A pilot program of physical activity promotion among clients receiving home and community care

Three Victorian local governments cooperated in a pilot study of physical activity promotion as part of home and community care (HACC) service delivery. Thirty-one people receiving HACC volunteered to participate, including completing the Transtheoretical Stages of Change Exercise Questionnaire and the short-form Stanford Health Assessment Questionnaire (HAQ) just before and at 3 months and 6 months after starting regular self-selected physical activity. Twenty-one participants returned questionnaires at 3 months, and 17 participants returned questionnaires at 6 months. Data were analysed using paired t tests and effect sizes were calculated as mean differences. At 3 months, mean improvements were identified on 6 of the 8 HAQDI (disability index) subscales, and in the overall HAQ-DI score. Improvement in dressing and grooming was preserved at 6 months. At either 3 or 6 months, improvements in dressing and grooming, reach, hygiene, and daily activities, and overall HAQ-DI score exceeded the minimum clinically important difference. No improvements were statistically significant, as is likely in a pilot study with a small sample, however, these results suggest that even very small increases in physical activity may afford clinically meaningful improvements in some areas of physical function required for independent living.

Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia

OBJECTIVES: The Teeth Tales trial aimed to establish a model for child oral health promotion for culturally diverse communities in Australia. DESIGN: An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from migrant backgrounds. Mixed method, longitudinal evaluation. SETTING: The intervention was based in Moreland, a culturally diverse locality in Melbourne, Australia. PARTICIPANTS: Families with 1-4-year-old children, self-identified as being from Iraqi, Lebanese or Pakistani backgrounds residing in Melbourne. Participants residing close to the intervention site were allocated to intervention. INTERVENTION: The intervention was conducted over 5 months and comprised community oral health education sessions led by peer educators and follow-up health messages. OUTCOME MEASURES: This paper reports on the intervention impacts, process evaluation and descriptive analysis of health, knowledge and behavioural changes 18 months after baseline data collection. RESULTS: Significant differences in the Debris Index (OR=0.44 (0.22 to 0.88)) and the Modified Gingival Index (OR=0.34 (0.19 to 0.61)) indicated increased tooth brushing and/or improved toothbrushing technique in the intervention group. An increased proportion of intervention parents, compared to those in the comparison group reported that they had been shown how to brush their child's teeth (OR=2.65 (1.49 to 4.69)). Process evaluation results highlighted the problems with recruitment and retention of the study sample (275 complete case families). The child dental screening encouraged involvement in the study, as did linking attendance with other community/cultural activities. CONCLUSIONS: The Teeth Tales intervention was promising in terms of improving oral hygiene and parent knowledge of tooth brushing technique. Adaptations to delivery of the intervention are required to increase uptake and likely impact. A future cluster randomised controlled trial would provide strongest evidence of effectiveness if appropriate to the community, cultural and economic context. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12611000532909).

The role of workplace health promotion in addressing job stress

The enormous human and economic costs associated with occupational stress suggest that initiatives designed to prevent and/or reduce employee stress should be high on the agenda of workplace health promotion (WHP) programmes. Although employee stress is often the target of WHP, reviews of job stress interventions suggest that the common approach to combating job stress is to focus on the individual without due consideration of the direct impacts of working conditions on health as well as the effects of working conditions on employees' ability to adopt and sustain ‘healthy’ behaviours. The purpose of the first part of this paper is to highlight the criticisms of the individual approach to job stress and to examine the evidence for developing strategies that combine both individual and organizational-directed interventions (referred to as the comprehensive approach). There is a risk that WHP practitioners may lose sight of the role that they can play in developing and implementing the comprehensive approach, particularly in countries where occupational health and safety authorities are placing much more emphasis on identifying and addressing organizational sources of job stress. The aim of the second part of this paper is therefore to provide a detailed description of what the comprehensive approach to stress prevention/reduction looks like in practice and to examine the means by which WHP can help develop initiatives that address both the sources and the symptoms of job stress.

Attaching unit costs to Australia`s national survey of mental health and wellbeing

Background: In mental health, policy-makers and planners are increasingly being asked to set priorities. This means that health economists, health services researchers and clinical investigators are being called upon to work together to define and measure costs. Typically, these researchers take available service utilisation data and convert them to costs, using a range of assumptions. There are inefficiencies, as individual groups of researchers frequently repeat essentially similar exercises in achieving this end. There are clearly areas where shared or common investment in the development of statistical software syntax, analytical frameworks and other resources could maximise the use of data.

Aims of the Study: This paper reports on an Australian project in which we calculated unit costs for mental health admissions and community encounters. In reporting on these calculations, our purpose is to make the data and the resources associated with them publicly available to researchers interested in conducting economic analyses, and allow them to copy, distribute and modify them, providing that all copies and modifications are available under the same terms and conditions (i.e., in accordance with the `Copyleft' principle). Within this context, the objectives of the paper are to: (i) introduce the `Copyleft' principle; (ii) provide an overview of the methodology we employed to derive the unit costs; (iii) present the unit costs themselves; and (iv) examine the total and mean costs for a range of single and comorbid conditions, as an example of the kind of question that the unit cost data can be used to address.

Method: We took relevant data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), and developed a set of unit costs for inpatient and community encounters. We then examined total and mean costs for a range of single and comorbid conditions.

Results: We present the unit costs for mental health admissions and mental health community contacts. Our example, which explored the association between comorbidity and total and mean costs, suggested that comorbidly occurring conditions cost more than conditions which occur on their own.

Discussion: Our unit costs, and the materials associated with them, have been published in a freely available form governed by a provision termed `Copyleft'. They provide a valuable resource for researchers wanting to explore economic questions in mental health.

Implications for Health Policies: Our unit costs provide an important resource to inform economic debate in mental health in Australia, particularly in the area of priority-setting. In the past, such debate has largely been based on opinion. Our unit costs provide the underpinning to strengthen the evidence-base of this debate.

Implications for Further Research: We would encourage other Australian researchers to make use of our unit costs in order to foster comparability across studies. We would also encourage Australian and international researchers to adopt the `Copyleft' principle in equivalent circumstances. Furthermore, we suggest that the provision of `Copyleft'-contingent funding to support the development of enabling resources for researchers should be considered in the planning of future large-scale collaborative survey work, both in Australia and overseas.

`This was a great project!`: reflections on a `successful` mental health promotion project in a remote Indigenous school

Issue addressed: The complexities encountered in an Indigenous community when a white project support team assisted a school (Bwgcolman on Palm Island, Queensland) to implement MindMatters, a centralised, national project aiming to promote the psychosocial health of young Australians through the development of a comprehensive, school- based mental health promotion program. Approach: The MindMatters consortium offered pilot schools curriculum materials, professional development for staff, funding and ongoing support at a local level in return for their participation in the project. The support team flew to the island on two occasions to provide support. Conclusion: Whether or not MindMatters constituted a community project at Bwgcolman is debatable. Nevertheless, the project at Bwgcolman was considered a 'success' by key players since initial aims identified by the school were tangible (eg, professional development, curriculum development) and met in a way that the school could take ownership of. Additionally, behavioural management policy was implemented in a manner that was cognisant of a history of coercive relations with Indigenous communities. So what?: It is important in the telling of the success story at Bwgcolman that even though MindMatters endeavoured to be culturally sensitive, it was nevertheless a centralist mental health promotion program. Future mental health promotion initiatives need to be aware that the approach of the support team in attempting to hand back some community control at the local level may have played a role in the school succeeding.

Program, agency and effect sustainability in health promotion

ISSUE ADDRESSED: Achieving sustainability is often considered a key objective of health promotion efforts despite a lack of consensus as to what sustainability is.

MATERIAL: A review of the international health promotion literature was conducted to identify understandings of sustainability in health promotion.

RESULTS:Three distinct understandings of sustainability in respect of programs, health promotion agencies and program effects were identified.

CONCLUSIONS: Despite a strong emphasis on program sustainability in the health promotion field, clear criteria for why programs should be continued is required rather than assuming that it is the best option. Arguably more important than the maintenance of either programs or the agencies which support them is the ability to produce sustainable program effects.

Core health promotion competencies in Australia : are they compatible with climate change action?

Issues addressed: Health promotion principles for practice are closely aligned with that of environmental sustainability. Health promotion practitioners are well positioned to take action on climate change. However, there has been scant discussion about practice synergies and subsequently the type and nature of professional competencies that underpin such action.

Methods: This commentary uses the Australian Health Promotion Association (AHPA) national core competencies for Health Promotion Practitioners as a basis to examine the synergies between climate change and health promotion action.

Results: We demonstrate that AHPA core competencies, such as program planning, evaluation and partnership building, are highly compatible for implementing climate change mitigation and adaptation strategies. We use food security examples to illustrate this case.

Conclusions: There appears to be considerable synergy between climate change and health promotion action. This should be a key focus of future health promotion competency development in Australia.

Process evaluation of an integrated health promotion/occupational health model in WellWorks-2

Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

A role for workforce competencies in evidence-based health promotion education

Education programs should be based on research about the knowledge and skills required for practice, rather than on intuition or tradition, but there is limited published curriculum research on health promotion education. This paper describes a case study of how workforce competencies have been used to assist evidence-based health promotion education in the areas of curriculum design, selection of assessment tasks and continuous quality assurance processes in an undergraduate program at an Australian university. A curriculum-competency mapping process successfully identified gaps and areas of overlap in an existing program. Previously published health promotion workforce competencies were effectively used in the process of selecting assessment items, providing clear guidelines for curriculum revision and a useful method to objectively assess competency content in an evidence informed framework. These health promotion workforce competencies constituted an additional tool to assess course quality. We recommend other tertiary institutions consider curriculum-competency mapping and curriculum based assessment selection as quality and evidence based curriculum review strategies.

Development of a collaborative model to improve school health promotion in the Netherlands

In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core-business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behavior of students is increasing. This article focuses on the processes and initial results of developing a collaborative model tailored for whole-school health in the Netherlands, named schoolBeat. The Dutch situation is characterized by fragmentation, a variety of health and welfare groups supporting schools, and a lack of sound integrated youth policies. A literature review, observations, and stakeholder consultation provided a clear picture of the current situation in school health promotion, and factors limiting a comprehensive and needs-based approach to school health. This revealed that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. A respected member of school staff should chair this team. To strengthen the link with the school care team, the school care coordinator should be a member of both teams. To provide coordinated support to all schools in a region, participating organizations decided to share advisory tasks. These tasks are included in the regular health promotion work of their staff. This means working with one advisor representing all school-health organizations per school, and using a comprehensive overview of possible support and projects promoting health. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This article concludes with an examination of emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement.

A health promotion intervention can affect diet quality in early childhood

Initiatives to promote children’s nutrition and prevent childhood obesity are vital. Dietary patterns are a useful way to characterize whole diets, though no previous early childhood health promotion trial has assessed intervention impact using this approach. This research aimed to assess the effect on young children’s dietary patterns of a healthy eating and physical activity intervention. The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a health promotion cluster-randomized controlled trial involving 542 families. Child diets were assessed by multiple 24-hour recalls post-intervention, at approximately 18 months of age. An Obesity Protective Dietary Index was created, and dietary patterns were also assessed by principal components analysis. These outcomes were used to compare intervention and control participants to test the effectiveness of the intervention. Children in the intervention arm scored significantly higher (15.6 ± 5.9) than those in the control arm (14.5 ± 6.7) for the Obesity Protective Dietary Index (scores out of 30, p=0.01). Three dietary patterns were identified by principal components analysis, however, scores were not significantly different between intervention and control arms. In conclusion, this paper presents novel results in both the evaluation of an early childhood health promotion intervention and in the assessment of child dietary patterns. The results highlight the capacity for such an initiative to improve child diets, and the need for further research in this area.

Healthy nature healthy people: 'contact with nature' as an upstream health promotion intervention for populations

Whilst urban-dwelling individuals who seek out parks and gardens appear to intuitively understand the personal health and well-being benefits arising from `contact with nature', public health strategies are yet to maximize the untapped resource nature provides, including the benefits of nature contact as an upstream health promotion intervention for populations. This paper presents a summary of empirical, theoretical and anecdotal evidence drawn from a literature review of the human health benefits of contact with nature. Initial findings indicate that nature plays a vital role in human health and well-being, and that parks and nature reserves play a significant role by providing access to nature for individuals. Implications suggest contact with nature may provide an effective population-wide strategy in prevention of mental ill health, with potential application for sub-populations, communities and individuals at higher risk of ill health. Recommendations include further investigation of `contact with nature' in population health, and examination of the benefits of nature-based interventions. To maximize use of `contact with nature' in the health promotion of populations, collaborative strategies between researchers and primary health, social services, urban planning and environmental management sectors are required. This approach offers not only an augmentation of existing health promotion and prevention activities, but provides the basis for a socio-ecological approach to public health that incorporates environmental sustainability.