Scaling-up an efficacious school-based physical activity intervention: study protocol for the 'Internet-based professional learning to help teachers support activity in youth' (iPLAY) cluster randomized controlled trial and scale-up implementation evaluat

BACKGROUND: Despite the health benefits of regular physical activity, most children are insufficiently active. Schools are ideally placed to promote physical activity; however, many do not provide children with sufficient in-school activity or ensure they have the skills and motivation to be active beyond the school setting. The aim of this project is to modify, scale up and evaluate the effectiveness of an intervention previously shown to be efficacious in improving children's physical activity, fundamental movement skills and cardiorespiratory fitness. The 'Internet-based Professional Learning to help teachers support Activity in Youth' (iPLAY) study will focus largely on online delivery to enhance translational capacity.

METHODS/DESIGN: The intervention will be implemented at school and teacher levels, and will include six components: (i) quality physical education and school sport, (ii) classroom movement breaks, (iii) physically active homework, (iv) active playgrounds, (v) community physical activity links and (vi) parent/caregiver engagement. Experienced physical education teachers will deliver professional learning workshops and follow-up, individualized mentoring to primary teachers (i.e., Kindergarten - Year 6). These activities will be supported by online learning and resources. Teachers will then deliver the iPLAY intervention components in their schools. We will evaluate iPLAY in two complementary studies in primary schools across New South Wales (NSW), Australia. A cluster randomized controlled trial (RCT), involving a representative sample of 20 schools within NSW (1:1 allocation at the school level to intervention and attention control conditions), will assess effectiveness and cost-effectiveness at 12 and 24 months. Students' cardiorespiratory fitness will be the primary outcome in this trial. Key secondary outcomes will include students' moderate-to-vigorous physical activity (via accelerometers), fundamental movement skill proficiency, enjoyment of physical education and sport, cognitive control, performance on standardized tests of numeracy and literacy, and cost-effectiveness. A scale-up implementation study guided by the RE-AIM framework will evaluate the reach, effectiveness, adoption, implementation, and maintenance of the intervention when delivered in 160 primary schools in urban and regional areas of NSW.

DISCUSSION: This project will provide the evidence and a framework for government to guide physical activity promotion throughout NSW primary schools and a potential model for adoption in other states and countries.

Examining health literacy disparities in the United States: a third look at the National Assessment of Adult Literacy (NAAL)

BACKGROUND: In the United States, disparities in health literacy parallel disparities in health outcomes. Our research contributes to how diverse indicators of social inequalities (i.e., objective social class, relational social class, and social resources) contribute to understanding disparities in health literacy.

METHODS: We analyze data on respondents 18 years of age and older (N = 14,592) from the 2003 National Assessment of Adult Literacy (NAAL) restricted access data set. A series of weighted Ordinary Least Squares (OLS) regression models estimate the association between respondent's demographic characteristics, socioeconomic status (SES), relational social class, social resources and an Item Response Theory (IRT) based health literacy measure.

RESULTS: Our findings are consistent with previous research on the social and SES determinants of health literacy. However, our findings reveal the importance of relational social status for understanding health literacy disparities in the United States. Objective indicators of social status are persistent and robust indicators of health literacy. Measures of relational social status such as civic engagement (i.e., voting, volunteering, and library use) are associated with higher health literacy levels net of objective resources. Social resources including speaking English and marital status are associated with higher health literacy levels.

CONCLUSIONS: Relational indicators of social class are related to health literacy independent of objective social class indicators. Civic literacy (e.g., voting and volunteering) are predictors of health literacy and offer opportunities for health intervention. Our findings support the notion that health literacy is a social construct and suggest the need to develop a theoretically driven conceptual definition of health literacy that includes a civic literacy component.

Optimising health literacy and access of service provision to community dwelling older people with diabetes receiving home nursing support

Background. Health literacy is the ability to access, understand, and use information and services for good health. Among people with chronic conditions, health literacy requirements for effective self-management are high. The Optimising Health Literacy and Access (Ophelia) study engaged diverse organisations in the codesign of interventions involving the Health Literacy Questionnaire (HLQ) needs assessment, followed by development and evaluation of interventions addressing identified needs. This study reports the process and outcomes of one of the nine organisations, the Royal District Nursing Service (RDNS).

Methods. Participants were home nursing clients with diabetes. The intervention included tailored diabetes self-management education according to preferred learning style, a standardised diabetes education tool, resources, and teach-back method.

Results. Needs analysis of 113 quota-sampled clients showed difficulties managing health and finding and appraising health information. The service-wide diabetes education intervention was applied to 24 clients. The intervention was well received by clients and nurses. Positive impacts on clients' diabetes knowledge and behaviour were seen and nurses reported clear benefits to their practice.

Conclusion. A structured method that supports healthcare services to codesign interventions that respond to the health literacy needs of their clients can lead to evidence-informed, sustainable practice changes that support clients to better understand effective diabetes self-management.

Research protocol for a digital intervention to reduce stigma among males with a personal experience of suicide in the Australian farming community

BACKGROUND: Australian farming communities have up to twice the suicide rate of the general population. Men, particularly, demonstrate debilitating self- and perceived-stigma associated with an experience of suicide. The Ripple Effect is aimed to reduce suicide stigma within the social, cultural, geographical and psychological contexts in which it occurs.

METHODS: A mixed-method design with multi-level evaluation will be effected following the development and delivery of a personalised website experience (combining shared stories, education, personal goal setting and links to resources) to farming men, aged 30-64 years, with an experience of suicide. Pre- and post-surveys will be used to assess changes in self- and perceived-stigma and suicide literacy. Online feedback from participants and semi-structured interviews during follow-up will be thematically analysed.

DISCUSSION: This project will provide information about increasingly accessible, innovative approaches to reducing the debilitating health and wellbeing effects of suicide stigma on a population of Australia's farmers.

TRIAL REGISTRATION: This research protocol was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN: ACTRN12616000289415 ) on 7(th) March, 2016.

Educational Intervention Project "R.E.D. Bull(ying)"

Introduction: Adolescence is a stage of life cycle marked by various physical, psychological and social changes. During this stage, young people are faced with the feeling of threat of identity, which may trigger aggressive behaviours. Bullying is a form of school violence with high prevalence, that shouldn't be a "normal" occurrence or a event that young people should experience during the transition between childhood and adolescent. In order to reduce the prevalence of bullying in the school community, we elaborated the Educational Intervention Project "R.E.D. BULL(ying)", with the specific objectives: Evaluate the knowledge level about bullyng, before and after the Project, and increase the level of literacy about the subject in the school community (students and teachers). Methodology: Our target population consisted in a total of 203 students from 5th to 9th grade and 13 teachers of school. It's a cross-sectional study of research - action, with the application of a diagnostic questionnaire, before and after, we conducted the educational sessions. Results: After the educational sessions, 93,1% of students identified what to do in a bullying situation, and 62,6% of students responded that in an assault situation, called an adult; 95,1% said they knew what was bullying, 56,8% associated the concept to physical aggression and 92,6 % mentioned to know the types of bullying, and physical bullying (71,9%) and verbal bullying (69,5%) were the most mentioned types. Meanwhile, the teachers: 76,9% considered that the school environment was pleasant, 84,6% characterized the relationship between the students as "adequate" and 77% said they didn't experience any bullying situation. Conclusions: We found an overall improvement to the level of bullying related knowledge after the educational intervention. So, we verified that the integrated intervention in the school health teams, allows greater attention to the detection, signalling and routing situations of violence.

EDUCATIONAL INTERVENTION PROJECT "R.E.D. BULL(YING)"

Introduction: Adolescence is a stage of life cycle marked by various physical, psychological and social changes. During this stage, young people are faced with the feeling of threat of identity, which may trigger aggressive behaviours. Bullying is a form of school violence with high prevalence, that shouldn't be a "normal" occurrence or a event that young people should experience during the transition between childhood and adolescent. In order to reduce the prevalence of bullying in the school community, we elaborated the Educational Intervention Project "R.E.D. BULL(ying)", with the specific objectives: Evaluate the knowledge level about bullyng, before and after the Project, and increase the level of literacy about the subject in the school community (students and teachers). Methodology: Our target population consisted in a total of 203 students from 5th to 9th grade and 13 teachers of school. It's a cross-sectional study of research - action, with the application of a diagnostic questionnaire, before and after, we conducted the educational sessions. Results: After the educational sessions, 93,1% of students identified what to do in a bullying situation, and 62,6% of students responded that in an assault situation, called an adult; 95,1% said they knew what was bullying, 56,8% associated the concept to physical aggression and 92,6 % mentioned to know the types of bullying, and physical bullying (71,9%) and verbal bullying (69,5%) were the most mentioned types. Meanwhile, the teachers: 76,9% considered that the school environment was pleasant, 84,6% characterized the relationship between the students as "adequate" and 77% said they didn't experience any bullying situation. Conclusions: We found an overall improvement to the level of bullying related knowledge after the educational intervention. So, we verified that the integrated intervention in the school health teams, allows greater attention to the detection, signalling and routing situations of violence.

Reducing the global burden of depression : population level analysis of intervention cost-effectiveness in 14 world regions

International evidence on the cost and effects of interventions for reducing the global burden of depression remain scarce. Aims: To estimate the population-level cost-effectiveness of evidence-based depression interventions and their contribution towards reducing current burden. Method: Primary-care-based depression interventions were modelled at the level of whole populations in 14 epidemiological subregions of the world. Total population-level costs (in international dollars or I$) and effectiveness (disability adjusted life years (DALYs) averted) were combined to form average and incremental cost-effectiveness ratios. Results: Evaluated interventions have the potential to reduce the current burden of depression by 10–30%. Pharmacotherapy with older antidepressant drugs, with or without proactive collaborative care, are currently more cost-effective strategies than those using newer antidepressants, particularly in lower-income subregions. Conclusions: Even in resource-poor regions, each DALYaverted by efficient depression treatments in primary care costs less than 1 year of average per capita income, making such interventions a cost-effective use of health resources. However, current levels of burden can only be reduced significantlyif there is a substantialincrease substantial increase intreatment coverage.