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.

Understanding the "black box" of a health-promotion program : keys to enable health among older persons aging in the context of migration

Although the need to make health services more accessible to persons who have migrated has been identified, knowledge about health-promotion programs (HPPs) from the perspective of older persons born abroad is lacking. This study explores the design experiences and content implemented in an adapted version of a group-based HPP developed in a researcher-community partnership. Fourteen persons aged 70-83 years or older who had migrated to Sweden from Finland or the Balkan Peninsula were included. A grounded theory approach guided the data collection and analysis. The findings showed how participants and personnel jointly helped raise awareness. The participants experienced three key processes that could open doors to awareness: enabling community, providing opportunities to understand and be understood, and confirming human values and abilities. Depending on how the HPP content and design are being shaped by the group, the key processes could both inhibit or encourage opening doors to awareness. Therefore, this study provides key insights into how to enable health by deepening the understanding of how the exchange of health-promoting messages is experienced to be facilitated or hindered. This study adds to the scientific knowledge base of how the design and content of HPP may support and recognize the capabilities of persons aging in the context of migration.

Measuring environmental education program impacts and learning in the field: Using an action research cycle to develop a tool for use with young students

Despite the increasing importance of, and interest in, documenting the impact of environmental education programs on students' learning for sustainability, few tools are currently available to measure young students' environmental learning across all the dimensions of knowledge, skills, attitudes and behaviours. This paper reports on the development of such a tool, using an iterative action research process with 134 students, aged six to eleven, attending programs at an Environmental Education Centre in Queensland. The resulting instrument, the Environmental Learning Outcomes Survey (ELOS) incorporates observations of students' engagement in learning processes as well as measuring learning outcomes, and allows both of these aspects to be linked to particular components of the environmental education program. Test data using the instrument are reported to illustrate its potential usefulness. It is envisaged that the refined instrument will enable researchers to measure student environmental learning in the field, investigate environmental education program impacts and identify aspects of programs that are most effective in facilitating student learning. [Author abstract]

Health promotion for dogs and humans : the 10,000 steps Rockhampton dog walking intervention

Purpose This paper describes the implementation and evaluation of an intervention aimed at increasing the dog-walking behaviour of residents from a community of approximately 60,000. This intervention was a sub strategy of the 10 000 Steps Rockhampton project – a community intervention aimed at decreasing sedentary behaviour in the adult population. Methods Brochures and posters were developed that promoted dog walking as a means to improve both human and canine health. The brochures were distributed by the local council to over 8 000 homes with the annual dog-renewal registrations. Results Evaluation of the intervention included a telephone survey of a randomly selected sample of Rockhampton residents (n=420) four-months post intervention. Although 63.6% of participants reported that owning a dog increased their physical activity levels, 40% of dog-owners did not walk their dog at all in the last week. The outcome evaluation of the intervention showed that 20.2% of dog-owners recalled receiving the brochure. Overall 15.3% of respondents with a dog in their household reported an increase in their physical activity levels since the intervention, 8.4% reported a decrease. Conclusions The intervention was an innovative and cost-effective way to tap into a section of the population that can benefit from engaging in regular walking behaviour. It was also a unique and useful way to engage local council in physical activity health promotion as part of a larger ongoing community-wide intervention.

Health promotion program implementation, a socio-technical networking process : a case study of a school-based nutrition intervention

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

Impact of worksite health-promotion programs in hospital admission costs and medical leaves in a sample of brazilian companies

Programas de saúde e bem-estar têm sido adotados por empresas como forma de melhorar a saúde de empregados, e muitos estudos descrevem retornos econômicos positivos sobre os investimentos envolvidos. Entretanto, estudos mais recentes com metodologia melhor têm demonstrado retornos menores. O objetivo deste estudo foi investigar se características de programas de saúde e bem-estar agem como preditores de custos de internação hospitalar (em Reais correntes) e da proporção de funcionários que têm licença médica, entre Abril de 2014 e Maio de 2015, em uma amostra não-aleatória de empresas no Brasil, através de parceria com uma empresa gestora de ‘big data’ para saúde. Um questionário sobre características de programas de saúde no ambiente de trabalho foi respondida por seis grandes empresas brasileiras. Dados retirados destes seis questionários (presença e idade de programa de saúde, suas características – inclusão de atividades de screening, educação sobre saúde, ligação com outros programas da empresa, integração do programa à estrutura da empresa, e ambientes de trabalho voltado para a saúde – e a adoção de incentivos financeiros para aderência de funcionários ao programa), bem como dados individuais de idade, gênero e categoria de plano de saúde de cada empregado , foram usados para construir um banco de dados com mais de 76.000 indivíduos. Através de um modelo de regressão múltipla e seleção ‘stepwise’ de variáveis, a idade do empregado foi positivamente associada e a idade do programa de saúde e a categoria ‘premium’ de plano de saúde do funcionário foram negativamente associadas aos custos de internação hospitalar (como esperado). Inesperadamente, a inclusão de programas de screening e iniciativas de educação de saúde nos programas de saúde e bem-estar nas empresas foram identificados como preditores positivos significativos para custos de admissão hospitalar. Para evitar a inclusão errônea de licenças-maternidade, apenas os dados de licença médica de pacientes do sexo masculino foram analisados (dados disponíveis apenas para duas entre as companhias incluídas, com um total de 18.957 pacientes do sexo masculino). Analisando estes dados através de um teste Z para comparação de proporções, a empresa com programa de saúde que inclui atividades voltadas a cessação de hábitos ruins (como tabagismo e etilismo), controle de diabetes e hipertensão, e que adota incentivos financeiros para a aderência de funcionários ao programa tem menor proporção de empregados com licençca médica no período analisado, quando comparada com a outra empresa que não tem estas características (também conforme esperado). Entretanto, a companhia com menor proporção de funcionários com licença médica também foi aquela que adota programa de screening entre as atividades de seu programa de saúde. Potenciais fontes de ameaça à validade interna e externa destes resultados são discutidas, bem como possíveis explicações para a associação entre programas de screening e educação médica a piores indicadores de saúde nesta amostra de companhias são discutidas. Novos estudos com melhor desenho, com amostras maiores e randômicas são necessários para validar estes resultados e possivelmente melhorar a validade interna e externa destes resultados.

Nurses and teachers : partnerships for green health promotion

Background: The term ‘green health promotion’ is given to health promotion underpinned by the principles of ecological health and sustainability. Green health promotion is supported philosophically by global health promotion documents such as the Ottawa Charter for Health Promotion (1986) and the ecological public health movement. Green health promotion in schools aims to practice the principles of ecological health and sustainability. Methods: An extended literature review revealed a paucity of literature about green health promotion in schools across disciplines. Literature about nurses and health promotion in schools is generally found in nursing publications. Literature about ecological sustainability in schools is mostly found in teaching publications. Results: This paper explores the nexus between nursing and health promotion, and teachers and ecological sustainability. Collaborative partnerships between health and education do not capitalise on programs such as Health Promoting Schools and the School Based Youth Health Nurse Program in Queensland, Australia. The authors consider how collaborative partnerships between health and education in schools can work towards green health promotion. Conclusion: Nursing’s approach to health promotion and education’s approach to ecological sustainability need to be aligned to enhance green health promotion in schools and promote a new generation of ‘tree huggers and hippies’.

Ask : a health advocacy program for adolescents with an intellectual disability : a cluster randomised controlled trial

Background Adolescents with intellectual disability often have poor health and healthcare. This is partly as a consequence of poor communication and recall difficulties, and the possible loss of specialised paediatric services. Methods/Design A cluster randomised trial was conducted with adolescents with intellectual disability to investigate a health intervention package to enhance interactions among adolescents with intellectual disability, their parents/carers, and general practitioners (GPs). The trial took place in Queensland, Australia, between February 2007 and September 2010. The intervention package was designed to improve communication with health professionals and families’ organisation of health information, and to increase clinical activities beneficial to improved health outcomes. It consisted of the Comprehensive Health Assessment Program (CHAP), a one-off health check, and the Ask Health Diary, designed for on-going use. Participants were drawn from Special Education Schools and Special Education Units. The education component of the intervention was delivered as part of the school curriculum. Educators were surveyed at baseline and followed-up four months later. Carers were surveyed at baseline and after 26 months. Evidence of health promotion, disease prevention and case-finding activities were extracted from GPs clinical records. Qualitative interviews of educators occurred after completion of the educational component of the intervention and with adolescents and carers after the CHAP. Discussion Adolescents with intellectual disability have difficulty obtaining many health services and often find it difficult to become empowered to improve and protect their health. The health intervention package proposed may aid them by augmenting communication, improving documentation of health encounters, and improving access to, and quality of, GP care. Recruitment strategies to consider for future studies in this population include ensuring potential participants can identify themselves with the individuals used in promotional study material, making direct contact with their families at the start of the study, and closely monitoring the implementation of the educational intervention.