Mental health system development in Asia: does Australia have a role?

BACKGROUND: Socioeconomic trends herald what many describe as the Asian Century, whereby Asian economic, political and cultural influence is in global ascendency. Broadening relevant ties between Australia and Asia is evident and logical and may include strengthening alliances in mental health systems. AIM: We argue the importance of strengthening Asian mental health systems and some of the roles Australian mental health workers could have in promoting strengthening the Asian mental health system. METHODS: This paper is a narrative review which sources data from reputable search databases. RESULTS: A well-articulated Australian strategy to support strengthening the mental health system in Asia is lacking. While there are active initiatives operating in this space, these remain fragmented and underdeveloped. Coordinated, collaborative and culturally respectful efforts to enhance health education, research, policy, leadership and development assistance are key opportunities. CONCLUSION: Psychiatrists and other mental health professionals have a unique opportunity to contribute to improved mental health outcomes in Asia.

Not just a fisherman's wife : women's contribution to health and wellbeing in commercial fishing

OBJECTIVE: To explore the role of women in fishing industry organisations and communities in promoting best-practice health behaviours among fishers in Australia. DESIGN: This paper reports aspects of research that examined how the fishing industry can best support physical health and mental well-being of fishers. The study employed a mixed-methods, multisite case study approach. Data were gathered from face-to-face and phone interactions. SETTING: Two sites in Victoria and one in Western Australia. PARTICIPANTS: Thirty-one male fishers, including commercial licence owners, skippers, deckhands, three female family members, three fishing association representatives, one local government representative, two health care providers, and three regional health planning and funding bodies. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: Often unrecognised, women associated with the fishing industry are integral to the promotion of good health for fishers. They are key to identifying health issues (particularly mental health issues) and proposing community-based health and well-being strategies. They often do so by incorporating health information and activities into 'soft entry points' - informal, non-health service mechanisms by which fishers can access health information and health services. CONCLUSIONS: While not working at the industry coalface, women have a stake, and are key players, in the commercial fishing industry. Their knowledge of, and credibility within, fishing enterprises makes them valuable sources of information about health issues facing the industry and effective strategies to address them. This expertise should be applied in conjunction with industry associations and health providers to achieve better health outcomes for fishers and their families.

Health literacy and the determinants of obesity: a population-based survey of sixth grade school children in Taiwan

BACKGROUND: Health literacy has become an important health policy and health promotion agenda item in recent years. It had been seen as a means to reduce health disparities and a critical empowerment strategy to increase people's control over their health. So far, most of health literacy studies mainly focus on adults with few studies investigating associations between child health literacy and health status. This study aimed to investigate the association between health literacy and body weight in Taiwan's sixth grade school children.

METHODS: Using a population-based survey, 162,209 sixth grade (11-12 years old) school children were assessed. The response rate at school level was 83%, with 70% of all students completing the survey. The Taiwan child health literacy assessment tool was applied and information on sex, ethnicity, self-reported health, and health behaviors were also collected. BMI was used to classify the children as underweight, normal, overweight, or obese. A multinomial logit model with robust estimation was used to explore associations between health literacy and the body weight with an adjustment for covariates.

RESULTS: The sample consisted of 48.9% girls, 3.8% were indigenous and the mean BMI was 19.55 (SD = 3.93). About 6% of children self-reported bad or very bad health. The mean child health literacy score was 24.03 (SD = 6.12, scale range from 0 to 32). The overall proportion of obese children was 15.2%. Children in the highest health literacy quartile were less likely to be obese (12.4%) compared with the lowest quartile (17.4%). After controlling for gender, ethnicity, self-rated health, and health behaviors, children with higher health literacy were less likely to be obese (Relative Risk Ratio (RRR) = 0.94, p < 0.001) and underweight (RRR = 0.83, p < 0.001). Those who did not have regular physical activity, or had sugar-sweetened beverage intake (RRR > 1.10, p < 0.0001) were more likely to report being overweight or obese.

CONCLUSIONS: This study demonstrates strong links between health literacy and obesity, even after adjusting for key potential confounders, and provides new insights into potential intervention points in school education for obesity prevention. Systematic approaches to integrating a health literacy curriculum into schools may mitigate the growing burden of disease due to obesity.

A school-based intervention incorporating smartphone technology to improve health-related fitness among adolescents : rationale and study protocol for the NEAT and ATLAS 2.0 cluster randomised controlled trial and dissemination study

INTRODUCTION: Physical inactivity has been described as a global pandemic. Interventions aimed at developing skills in lifelong physical activities may provide the foundation for an active lifestyle into adulthood. In general, school-based physical activity interventions targeting adolescents have produced modest results and few have been designed to be 'scaled-up' and disseminated. This study aims to: (1) assess the effectiveness of two physical activity promotion programmes (ie, NEAT and ATLAS) that have been modified for scalability; and (2) evaluate the dissemination of these programmes throughout government funded secondary schools. METHODS AND ANALYSIS: The study will be conducted in two phases. In the first phase (cluster randomised controlled trial), 16 schools will be randomly allocated to the intervention or a usual care control condition. In the second phase, the Reach, Effectiveness, Adoption, Implementation and Maintenance (Re-AIM) framework will be used to guide the design and evaluation of programme dissemination throughout New South Wales (NSW), Australia. In both phases, teachers will be trained to deliver the NEAT and ATLAS programmes, which will include: (1) interactive student seminars; (2) structured physical activity programmes; (3) lunch-time fitness sessions; and (4) web-based smartphone apps. In the cluster RCT, study outcomes will be assessed at baseline, 6 months (primary end point) and 12-months. Muscular fitness will be the primary outcome and secondary outcomes will include: objectively measured body composition, cardiorespiratory fitness, flexibility, resistance training skill competency, physical activity, self-reported recreational screen-time, sleep, sugar-sweetened beverage and junk food snack consumption, self-esteem and well-being.

The potential contribution of intermediary organizations for implementation of school mental health

Questions persist regarding implementation of mental health promotion, prevention, and early intervention initiatives in schools. To date, attention has targeted the ‘Whats’ and ‘Hows’ in design and implementation. Ongoing clarification of ‘Who’ the key proponents are working in this space receives less consideration. This paper presents outcomes from a national colloquium involving leaders from organizations committed to school-based mental health practice in Australia. The aim of the colloquium was to introduce the concept of Intermediary Organizations (IOs) examining this for its potential contribution to improved mental health and school improvement. The central challenge for IOs is implementation, that is, assisting in knowledge mobilization connecting research to policy and practice. The colloquium discussion was grounded in an understanding of public value as an organizing principle for improving public sector effectiveness. The participants evaluated the nature, role, and potential contribution of IOs. Three key issues emerged as being central to effective implementation: health promotion and prevention, relational ethics, and evidence-based practice.

A multiple case history and systematic review of adoption, diffusion, implementation and impact of provincial daily physical activity policies in Canadian schools

BACKGROUND : Few children meet physical activity (PA) recommendations, and are therefore at increased risk for overweight/obesity and adverse health outcomes. To increase children's opportunities for PA, several Canadian provinces have adopted school-based daily PA (DPA) policies. It is not clear why some jurisdictions have adopted DPA policies, and others have not, nor whether these policies have been implemented and have achieved their intended outcomes. The purpose of this study was to understand the processes underlying adoption and diffusion of Canadian DPA policies, and to review evidence regarding their implementation and impact.

METHODS: We adopted a multiple case history methodology in which we traced the chronological trajectory of DPA policies among Canadian provinces by compiling timelines detailing key historical events that preceded policy adoption. Publicly available documents posted on the internet were reviewed to characterize adopter innovativeness, describe the content of their DPA policies, and explore the context surrounding policy adoption. Diffusion of Innovations theory provided a conceptual framework for the analyses. A systematic literature search identified studies that had investigated adoption, diffusion, implementation or impact of Canadian DPA policies.

RESULTS: Five of Canada's 13 provinces and territories (38.5%) have DPA policies. Although the underlying objectives of the policies are similar, there are clear differences among them and in their various policy trajectories. Adoption and diffusion of DPA policies were structured by the characteristics and capacities of adopters, the nature of their policies, and contextual factors. Limited data suggests implementation of DPA policies was moderate but inconsistent and that Canadian DPA policies have had little to no impact on school-aged children's PA levels or BMI.

CONCLUSIONS: This study detailed the history and current status of Canadian DPA policies, highlighting the conditional nature of policy adoption and diffusion, and describing policy and adopter characteristics and political contexts that shaped policy trajectories. An understanding of the conditions associated with successful policy adoption and diffusion can help identify receptive contexts in which to pioneer novel legislative initiatives to increase PA among children. By reviewing evidence regarding policy implementation and impact, this study can also inform amendments to existing, and development of future PA policies.

Health inclusive education

When considering the relevance of contemporary learning theories to health education and promotion work in schools, it is necessary to inspect the kinds of discourses used therein for how they understand and thereby constitute people and their worlds. For instance, contemporary educational practices, teaching and learning included, are dominated by constructivist theory and its person-in-the world purview. It follows that from these discourses potentials for inclusion (and exclusion) emanate helping to constitute the very form and nature of our schools. This paper contributes to an ongoing explication of existing and persisting discursive conditions in the cultural politics of education focussing on how these inform teaching and learning in health education. By critically examining the purposes of contemporary educational practice and the theoretical precepts which support its activities, we move closer to being able to realise the possibilities of a refocussed kind of work. Such practice is dedicated to engaging meaning as it is applied by those in the living of their daily lives and accordingly decentres teaching and learning to enable health inclusive education.

Critical psychologies for critical health literacies

Health education is largely informed by psychological theories and practices that pursue reductionist views of people learning. However, critical attention is moving to understand health in ways that reconsider relationships to context and the forms of life within which everyday living takes place. This shift is apparent in theoretical developments from health literacy to critical health literacies. The discussion herein presents an introduction to critical health literacies focusing on potential contributions critically oriented psychologies offer this work. Research is introduced from critical health psychology, critical educational psychology and critical community psychology to engage psychological phenomena as jointly constituted via embodied, discursive and relational means. Subsequently, it is argued, by re-evaluating understanding in this way, a prospective kind of psychosocial theory is elucidated capable of promoting and sustaining health inclusive education.

Promoting critical thinking to high school students when teaching about climate change through a participatory approach

New paradigms in science education are focused on moving towards a sustainable society, meaning redefining the educational practices and developing new methods in order to establish better relationships among individuals, groups, and the society. Being able to reflect upon developing new pedagogic strategies, that support collective action, is crucial to favour social change. Education in the twenty-first century should be based on critical and social theories of the environment and development, in order to link the prospects for sustainability to new forms of economy, social welfare, governance and education (Barraza et al., Environ Educ Res 9(3):347-357, 2003). The nature of contemporary knowledge and knowledge construction demands increasing collaboration and communication between once isolated disciplines. Curriculum integration can reduce curriculum fragmentation, promoting a better awareness of the way different forms of knowledge work and contribute to collaborative knowledge construction, stimulating a critical and a reflexive perspective in their learners. This chapter will focus on the pedagogic strategies used in a research project aiming to provide potential young scientists from rural communities of Mexico and Alaska with a unique opportunity to learn more about their own local knowledge whilst gaining a better understanding of how it intersects with global processes. The project has helped students make cognitive links between their scientific knowledge and life experience, and has established affective and behavioral links which have intensified the ways in which they value their environment, culture, traditions and communities (Tytler et al. 2010; Bodenhorn, Learning about environmental research in a context of climate change: an international scholastic interchange (pilot project). Final report. BASC (Barrow Arctic Science Consortium)). The conjunction of collaborative, interdisciplinary work and multiple pedagogic strategies applied in this specific educational practice has shown the potential of implementing research group initiatives in science education. We believe that educational approaches that create spaces for students to work together towards a goal defined as a common good, can contribute significantly to develop effective science programs in schools.

Women’s health Goulburn North East community crime prevention plan – regional preventing violence against women and children strategy: summative evaluation report from the external evaluator, February 2016

This report presents the external evaluation of the Hume Regional Preventing Violence Against Women Strategy. This is one of 12 projects funded by the Department of Justice and Regulation in Victoria under its initiative to support primary prevention and early intervention-focused partnership projects that seek to prevent violence before it occurs or address the key contributing factors of violence against women and their children. The focus is on changing behaviours and attitudes that allow violence against women and children to continue. The lead agency in the project was Women’s Health Goulburn North East (WHGNE).The Hume regional strategy The focus of the project was to develop and implement a coordinated regional strategy that addresses the determinants of violence against women and builds the capacity of communities to take action to prevent such violence. At the outset it was envisaged that a key component of the strategy would be to undertake preventive activities that respond to identified gaps in the region.The first version of the strategy was completed in September 2013 and formally launched in November 2013. In October 2013, Courageous Conversations was identified as the brand to be used for activities in the strategy, including a charter and other resources. As the project evolved, the strategy was revised to reflect differing levels of engagement and progress with the different parts of the work and to identity explicitly the activities associated with the brand. A revised version of the regional strategy was produced in September 2014, with four aims:• promoting equal and respectful relationships between men and women;• working across local government, workplaces and sporting settings to coordinate a region-wide approach to preventing violence against women;• bringing about structural and systemic organisational change to promote gender equitable and non-violent cultures;• build the capacity of leaders in preventing violence against women.Different components of the activities carried out under the strategy included: partnership and capacity building; building gender equity in organisations; gender equity and masculinities training; bystander training; knowledge dissemination and the Courageous Conversations website.