurations that contribute to our programme theory. The findings will be synthesised to produce a refined programme theory model. DISCUSSION The goal of this realist review is to identify and refine a programme theory for community mobilisation approaches to the prevention and/or reduction of adolescent multiple risk behaviour. Our aim is that the findings surrounding the programme theory refinement can be used to develop and implement adolescent multiple risk behaviour interventions and maintain collaboration between local policy makers, researchers and community members. SYSTEMATIC REVIEW REGISTRATION This realist review is registered on the PROSPERO database (registration number: CRD42020205342).
Collapse
Affiliation(s)
- Tinner Laura
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL UK
| | - Caldwell Deborah
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL UK
| | - Campbell Rona
- Population Health Sciences, Bristol Medical School, Canynge Hall, University of Bristol, Bristol, BS8 2PL UK
| |
Collapse
|
23
|
Schneiderman JU, Olshansky EF. Nurses' perceptions: Addressing social determinants of health to improve patient outcomes. Nurs Forum 2021; 56:313-321. [PMID: 33484172 DOI: 10.1111/nuf.12549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/27/2020] [Accepted: 01/03/2021] [Indexed: 01/13/2023]
Abstract
Nursing organizations and leaders adopted the social determinants of health (SDOH) as essential to the delivery of health care, but little is known about working registered nurses' (hereafter nurses) views on the SDOH. The purpose of this study was to (1) explore nurses' perceptions of how SDOH affect patient care and (2) describe nurses' ideas about how SDOH can be addressed to improve outcomes and services. Thirteen registered nurses with a baccalaureate in nursing beginning their online graduate advanced practice educational program were interviewed. This qualitative descriptive study used constant comparative analysis for data analysis. The analysis found two major themes: (1) SDOH are integrated into the nurses' care. The SDOH experienced by patients challenges the nurses to provide care at the patient's level and to provide usable patient education, and (2) health-care delivery change is needed to achieve equity and to provide health care to those in need. The nurses recommended more organized, seamless health-care delivery and interdisciplinary advocacy to achieve these needed changes. Nurse educators and nurse leaders can harness the frustration and ingenuity of nurses to help the nurses advocate for health-care change that integrates the SDOH.
Collapse
Affiliation(s)
- Janet U Schneiderman
- Nursing Department, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Ellen F Olshansky
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| |
Collapse
|