The intervention objectives were to evaluate and describe the feasibility of using a community-based research (CBR) approach to adapt and implement HIV-prevention materials and tools with incarcerated men. We found no prior published reports about CBR HIV-prevention education in Canadian correctional facilities.
Twelve members of the correctional Peer Education Committee (PEC) and Aboriginal PEC, whom a correctional nurse identified as being interested in preventive health, were purposively invited to participate. Eight participants were serving life sentences, three were Aboriginal and their education levels ranged from below grade 8 to 11 years of post-secondary education. The setting was a medium-security federal correctional facility, housing 324 men. The intervention was guided by CBR and ‘greater involvement of people with AIDS’ principles. Participants were invited to attend four workshops, over seven days in May 2014, and to provide their insights regarding future scaled-up CBR HIV prevention. Each workshop included an HIV-prevention presentation and a focus group discussion, two of which were audio-recorded.
All participants attended all sessions. Synthesis of mixed-method findings, with quantitative and qualitative data triangulation, demonstrated two major outcomes: ‘new knowledge was generated’ regarding feasibility of CBR HIV prevention in a men’s correction facility; and ‘capacity building occurred’ with increased participants’ social capital. Thirty incarcerated men requested HIV testing following the intervention, because participants spread their knowledge about HIV prevention to others. Participants asked to become ‘health ambassadors’ – champion advisors for future scaled-up CBR HIV-prevention intervention for the entire correctional facility.
CBR HIV prevention is feasible within a Canadian men’s correctional facility.
Cet article présente le processus suivi pour développer et implanter une intervention ciblée encourageant les femmes travailleuses du sexe (TS) à se faire dépister régulièrement pour le virus de l’immunodéficience humaine (VIH) dans les services de santé adaptés au Bénin. Le modèle de planification d’intervention mapping (IM) de Bartholomew et al. (2006), structuré en six étapes, a servi de référence pour guider le développement et l’implantation de l’intervention. Une analyse des besoins a été réalisée à partir d’une revue de littérature et d’une étude basée sur la théorie du comportement planifié, d’Ajzen (1991). Cette analyse a permis d’identifier les déterminants associés au comportement sur lesquels ont porté les actions de changement. Les méthodes et stratégies d’intervention ont été basées sur des théories et adaptées aux besoins des femmes TS.
Les résultats consistent en une intervention de neuf mois visant à couvrir plus de 1200 femmes TS, en impliquant divers acteurs (intervenants communautaires, agents de santé et pairs éducatrices). La perception de contrôle comportemental, la norme descriptive, les connaissances, l’attitude et l’intention d’adopter le dépistage régulier du VIH constituent les cibles d’action. L’intervention comporte des activités visant des changements individuels et environnementaux à travers diverses méthodes comme le counseling motivationnel, l’éducation par les pairs, le modeling, la communication persuasive, le renforcement de capacités et la réorganisation des services cliniques.
L’IM a permis de structurer et d’implanter avec transparence une intervention ciblée visant l’adoption d’un comportement favorable à la santé chez les femmes TS. Les enjeux rencontrés et les lecons tirées de l’application de l’IM en contexte africain francophone peuvent inspirer les planificateurs et professionnels pour améliorer leurs interventions en promotion de la santé.
The increasing prevalence of childhood overweight/obesity caused by an unhealthy diet, insufficient physical activity (PA) and high levels of sedentary behaviour (SB) is a prominent public health concern. Parenting practices may contribute to healthy behaviour change in children, but well-researched examples are limited. The aim of this study is to describe the systematic development of an intervention for parents to prevent childhood overweight/obesity through the improvement of parenting practices.
The six steps of the Intervention Mapping Protocol (IMP), a theory- and evidence-based tool to develop health-related interventions, were used as a framework to develop the ‘Movie Models’ programme.
In Step 1, a needs assessment was performed to better understand the health problem of overweight/obesity in children and its association with diet, PA and SB. In Step 2, the programme goal (increasing the adoption of effective parenting practices) was sub-divided into performance objectives. Change objectives, which specify explicit actions required to accomplish the performance objectives, were also identified. Step 3 included the selection of theoretical methods (e.g. ‘modelling’ and ‘images’), which were then translated into the practical strategy of online parenting videos. Step 4 comprised the development of a final intervention framework, and Step 5 included the planning of programme adoption and implementation. The final phase, Step 6, included the development of an effect- and process-evaluation plan.
The IMP was used to structure the development of ‘Movie Models’, an intervention targeting specific parenting practices related to children’s healthy diet, PA, SB, and parental self-efficacy. A clear framework for process analyses is offered, which aims to increase the potential effectiveness of an intervention and can be useful for those developing health promotion programmes.
Inadequate drinking water, sanitation, and hand hygiene are responsible for approximately 800,000 deaths per year in low- and middle-income countries. We evaluated the benefits of a behavior change communication method to motivate water treatment practices in urban low income communities in Dhaka, Bangladesh. To motivate people to chlorinate their water we used a device called the ‘Disgust Box’. This box provides a vivid demonstration of how piped water is contaminated with feces. Most of the respondents were able to recall the Disgust Box demonstration at both 4-month and 1-year follow-up qualitative assessments. At 4 months, the majority of participants stated that they still felt disgusted by the demonstration and mentioned it as a motivator for water chlorination. However, after one year, despite being able to recall the demonstration, disgust was no longer mentioned as a motivator to chlorinate water. The Disgust Box has the potential to be an effective communication method and is more likely to work if it is part of an intervention that includes repeated presentations and a more attractive water treatment option.
Over the past three decades there has been a surge in the prevalence of overweight and obesity worldwide in both adults and children. To date few studies have examined obesity in India and most have only looked at prevalence estimates. While studies in Western countries have identified parent weight status as a predictor of child weight status, there have been no studies examining this association in India. This study examined the relationship between parent weight status and child weight status using an internationally representative growth reference for children and Asian-specific action points for adults.
Overall, this study found 29.6% of children and 77.7% of parents in a sample of private schools in Delhi, India were overweight/obese. Parent weight status was found to be associated with child weight status after controlling for child grade and sex. However, while maternal weight status was associated with child weight status (odds ratio=1.51, 95% confidence interval: 1.04–2.20), paternal weight status was not (odds ratio=1.10, 95% confidence interval: 0.81–1.48). The association was greatest between mothers and sons (odds ratio=2.13, 95% confidence interval: 1.39–3.27).
These results provide initial evidence that parent weight status is associated with child weight status in Delhi, India. Future research should continue to explore the relationship between parent, particularly maternal, and child weight status to better understand the nature of the relationship and the differences between male and female children. Interventions to address child overweight and obesity in India should include parents as direct targets.
Partnerships between sectors can achieve better outcomes than can be achieved by individual partners working alone. Trust is necessary for partnerships to function effectively. Mistrust makes partnership working difficult, if not impossible. There has been little research into partnership functioning factors that influence trust and mistrust. This study aimed to identify these factors in health promotion partnerships. Data were collected from 337 partners in 40 health promotion partnerships using a postal survey. The questionnaire incorporated multi-dimensional scales designed to assess the contribution of factors that influence partnership trust and mistrust. Newly validated scales were developed for trust, mistrust and power. Multiple regression analysis was used to identify the significance of each factor to partnership trust and mistrust. Power was found to be the only predictor of partnership trust. Power, leadership, and efficiency were the most important factors influencing partnership mistrust. Power in partnerships must be shared or partners will not trust each other. Power-sharing and trust-building mechanisms need to be built into partnerships from the beginning and sustained throughout the collaborative process.
This article explores the potential for health promotion capacity building across boundaries in a place-based health promotion learning network generated as part of a recent Australian Research Council-funded project in Queensland, Australia. We emphasise in particular the potential of creating new ‘at the boundary’ spaces of knowing that encourage and enable health promotion workers to work in interdisciplinary and intersectoral ways. The article discusses the way that diverse health promotion workers from different disciplines and government and non-government organisations came together to learn ‘how to do’ in new or re-invigorated ways. For many network participants, this cross-boundary space of knowing and capacity building provided a welcome respite from their daily contexts of practice which may be limited by institutional, disciplinary or other boundaries.
Currently, health literacy (HL) worldwide is measured primarily among adults from a medical perspective. A children’s HL test from a health promotion perspective is needed. This study develops the Taiwan Children’s Health Literacy Test (TCHL) targeted at Taiwanese sixth-graders.
HL indicators were identified through interviews of sixth-grade teachers, primary caregivers, and sixth-graders. They were used to develop a 25-item online test, which was finalized after pretesting and administered to a stratified random sample of 671 students across 29 sixth-grade classes.
The response rate was 87.2% (585 participants). Cronbach’s α was 0.60–0.78 for the HL subtests and 0.79 for the overall HL test. Correlation coefficients among subtests ranged from 0.49 to 0.87. The average proportion correct was 0.80 for overall HL. In item response theory analysis, the difficulty level ranged from –2.77 to –0.40, while the degree of discrimination was 0.44–2.65. Item information peaked when the ability value was approximately –1.8. Furthermore, HL scores had a significant positive correlation with health behaviors.
Overall, the test was found to be reliable and valid, with a low level of difficulty for basic HL ability. The present results can be used as a reference by government health education units to investigate national HL in children.
In the lives of women, puberty is marked by the onset of menarche. From this stage onwards until menopause, reproductive health and menstrual hygiene are important aspects of women’s lives. In Zambia’s Western Province, the natural process of menstruation is a taboo and dealt with secretly. Information and knowledge about menstruation and menstrual hygiene among adolescent girls is inadequate. This paper explores the factors influencing the understanding, experiences and practices of menstrual hygiene among adolescent girls in Mongu District, Western Province of Zambia.
An explorative study design was used by means of six focus group discussions conducted with 51 respondents, aged 13–20 years, from three secondary schools. Their age at menarche was 11–15. For data analysis thematic content analysis was used.
The paper shows that the girls suffer from poor menstrual hygiene, originating from lack of knowledge, culture and tradition, and socio-economic and environmental constraints, leading to inconveniences, humiliation and stress. This leads to reduced school attendance and poor academic performance, or even drop outs, and ultimately infringes upon the girls’ human rights.
To address these shortcomings, a ‘super setting approach’ is recommended, in which a Health Promoting School could improve the girls’ individual and group needs, and a community setting which would address the broader socio-economic, cultural and environmental conditions. This would enable creating a supportive environment for the girls to manage their periods. To successfully utilize the approach, all stakeholders (parents, teachers, children, governments and communities) should cooperate to generate context-specific solutions for creating safe menstrual care, and better and dignified conditions for adolescent girls. Therefore, this calls for comprehensive, strident advocacy for policy changes at national level, and mediation and involvement at community level.
The misuse of medicine is a serious public health issue worldwide. An important factor that contributes to the misuse of medicine is the lack of medication label viewing by consumers. The objective of the present study is to examine the socio-economic, demographic and lifestyle factors associated with medication label viewing among Malaysian adults. The empirical analysis is based on a nationally representative data set of 30,992 respondents. An ordered probit model is used to examine different types of medication label viewers. The results of this study suggest that socio-economic (i.e. age, income level, education level, location of residence), demographic (i.e. gender, ethnicity, marital status) and lifestyle factors (i.e. physical activity, smoking) have significant effects on medication label viewing. It is found that age, low-income and low-education level reduce the likelihood of viewing medication label. Based on these findings, several policy implications are suggested. The present study provides policy makers with baseline information regarding which cohorts of individuals to focus on in efforts to increase the frequency of medication label viewing.
The need to address the growing prevalence of non-communicable diseases through changing the lifestyle behaviours that contribute to them has become a global priority. Settings-based health promotion strategies such as workplace health promotion programmes are growing in an attempt to start meeting this need. In order for settings-based health promotion programmes to be successful, they need to be based on the specific risk profiles of the population for whom they are designed. Workplace health promotion programmes are becoming popular in South Africa, but there are currently few data available about the health risks and lifestyle behaviours of the South African employed population. In order to obtain such data and reward workplace health promotion initiatives, Discovery Health initiated healthy company campaigns in South Africa and the UK. These campaigns took the form of a competition to assess the healthiest companies in each country. Through these campaigns, an extensive data set was collected encompassing UK and South African employees’ lifestyle behaviours and health risks. In this article, we used these data to compare self-reported physical activity levels, self-reported fruit and vegetable consumption, calculated BMI, self-reported smoking, mental health indicators, and health screening status of the UK and South African employee samples. We found significant differences across all measures, with the exception of self-reported fruit and vegetable consumption. The findings emphasise the importance of using local data to tailor workplace health promotion programmes for the population for which the programmes have been designed.
Immigrants to Canada are less likely to be physically active compared with non-immigrants, and the interrelations between personal and environmental factors that influence physical activity for immigrants are largely unexplored. The goal of this qualitative descriptive study was to understand how the experience of being new to Canada impacts opportunities and participation in physical activity. Two focus group interviews with immigrants to Canada were conducted. The first group (n=7) included multicultural health brokers. The second group (n=14) included English as a second language students. Qualitative content analysis was used to determine three themes consistent with the research question: transition to Canadian life, commitments and priorities, and accessibility. Discussion was framed using a social ecological model. Implications for practice and policy are suggested including enhanced community engagement, and organizational modifications. Overall, the development and implementation of physical activity policies and practices for newcomers to Canada should be centered on newcomers’ perspectives and experiences.
One risk factor for infant and childhood morbidity is not exclusive breastfeeding (EBF) during the first six months of life. Entertainment Education (EE) is a communication strategy consisting of placing educational information into television, movies, and radio programs. In developing countries this form of behavioral change communication has proven effective in addressing health-related issues; however, no research has determined if EE is effective in promoting EBF. The objective of this research was to develop an EE audio program and discussion guide and to determine if a series of four 15-minute episodes and post-listening discussion improved knowledge, perceived benefits, self-efficacy, and intention and decreased misconceptions and perceived barriers toward EBF in the Kumbo West Health District, Cameroon. Pregnant women and their partners were assigned to either the control group (N = 116; 74 women, 42 partners) or intervention group (N = 148; 99 women, 49 partners) based on expected date of delivery. All control and intervention group participants completed a questionnaire prior to listening to the first and after the last episode. Pre- and post-listening questionnaires were used to determine changes in the EBF knowledge, misconceptions, perceived barriers, self-efficacy, and intention variables as a result of exposure to the audio program. The Wilcoxon Sign Rank test showed significant improvement in all of the variables, except perceived barriers, within the intervention group (p < 0.05) and the Mann–Whitney test indicated significant differences between the control and intervention group in all of the variables (p < 0.05), indicating that using an audio program and discussion guide based on the EE model is an effective tool for promoting EBF in this setting. The strength of this approach is that it goes beyond simply telling women about what constitutes EBF, but addresses misconceptions and perceived barriers that may prevent women from practicing EBF for six months.
Antonovsky’s salutogenesis is a theoretical perspective on health development that explores physical, mental, and social factors that contribute to a ‘healthy life orientation’ and also a theoretical approach to behavior change. Previous studies applying salutogenesis show that a high sense of coherence (SOC), a composite measure from salutogenesis indicating one’s capacity to cope with stress, is associated with a healthy life orientation and lifestyle behaviors, including healthy eating patterns. However, limited evidence exists on the factors that underlie SOC, which could be used to strengthen this capacity as a means to enable healthier eating. Dutch adults (N = 781) participated in a cross-sectional study examining the relationship between SOC and a set of individual, social-environmental, and physical-environmental factors. The main findings indicate that high SOC was associated with a diverse set of factors including lower doctor-oriented health locus of control; higher satisfaction with weight; higher perceived levels of neighborhood collective efficacy; higher situational self-efficacy for healthy eating; lower social discouragement for healthy eating; and higher neighborhood affordability, accessibility and availability of healthy foods. These findings can inform the design of nutrition interventions that target these factors that strengthen SOC and provide the building blocks for a healthier life orientation.
Non-communicable diseases (NCDs) are the leading causes of death worldwide, with higher rates of premature mortality in low- and middle-income countries (LMICs). This places a high economic burden on these countries, which usually have limited capacity to address this public health problem. We developed a guided self-assessment tool for describing national capacity for NCD prevention and control. The purpose of this tool was to assist countries in identifying key opportunities and gaps in NCD capacity. It was piloted in three countries between 2012 and 2013: Mozambique, Colombia, and the Dominican Republic. The tool includes details about NCD burden; health system infrastructure and primary care services; workforce capacity; surveillance; planning, policy, and program management; and partnerships. In the three pilot countries, the tool helped to identify differences in capacity needs pertaining to staff, training, and surveillance, but similarities were also found related to NCD challenges and opportunities. The NCD tool increased our understanding of needs and critical capacity elements for addressing NCDs in the three pilot countries. This tool can be used by other LMICs to map their efforts toward addressing NCD goals and defining priorities.
Health literacy is related to health inequality, health behaviors, and health status. Globally, health literacy has primarily focused on adults and has been based on the medical model. It is necessary to understand children’s life experiences as they relate to health; thus, this study attempted to evaluate and describe the health literacy abilities of sixth-graders in Taiwan.
Interviews were conducted with 10 teachers and 11 caregivers, and focus groups were conducted with 32 children. Health literacy abilities corresponding to real-life situations were identified from life skills and the Taiwanese Curriculum Guidelines for health education. Three expert meetings were held to redefine children’s health literacy using a health promotion perspective and confirmed indicators.
An operational definition of three aspects of children’s health literacy and 25 abilities was proposed: 11 functional health literacy abilities (e.g. understands the connection between personal health care behaviors and health); seven interactive health literacy abilities (e.g. obtains and understands information from various channels); and seven critical health literacy abilities (e.g. analyzes the relationship between personal needs and diet choices for a balanced diet). These indicators cover 10 health education categories.
These findings highlight the importance of understanding Taiwanese children’s health literacy, and the urgency of developing an appropriate measurement tool. The definition and indicators in this study were identified using a child-centered approach focusing on children’s real-life experiences. The result serves as a solid basis for the development of the Taiwan Children’s Health Literacy Scale, and provides information for the decision-making sector on health education.
Understanding social conditions prior to intervention design can enhance tobacco control interventions. This paper describes formative research conducted in 2010 about tobacco use in eight economically disadvantaged Dominican Republic communities, four of which participated in a previous intervention study (2003–2008). A combined US-Dominican team used a rapid assessment process to collect qualitative social and cultural data on tobacco use, knowledge and attitudes; plus observations about social and policy factors, such as exposure to secondhand smoke (SHS), tobacco regulations, pregnancy, health care provider (HCP) practices and sustainability of the 2003–2008 intervention. This assessment found that tobacco use varied by age. While all ages typically used cigarettes, older adults used relatively more unprocessed tobacco, which is seen as less harmful and less addictive. Middle-aged smokers typically used commercial cigarettes, which are viewed as dangerous, addictive, expensive and offensive. Young adults reported avoiding smoking, but using relatively more smokeless tobacco. Smoking during pregnancy has reportedly decreased. SHS was viewed as harmful, although smoke-free homes were uncommon. HCPs discussed tobacco issues mostly for patients with tobacco-related conditions. Sustainability of the 2003–2008 intervention appeared to be linked to active Community Technology Centers with strong leadership, and community social capital. This information could be used to design better targeted interventions in these communities.
This study was conducted to investigate the relationship between perceived insufficient milk and breastfeeding self-efficacy levels among Turkish mothers.
The study was conducted on 200 mothers whose infants were hospitalized and under treatment and who could breastfeed their infants in the newborn clinic of a university hospital in eastern Turkey between June 2013 and February 2014. A sampling method was not applied in the study, so the sample consisted of the population of the study. The ‘Personal Information Form’, ‘Breastfeeding Self-Efficacy Scale’ and ‘Perception of Insufficient Milk Questionnaire’ were used to collect the data. Data were analysed by using percentage distribution and arithmetic average; independent sample t test, Mann–Whitney U test, Kruskal–Wallis variance analysis, Pearson correlation analysis and Cronbach alpha reliability coefficiency in the SPSS 18.0 package program.
The study determined that advanced age, higher education level and higher income status, male gender of the child, planning of the pregnancy, many births, receiving breastfeeding education and the length of time that mothers planned to exclusively breastfeed affected breastfeeding self-efficacy and perception of milk sufficiency positively (p<0.05). The study showed that, as breastfeeding self-efficacy levels of mothers increased, their perception of milk sufficiency also increased (p<0.05).
The study concluded that some factors related to the mother, infant, pregnancy and breastfeeding affected breastfeeding self-efficacy and the perception of milk insufficiency. As the breastfeeding self-efficacy level increased, the milk was perceived to be more sufficient.
Suntanning increases skin cancer risk and prematurely ages skin. Photoageing photography is an effective means of increasing adult ultraviolet radiation (UVR) awareness and skin-protection practices. While adults’ largely positive suntanning-deterrence responses to photoageing photography are well-documented, comparatively little is known about the deterrence effectiveness of photoageing photography with adolescents. To help fill this knowledge gap, in-depth interviews were collected from 10 adolescent females and were subsequently subjected to interpretive phenomenological analysis. The emergent central theme – Having a tan and looking good in the short-term is okay, however, in the longer-term you can end up looking far worse... but still a tan is worth it – and its component subthemes reveal that the adolescent female’s desire for a suntan is largely appearance driven. While photoaged photography is effective in increasing their awareness of the skin damage that UVR exposure causes, it does not alter their suntanning intentions. The analysis also revealed that one of the major barriers to adolescent females’ adoption of skin-protective behaviours is their belief in their own invincibility. Hence, skin-protection interventions that lessen the aura of invincibility around adolescent females’ understanding of their risk for developing skin cancers are vital to reducing the incidence of malignant melanoma.
A focus group session, using the Theory of Planned Behavior to guide questions and discussion, was conducted at midpoint of a 12-month cooking skills program in a rural Appalachian food desert. The purpose of this qualitative study was to determine the attitudes, subjective norms and perceived behavioral control beliefs that influenced participation in these classes. Participants viewed the classes as opportunities for social interaction and to have new experiences. Subjective norms were influenced by family members and traditional cooking. Perceived behavioral control was influenced by the opportunity to try new foods without concern of food waste, acquisition of the knowledge to introduce healthy foods into family meals and enhanced food preparation skills. During the evaluation, a strong sense of participant appreciation of researcher presence was discovered. This unexpected positive component of the program will be promoted using motivational interviewing techniques to enhance adherence to healthy eating behaviors during and after cooking skills programs.
Lead exposure from lead-glazed ceramics (LGCs) and traditional folk remedies have been identified as significant sources of elevated blood lead levels in Mexico and the United States. This study took place from 2005 to 2012 in a rural community in Baja California, Mexico.
1) Investigate the knowledge, attitudes, and practices related to lead and lead exposures from LGCs and two lead-based folk remedies (azarcon and greta); and 2) evaluate a pilot intervention to provide alternative lead-safe cookware.
A baseline household survey was conducted in 2005, followed by the pilot intervention in 2006, and follow-up surveys in 2007 and 2012. For the pilot intervention, families who reported using LGCs were given lead-safe alternative cookware to try and its acceptance was evaluated in the following year.
The community was mostly of indigenous background from Oaxaca and a high proportion of households had young children. In 2006, all participants using traditional ceramic ware at the time (n = 48) accepted lead-safe alternative cookware to try, and 97% reported that they were willing to exchange traditional ceramic ware for lead-safe alternatives. The use of ceramic cookware decreased from over 90% during respondents’ childhood household use in Oaxaca to 47% in 2006 among households in Baja California, and further reduced to 16.8% in 2012. While empacho, a folk illness, was widely recognized as an intestinal disorder, there was almost universal unfamiliarity with the use and knowledge of azarcon and greta for its treatment.
This pilot evaluation provides evidence 1) for an effective and innovative strategy to reduce lead exposure from LGCs and 2) of the feasibility of substituting lead-free alternative cookware for traditional ceramic ware in a rural indigenous community, when delivered in a culturally appropriate manner with health education. This strategy could complement other approaches to reduce exposure to lead from LGCs.
Globally, individuals and groups have different notions of health promotion influenced by their social and cultural contexts. Effective primary health care and healthy public policy depend on a clear understanding of people’s perceptions of health and their health needs. Women in the Far Western Region (FWR) of Nepal live in one of the most remote and rural areas in that country, and their general health status is one of the worst in that country. In this study we explored the socio-cultural health concepts and needs of women in a district of Nepal’s FWR.
Qualitative research methods and a culture-centred approach guided the study, with 30 women from the district of Dadeldhura in the FWR participating in in-depth interviews. Data were analysed through qualitative content analysis.
The women’s concepts of health included ‘absence of disease’, ‘no tension’, ‘peace in the family’ and ‘being able to work’. The participants felt good health required good food, wealth, education and employment for their children, and a healthy community (free of drug or alcohol addiction). ‘Money is everything’ also emerged as a main theme, linking the concept of wealth to good health. To improve health, respondents recommended that the government provide financial support for education and employment and a focus on listening to and caring for the country’s rural poor.
Overall, participants’ perceived health as not just about themselves but their families and communities. Socially as well as culturally determined gender roles influenced the health concepts and needs of the women. This study’s findings can be used to guide public health leaders in priority-setting and in determining strategies for women’s health promotion in rural districts of Nepal and other similar cultures.
Evidence-based medicine (EBM) is well known in medical practice. Although health promotion (HP) is promoted worldwide, there is still some debate as to whether EBM is needed or useful in the teaching of health promotion.
To assess the perceived usefulness of EBM in the teaching of HP among medical students and faculty members.
A comparative study was conducted between two groups of fourth-year medical students in the academic year 2012 during the five-week Health Promotion Teaching Block at Prince of Songkla University, southern Thailand. A one-week EBM course was conducted with half the students in the first week of the block and the other half of the students in the last week of the block. All activities in the HP block were similar except for the different periods of the one-week of EBM teaching. The effect on knowledge, ability and perceived application of EBM in future practice was assessed by student self-evaluations before versus after taking the EBM course, and by faculty member evaluation of the students’ end-of-block presentations. All evaluation items were rated from 1 (lowest) to 5 (highest). Data were analyzed using a t-test or Wilcoxon test, as appropriate.
The students’ self-evaluations of knowledge and ability on EBM between the two groups were similar. The perception that teaching EBM is beneficial in health promotion and future practice increased significantly (p<0.001) in both groups. Faculty members rated higher scores for the first group than the second group, although the rating differences were not at the level of significance. Ninety percent of the students believed that EBM was a useful addition to the teaching of HP.
Medical students and faculty members perceived that EBM is useful in the HP context. Future studies to evaluate the effect of using evidence-based teaching for health promotion are needed.
This study was conducted to investigate the electronic waste workers’ knowledge about the potential health hazards associated with their work as well as the livelihood alternatives that they would prefer if they were given the opportunity.
A qualitative cross-sectional study was conducted to gather empirical information on e-waste workers’ knowledge about the potential hazards associated with their work and the livelihood alternatives to e-waste recycling with a sample consisting of twenty all-male electronic waste workers at the Agbogbloshie scrap metal yard in Accra, Ghana.
Electronic waste workers at Agbogbloshie were found to be exposed to a variety of injuries and illnesses. The workers’ knowledge of the association between their health status and their work was generally poor. Apart from the physical injuries, they did not believe their work played any negative role in their health conditions. They preferred occupations such as farming or professional driving located in the northern region of Ghana to be closer to their families.
The study concludes that the low knowledge level of the workers on the hazards that are associated with their work has implications for them accepting technologies to protect them and the natural environment from contamination. It is therefore imperative for any intervention to consider the current low level of knowledge and actively educate the workers to raise their awareness level, taking into account the provision of opportunities for workers to acquire applicable skills for future employment in other fields.
This study demonstrates the importance of understanding the diffusion process in social media such as Twitter as an example of the relationship between new media platforms and health promotion interventions. Evidence-informed tweets were developed, pilot tested and distributed to all followers of the Ministry of Health’s Twitter account with the aim of influencing the agenda on road safety in Saudi Arabia. The dissemination pattern and influence of this health communication was assessed. We collected 70 tweets into two groups (29 intervention tweets and 41 additional supported tweets) extracted from the Tweetreach data set and then analysed them using Microsoft Excel and SPSS.
Using the concept of innovation/imitation as defined in the Bass Model, we classified retweeting by direct followers as innovation and retweeting by users who were not followers as imitation. In the study, we identify an informative indicator of successful diffusion and propose a novel procedure to measure innovation/imitation coefficients (p and q). We also provided a statistical procedure for evaluating tweet adoption by innovators (influentials) and imitators. In addition, we also assessed the use of message design tools for new media messages. The resulting information can be used to improve public health and health promotion interventions at the levels of planning, design, implementation and evaluation.
Couples HIV counselling and testing (CHCT) is a key preventive strategy used to reduce the spread of HIV. In Uganda, HIV prevalence among married or cohabiting couples is 5.6%, compared to 2.2% among those never married. CHCT can help ease disclosure of HIV positive status, which in turn may help increase opportunities to obtain social supports and reduce new infections. The purpose of this study was aimed at exploring the possible reasons for the low uptake of CHCT in Mukono district, a rural in setting in Uganda.
The study was conducted in two sub-counties in a rural district (Mukono district) using a descriptive qualitative research design. Specifically, we conducted four focus group discussions and 10 key informant interviews. We also interviewed 53 individuals in couple relationships. Data were collected mainly in the local language Luganda and English, all data were transcribed into English and coded for emergent themes. Ethical clearance for this study was obtained from the Mengo Hospital Research Review Board and from the Uganda National Council of Science and Technology.
Fear of a positive HIV test result emerged strongly as the most significant barrier to CHCT. To a lesser extent, perceptions and knowledge of CHCT, mistrust in marriages and culture were also noted by participants as important barriers to the uptake of CHCT among couples. Participants offered suggestions on ways to overcome these barriers, including peer couple counselling, offering incentives to couples that test together and door-to-door CHCT testing.
In an effort to improve the uptake of CHCT, it is crucial to involve both females and males in the planning and implementation of CHCT, as well as to address the misconceptions about CHCT and to prioritise CHCT within health care systems management.
The purpose of this article is to examine the effect of a school-based nutrition intervention using an ecological approach to improve adolescents’ nutrition-related knowledge, attitudes and behaviour in rural China.
A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to the school that was conducting a holistic school-based intervention using health-promoting school (HPS) framework, ‘HPS School’, or to the ‘Control School’ in Mi Yun County, Beijing. From each school we randomly selected 65 seventh-grade students to participate in the study. Their nutrition-related knowledge, attitudes and behaviour were measured by pre- and post-intervention surveys with the same instrument. The nutrition intervention lasted for six months.
Adolescents in the intervention school were more likely to know the nutrition knowledge items, with an odds ratio (OR) ranging from 1.86 (95% confidence interval (CI): 1.11–3.09) to 6.34 (95% CI: 3.83–10.47); more likely to think nutrition is very important to health, developing healthy dietary habits is very important, and that expired foods should be thrown away, with ORs of 3.03 (95% CI: 1.60–5.76), 2.76 (95% CI: 1.66–4.59) and 2.35 (95% CI: 1.33–4.17) respectively, and more likely to consume no soft drinks, desserts or fried food, and to eat vegetables every day of the last week, with ORs of 1.99 (95% CI: 1.31–3.04), 3.96 (95% CI: 2.43–6.46), 3.63 (95% CI: 2.26–5.85), and 2.51 (95% CI: 1.41–4.48) respectively, as compared with those in the control school after interventions.
Our intervention using the HPS framework, an ecological approach, was an appropriate model to promote nutrition among adolescents in rural China and its use should be advocated in future school-based nutrition promotion programmes for adolescents.
The aim of this pilot study was to examine the impact of a brief physical activity intervention on adolescents’ subjective sleep quality. Cross-sectional studies indicate that physically active adolescents have better subjective sleep quality than those with more sedentary habits. However, less is known about the effectiveness of physical activity interventions in improving adolescents’ subjective sleep quality.
In a three-week physical activity intervention, four Icelandic upper secondary schools were randomized to either an intervention group with pedometers and step diaries or a control group without pedometers and diaries. Out of 84, a total of 53 students, aged 15–16 years, provided complete data or a minimum of two days step data (out of three possible) as well as sleep quality measures at baseline and follow-up. Subjective sleep quality, the primary outcome in this study, was assessed with four individual items: sleep onset latency, nightly awakenings, general sleep quality, and sleep sufficiency. Daily steps were assessed with Yamax CW-701 pedometers.
The intervention group (n = 26) had significantly higher average step-count (p = 0.03, partial 2 = 0.093) compared to the control group (n = 27) at follow-up. Subjective sleep quality improved (p = 0.02, partial 2 = 0.203) over time in the intervention group but not in the control group.
Brief physical activity interventions based on pedometers and step diaries may be effective in improving adolescents’ subjective sleep quality. This has important public health relevance as the intervention can easily be disseminated and incorporated into school curricula.
This study explores the effectiveness of a multifaceted intervention featuring a combination of tailored print and video (TPV) and peer education on improving the hand-washing skills and behaviors of migrant workers in the capital city of China. In the control group, supportive measures in both policy and environment were adopted. In addition, the intervention group received TPV and peer education. A total of 1496 participants were involved in the baseline and evaluation survey. The results showed that the participants experienced significant changes in developing health behaviors and skills as a whole after the intervention. The intervention effectiveness of hand-washing skills on vendors was relatively small compared with those on restaurant waiters and waitresses (44.3% and 87.2%, respectively). About 81.2 percent of the participants always forgot to carefully wash their thumbs and 81.8 percent failed to properly clean the back of their hands. The multifaceted intervention of this study has helped in improving the hand-washing skills and behaviors of migrant workers. Key steps should be strengthened to enhance the intervention effect. Moreover, the elderly should be given more attention with regards to hand-washing skills.
Despite evidence supporting the ongoing provision of health education interventions in First Nations communities, there is a paucity of research that specifically addresses how these programs should be designed to ensure sustainability and long-term effects. Using a Community-Based Research approach, a collective case study was completed with three Canadian First Nations communities to address the following research question: What factors are related to sustainable health education programs, and how do they contribute to and/or inhibit program success in an Aboriginal context? Semi-structured interviews and a sharing circle were completed with 19 participants, including members of community leadership, external partners, and program staff and users. Seven factors were identified to either promote or inhibit program sustainability, including: 1) community uptake; 2) environmental factors; 3) stakeholder awareness and support; 4) presence of a champion; 5) availability of funding; 6) fit and flexibility; and 7) capacity and capacity building. Each factor is provided with a working definition, influential moderators, and key evaluation questions. This study is grounded in, and builds on existing research, and can be used by First Nations communities and universities to support effective sustainability planning for community-based health education interventions.
Youth living in rural Uganda represent over 20% of the country’s population. Despite the size of this demographic, there is a paucity of data on their health priorities. Engaging people in understanding their own health status has been proven to be an effective mechanism for health promotion. The objective of this study was to use Photovoice, a community-based, participatory action research methodology, to understand the current health priorities of youth living in rural Uganda. Thirty-two students between the ages of 13 and 17 were recruited from four schools within the region of Soroti, Uganda. Participants were given a disposable camera and were asked to photograph situations that contributed or detracted from their health status. The cameras were then returned to the investigators and each photo taken by the participant was reviewed with the investigators during a semi-structured interview. Codes were applied to the photographs and organized into overarching themes. Each participant chose one to two photos that were most representative of their health priorities for a secondary analysis. Participants provided 499 photos that met the eligibility criteria. The most common themes presented in the photographs were ‘hygiene’ (n = 73, 12.4%), ‘nutrition’ (n = 69, 11.7%), and ‘cleanliness’ (n = 48, 8%). ‘Hygiene’ (n = 6, 14.6%) and ‘exercise’ (n = 6, 14.6%) were the most common priorities articulated in the representative photographs. Photovoice proved to be an effective method to assess and express the health concerns of youth in rural Uganda. Study participants were able to articulate their health concerns and priorities through photographs and reflect on opportunities for health promotion through subsequent interviews.
In recent decades, China has experienced an exponential growth in the number of internet users, especially among the youngest population, as well as a rapid proliferation of Western-type fast food restaurants. The health consequences of internet availability and fast food consumption among youth have been largely studied in Western countries, but few studies have focused on China.
This paper has two goals. The first is to evaluate the differences in new media exposure and preferences for fast foods between rural and urban areas. The second goal is to test the association between new media exposure and fast food consumption. The targets of this analysis are Chinese children and adolescents aged 6–18 attending school at the time of the interview.
Research hypotheses were tested using mean-groups comparisons for differences between rural urban sub-samples, and logistic regressions with odds ratios to estimate the relationship between media exposure and preferences towards fast foods. Cross-sectional data from the 2009 China Health and Nutrition Survey were employed.
Watching online videos and playing computer games are behaviors associated with higher probabilities of eating at fast food restaurants in both rural and urban young residents, with higher odds in rural areas. Surfing the internet is associated with higher odds of being overweight in both rural and urban settings. Results also show that children living in rural areas spend significantly more time playing computer games, watching TV and videotapes, but less time doing homework than their urban peers.
This paper suggests that monitoring the nutritional effects of new media exposure in China is of key importance in order to develop adequate health promotion policies, in both rural and urban areas.
Depuis le rapport de la Commission sur les Déterminants Sociaux de la Santé, plusieurs pays ont commencé à intégrer à leurs plans de santé la question des déterminants et de leur impact sur les inégalités de santé. En France, la création des Agences Régionales de Santé en 2009 est considérée comme une opportunité pour agir sur les inégalités sociales de santé (ISS) avec les instances régionales, départementales et locales qui détiennent les leviers appropriés. A la suite d’une analyse thématique des projets régionaux de santé, visant à identifier l’intégration des ISS ainsi que les approches retenues pour les aborder, quatre régions ont été étudiées plus finement. Des entretiens collectifs et individuels (N = 45 interviewés) ont été menés auprès d’acteurs de terrain et institutionnels, afin de mieux comprendre et identifier les types de programmes et processus pour réduire les ISS. Nos analyses font ressortir une prise en compte généralisée des ISS dans les documents de planification et de programmation des instances régionales, des stratégies régionales qui restent centrées sur les populations vulnérables avec une faible considération du gradient social, l’existence d’instances de concertations intersectorielles dans les quatre régions qui constituent un potentiel de gouvernance important à mieux exploiter, l’existence de modalités de suivi et d’évaluation des ISS qui restent à consolider, et une forte mobilisation de plusieurs secteurs dans les processus régionaux de consultation des publics et des acteurs, mais des résultats variables, souvent reliés au niveau de ressources investies et des approches privilégiées. L’analyse de ces expériences francaises démontre un intérêt croissant pour l’action sur les déterminants sociaux de la santé et les ISS ; mais leur opérationnalisation, toujours en cours, appelle à des analyses plus fines qui permettront de mieux éclairer les politiques publiques.
Le Burkina Faso met en œuvre depuis plusieurs années la stratégie de la participation communautaire. Des comités de gestion (CoGes) ont été mis en place dans les centres de santé de la première ligne et doivent participer aux prises de décisions. L’objectif principal de cette stratégie est de favoriser l’utilisation des services de santé et une adhésion massive des communautés aux activités de promotion de la santé. Seulement, on constate que les résultats escomptés par les autorités sanitaires tardent à se réaliser. Le présent article convoque les facteurs liés au contexte socioculturel du district sanitaire, pour analyser le phénomène de la participation communautaire.
L’étude s’est déroulée dans le district sanitaire de Tenkodogo, situé dans la région administrative du Centre-est, à environ 190 km de la capitale. Cette étude exclusivement qualitative, a utilisé deux méthodes de collecte : les entretiens individuels et les focus groups. Les participants à l’étude sont les chefs de ménage (n = 48), les membres des CoGes (n = 10), les agents de santé (n = 8) et les agents de santé communautaire (n = 24). La méthode de l’analyse de contenu a été utilisée pour l’analyse des données.
Les résultats de l’étude montrent que plusieurs facteurs socioculturels influencent la dynamique de la participation communautaire dans le district. Ce sont les conditions économiques, la perception négative des services de santé, les inégalités sociales de sexe et d’âge, le faible ancrage social des organisations communautaires, les rivalités inter-villages et les conflits coutumiers. L’étude relève également que les communautés ne percoivent pas leur implication dans le processus décisionnel des services de santé comme une priorité. Leurs principales attentes s’orientent vers la disponibilité de soins de qualité et à coût réduit.
Myopia, the most common refractive error, is the most common cause of avoidable visual impairment among children and has reached epidemic proportions among children and young adults in urban areas of East and Southeast Asia that contain populations of Chinese ancestry. Moreover, vision health is an important theme of the health-promoting school program issued by the Ministry of Education in Taiwan. The aim of this study is to assess the impact of pre- and post-intervention proposed by the health-promoting school (HPS) model. The objectives are to understand whether the HPS model influenced the vision screening results and the attitude, knowledge level, and vision care behavior of the students involved. A prospective cohort study design was used to evaluate a vision health program. Four elementary schools, local education authorities, and one university in northern Taiwan established a coalition partnership to design a six-month program to combat myopia among students. The target population was 6668 school children from local elementary schools. For the purpose of this study, the outcome of visual acuity testing (in logMAR) was analyzed with a sampling of 373 school children (aged 11–12 years old) who were chosen from high prevalence of poor vision classes. After the HPS program, the attitudes, behaviors, and knowledge levels of the school children regarding vision health were significantly improved. The pre-intervention mean logMAR of all participating students (N = 373) was –.10, which increased to –.19 after the intervention. Analysis using the Wilcoxon signed-rank test showed that the logMAR value was significantly improved after the intervention (t = 2.13, p < 0.05). Our findings highlight the relevance and effectiveness of the coalition’s efforts, which reinforces the usefulness of co-operatively implementing the HPS program.
Globalization has resulted in an influx of migrant families from rural provinces into the urban areas of China. Although the migrant population may live in the same cities as urban residents, they experience different lives because of restricted access to job opportunities, social services, and schools for children. Limited research exists with Chinese rural-to-urban migrant youth, particularly using community-based approaches. This study explored migrant youths’ perceptions of their nutrition, physical activity, and health environment, using the community-based participatory research method of photovoice. Twelve migrant youth (6 boys and 6 girls) in Beijing, China, participated in two photovoice assignments focused on personal safety, nutrition, and physical activity. The photographs taken by the youth guided group discussions and semi-structured interviews. Inductive and deductive processes were used to identify codes (ideas emerging from text); similar codes were grouped into themes. Pedestrian safety was the most common personal safety concern. Another safety issue was the excess garbage in the community. Garbage was also a barrier to nutrition and physical activity as it was a food sanitation concern and limited the physical environments where children could play. Schools and community recreation centers were perceived as facilitators of physical activity. However, community centers were also a barrier as a limited number of them caused overcrowding, resulting in safety concerns. Photovoice enables youth to express their health perceptions. Our data provide interesting preliminary insight into the lives of Chinese migrant youth, which could help inform the development of interventions and advocate for positive environmental changes for this marginalized population.
West Nile Virus (WNV) has been reported as one of the worst epidemics in US history. This study sought to understand how WNV news stories were framed and how risk information was portrayed from its 1999 arrival in the US through the year 2012. The authors conducted a quantitative content analysis of online news articles obtained through Google News (N = 428). The results of this analysis were compared to the CDC’s ArboNET surveillance system. The following story frames were identified in this study: action, conflict, consequence, new evidence, reassurance and uncertainty, with the action frame appearing most frequently. Risk was communicated quantitatively without context in the majority of articles, and only in 2006, the year with the third-highest reported deaths, was risk reported with statistical accuracy. The results from the analysis indicated that at-risk communities were potentially under-informed as accurate risks were not communicated. This study offers evidence about how disease outbreaks are covered in relation to actual disease surveillance data.
In the field of development cooperation, interest in systems thinking and complex systems theories as a methodological approach is increasingly recognised. And so it is in health systems research, which informs health development aid interventions. However, practical applications remain scarce to date. The objective of this article is to contribute to the body of knowledge by presenting the tools inspired by systems thinking and complexity theories and methodological lessons learned from their application. These tools were used in a case study. Detailed results of this study are in process for publication in additional articles. Applying a complexity ‘lens’, the subject of the case study is the role of long-term international technical assistance in supporting health administration reform at the provincial level in the Democratic Republic of Congo. The Methods section presents the guiding principles of systems thinking and complex systems, their relevance and implication for the subject under study, and the existing tools associated with those theories which inspired us in the design of the data collection and analysis process. The tools and their application processes are presented in the results section, and followed in the discussion section by the critical analysis of their innovative potential and emergent challenges. The overall methodology provides a coherent whole, each tool bringing a different and complementary perspective on the system.
Like most countries in sub-Saharan Africa, hypertension contributes substantially to morbidity and mortality in Ghana, yet nationally representative studies that examine the odds of becoming hypertensive among Ghanaians are conspicuously missing. We aimed to fill this void in the literature. The data used for analysis came from the first wave of the Study on Global Ageing and Adult Health (SAGE), collected in Ghana from January 2007 to December 2008 by the World Health Organization (WHO). A total of 5573 respondents were sampled for the study. Random-effects C-log-log models were employed in examining socio-economic, lifestyle and psychosocial factors on the odds of becoming hypertensive in Ghana. Separate models were run for male and females. Results indicated there were strong significant associations between socio-economic, lifestyle and psychosocial factors on the likelihood of becoming hypertensive, among Ghanaian men and women. Compared with the poorest, Ghanaians from wealthy households were significantly more likely to be hypertensive. Educated women, as compared with the uneducated, were also more likely to be hypertensive. Ghanaians who engaged in vigorous or intensive activities continuously, for at least 10 minutes, were significantly less likely to be hypertensive, compared to those who did not. Happier men had lower odds of becoming hypertensive, and depressed women had increased odds of reporting they were hypertensive.
In Brazil, although many children from low income families attend day care centers with appropriate hygiene practices and food programs, they have nutritional disorders and communicable diseases. This quantitative and qualitative cross-sectional study identified staff challenges in child day care centers and suggested alternative activity management to prevent nutritional disorders and communicable diseases. The study included 71 nursery teachers and 270 children from public and philanthropic day care centers (teacher to child ratios of 1:2.57 and 1:6.40, respectively). Interviews and focus groups were conducted with teachers and parents, and anthropometry and blood samples were drawn from the children by digital puncture. Children in philanthropic child day care centers were more likely to be hospitalized due to communicable diseases. Teachers from philanthropic child day care centers had lower age, income and education and higher work responsibilities based on the number of children and working time. The focus groups characterized institutions with organized routines, standard food practices, difficulties with caretaking, and lack of training to provide healthcare to children. Strategies to improve children’s health in day care settings should focus on training of teachers about healthcare and nutrition.
Researchers using an achievement goal theory and caring climate framework have highlighted the connection between fitness center members’ climate perceptions and their exercise motivation. However, much of what is known comes from current members, with little known about former and non-members’ perceptions. The purpose of this study was to compare current, former, and non-members’ perceptions of the motivational climate of a university campus fitness facility. Faculty and staff (N = 657) at a large American university completed a one-time mixed-methods survey about their perceptions of the motivational climate (i.e. caring climate; preference for caring, task-, ego-involving climate), staff behaviors (i.e. caring, task involving), and usage of their campus fitness facility. Despite usage, quantitative analyses indicated that all participants reported valuing a caring, task-involving climate over a non-caring, ego-involving climate when choosing a fitness center. When asked about the particular fitness center for this study, current members were more likely than former and never users to perceive a caring climate where staff engaged in task-involving behaviors. Content analysis of the qualitative comments revealed that three main themes emerged with regard to perceptions and fell into positive, negative, and neutral categories. Overall, current users were more likely to perceive caring behaviors among the staff such as taking measures to welcome members and supporting their individualized goals. Former and never users were more likely to perceive staff as unhelpful, unwelcoming, and unfriendly. In an effort to remove barriers to physical activity, fitness professionals should consider how their behaviors, interactions, and promotional materials impact individuals’ decision of whether to exercise at their fitness facility. The findings include a discussion for fitness staff to consider when creating advertisement and outreach efforts as well as how to foster the most effective climate to attract and retain exercisers.
Physical inactivity is the fourth most important risk factor contributing to global non-communicable disease (NCD) deaths, occurring in high-, middle- and low-income countries. Building capacity in NCD prevention is a daunting task, and toward this end, an introductory open online course about physical activity (PA), exercise, and NCD prevention was developed. This was led by academics from the University of Sydney and the WHO Collaborating Centre for Physical Activity, Nutrition and Obesity. The course was designed to address the needs of participants from areas where geography and economy would often prevent them from participating in NCD training programs.
Around 120 participants from four continents signed up for the six-week online course, with the greatest numbers from the host country (Australia) followed by participants from Pacific Island nations and from the Middle East. The course consisted of video lectures, quizzes, and online discussions facilitated by experts.
More than a third of the participants fully completed the course, which received very positive participant evaluations. This also included completion of relevant quiz questions on each section of the PA course, and averaged over 70% correct responses.
This successful online course has the potential to increase knowledge and skills about PA and prevention, as part of building global capacity in NCD prevention at low cost, and importantly within easy reach of potentially isolated practitioners.
Unplugged is a school-based prevention programme designed and tested in the EU-Dap trial. The programme consists of 12 units delivered by class teachers to adolescents 12–14 years old. It is a strongly interactive programme including a training of personal and social skills with a specific focus on normative beliefs. The aim of this work is to define the theoretical model of the program, the contribution of the theories to the units, and the targeted mediators. The programme integrates several theories: Social Learning, Social Norms, Health Belief, theory of Reasoned Action-Attitude, and Problem Behaviour theory. Every theory contributes to the development of the units’ contents, with specific weights. Knowledge, risk perception, attitudes towards drugs, normative beliefs, critical and creative thinking, relationship skills, communication skills, assertiveness, refusal skills, ability to manage emotions and to cope with stress, empathy, problem solving and decision making skills are the targeted mediators of the program.
In 2010, the global adult tobacco survey (GATS) for India revealed that nearly 40% of current smokers and 42% of current chewers had initiated tobacco use before they were of the legal age (18 years old or over). Global evidence shows that those who initiate earlier have a lower probability of quitting the use of tobacco during their lifetime. In order to sustain its profits, the tobacco industry will make every effort to recruit underage users who become lifelong users of their products.
We estimate the consumer expenditure on tobacco products by underage users in India.
Using nationally representative data we estimated the number of daily underage tobacco users for a year and their annual expenditure on different types of smoked and chewed tobacco products.
There are nearly 4.4 million underage daily tobacco users (age group 15–17 years old) in India. Approximately 7.2% of the population in the 15–17 age group are current daily users of tobacco (0.1% cigarette smokers, 0.5% bidi smokers and 6.6% tobacco chewers). Underage users spend nearly US$16.9 million and US$270.8 million respectively on smoking and chewing tobacco products.
There is a substantial expenditure on tobacco products by underage individuals in India. A significant number of new users are added every year that provide an estimate for the size and nature of the future of the tobacco epidemic, one on which the tobacco industry depends on for its sustenance. The government of India’s efforts to reduce sale to underage users has had limited effect and needs to be strengthened.
To assess and explore the relationship between the health information (HI)-related attitudes and skills of patients with chronic disease in China.
A questionnaire was developed to measure the participants’ HI-related attitudes and skills. The study included all participants (N = 1671) undergoing routine physical examinations at the Health Management Centre, Third Xiangya Hospital of Central South University, Changsha, Hunan province, from September to November 2013. The Kruskal–Wallis test was used to assess the impacts of social demographic factors and chronic disease conditions on the patients’ HI-related attitudes and skills. Multiple linear regression and bivariate correlation analyses were adopted to explain the relationship between attitudes and skills.
The chronic disease patients clearly know that HI was valuable for their health, but their general HI-related skills were inadequate, particularly for elderly and undereducated patients. Additionally, the participants’ HI attitudes positively correlated with their HI-related skills (r = 0.47, p < 0.001). Because the attitudes ascended by grade (i.e. negative, moderate, and active), the HI-related evaluation, expression and comprehension, and seeking skills categories increased by 11%, 5.3%, and 8.4%, respectively.
Although the chronic disease patients held explicit and active attitudes towards HI, their skills were unsatisfactory. Attitudes and skills, however, present a positive relationship. These results suggest that training in HI-related skills should be the main goal of health literacy promotion in patients who suffer from long-term chronic diseases, particularly elderly and undereducated patients. However, cultivating an active attitude towards HI is important to improve HI-related skills.
Women’s health is a public health priority. The origins of health inequalities are very complex. The present study was conducted to determine the association between social capital and health status in reproductive-age women in Tehran, Iran. In this population-based, cross-sectional study, the Social Capital Integrated Questionnaire, the SF-36 and socio-demographic questionnaires were used. Analysis of data by one-way ANOVA test and stepwise multiple linear regression showed that the manifestation dimensions of social capital (groups and networks, trust and solidarity, collective action and cooperation) can potentially lead to the outcome dimensions of social capital (social cohesion and inclusion, and empowerment and political action), which in turn affect health inequities after controlling for socio-demographic differences.
The importance of salutogenesis, with the focus of what creates health rather than what causes diseases, has been highlighted for a long time. This has been operationalized by Aaron Antonovsky as the Sense of Coherence (SOC-13) scale. The aim of this study was to further examine the psychometric properties of the SOC-13 in India.
The present study was carried out among second-year degree students at three randomly chosen institutions at Mangalore University. Investigators assessed the appropriateness, relevance, comprehensiveness and understandability of the scale. Further, the scale was assessed by five subject experts. The SOC-13 was then pretested by administering it to peers, individuals and a few of the study subjects. Internal consistency was assessed by Cronbach’s alpha and split-half reliability. Test-retest reliability was assessed by administering the instrument to the same study participants after two weeks. Confirmatory factor analysis employing varimax rotation was employed.
The SOC-13 revealed a Cronbach’s alpha value of 0.76. Split-half reliability and Guttman split-half reliability were found to be 0.71 and 0.70, respectively. Test-retest reliability was found to be 0.71 (p < 0.01). Factor analysis revealed a three-factor solution explaining 40.53% of the variation in SOC.
SOC-13 was found to be a reliable and valid instrument for measuring SOC in an Indian context. The present study contributes to health promotion in an Indian context, and could be useful even in other developing countries and for further research in India.
Student-school connectedness is inversely associated with multiple health risk behaviors, yet research is limited on the relative contributions of a student’s connectedness with school and an overall context of school social cohesion to peer victimization/bullying.
We examined associations of perceived school cohesion and student-school connectedness with physical victimization, verbal victimization, and social exclusion in the past six months in adolescents in grades 6–11 (N = 774) attending 11 public and private urban schools in Colombia.
Cross-sectional data were collected via a self-administered questionnaire and analyzed using mixed-effects linear regression models.
Higher perceived school cohesion was inversely related with exposure to three bullying types examined (p < 0.05); student-school connectedness was negatively related to verbal victimization among girls only (p < 0.01). In full models, school cohesion maintained inverse associations with three bullying types after controlling for student-school connectedness (p ≤ 0.05).
Enhancing school cohesion may hold benefits for bullying prevention beyond a student’s individual school connectedness.
L’Evaluation d’Impact sur la Santé (EIS) se développe au niveau international et est encore au stade émergent en France. Elle vise à évaluer les effets positifs et négatifs potentiels d’un projet, d’un programme ou d’une politique sur la santé. L’objectif est de produire des recommandations en direction des décideurs, afin d’en maximiser les effets positifs et d’en diminuer les effets négatifs. L’EIS est un moyen particulièrement intéressant d’action sur les déterminants de la santé au-delà des comportements individuels et du système de santé. Les politiques de logement, de transport, de solidarité, économiques, etc. ont, en effet, des impacts souvent non prévus sur la santé. Au-delà des effets sur la santé, l’EIS doit aussi permettre d’apprécier la distribution de ces effets dans la population.
Si la préoccupation pour l’équité en santé est centrale dans l’EIS, elle reste cependant difficilement traduite en pratique. Face à cette difficulté, des démarches d’évaluation d’impact ont été développées pour renforcer la prise en compte de l’équité à chaque étape de l’EIS ou « Equity Focused Health Impact Assessment », ou prendre en compte les impacts sur les inégalités de santé de façon spécifique. Ainsi, l’Evaluation de l’Impact sur l’Equité en Santé (EIES) semble, par exemple, particulièrement intéressante pour évaluer l’impact sur les inégalités de projets dans le champ sanitaire.
L’EIS et l’EIES posent de nombreuses questions de recherche, notamment autour de la réunion, dans une même démarche, du politique, du citoyen et de l’expert. La participation des populations vulnérables potentiellement affectées par la politique évaluée est une valeur centrale de l’EIS, mais pose des questions d’acceptabilité sociale. La collaboration avec les décideurs politiques est également un enjeu majeur. Les difficultés méthodologiques, notamment de quantification des impacts, peuvent constituer des freins à la promotion de la démarche auprès des décideurs.
Despite the known benefits of physical activity, very few people, especially women, are found to engage in regular physical activity. This study explored the perceptions, barriers and facilitators related to physical activity among women in Thiruvananthapuram City, India.
Four focus group discussions were conducted among individuals between 25 and 60 years of age, in a few areas of Thiruvananthapuram City Corporation limits in Kerala, preparatory to the design of a physical activity intervention trial. An open-ended approach was used and emergent findings were analyzed and interpreted.
Women associated physical activity mostly with household activities. The majority of the women considered their activity level adequate, although they engaged in what the researchers concluded were quite low levels of activity. Commonly reported barriers were lack of time, motivation, and interest; stray dogs; narrow roads; and not being used to the culture of walking. Facilitators of activity were seeing others walking, walking in pairs, and pleasant walking routes. Walking was reported as the most feasible physical activity by women.
Physical activity promotion strategies among women should address the prevailing cultural norms in the community, and involve social norming and overcoming cultural barriers. They should also target the modifiable determinants of physical activity, such as improving self-efficacy, improving knowledge on the adequacy of physical activity and its recommendations, facilitating goal-setting, and enhancing social support through peer support and group-based activities.
Growing evidence supports engagement in physical exercise throughout life for optimal bone health. However, promotion of physical exercise among premenopausal women presents significant challenges, which are yet to be addressed in the design of many bone-health exercise regimes. As a deviation from traditional, facility-based, supervised, long-duration and intense exercise regimes, the efficacy of short-duration, practical, lifestyle physical exercises for improving bone health and quality of life was examined.
Premenopausal women (N = 96, mean age 22.25 ± 3.5 years; mean BMI 23.43 ± 3.5 kg/m2) participated in a 6-month randomised trial of lifestyle physical exercises for the intervention group and sham exercises for the control group. The participants’ scores on the outcome measure SF-36 was accessed pre- and post-intervention and compared with general population norms according to the SF-36 scoring manual. Paired t-tests were used to examine changes within trial arms from baseline to post-intervention, while analysis of covariance was performed to examine the effect of the lifestyle exercise programme on quality of life of premenopausal women.
Compared to 51% at baseline, 63% of the participants were either at or above the general population norm for general health, and the percentage of participants who were below the population health norm for mental health was reduced from 46% at baseline to 38% post-exercise intervention. Comparable improvements in quality of life were found in both trial arms post-participation in the bone-health promotion programme.
Bone-health exercises, when implemented as easily adoptable, lifestyle physical activity, may also enhance the quality of life of premenopausal women. Hence, a practical lifestyle approach to exercise may offer a much-needed public health strategy for bone-health promotion among women.
Many nongovernmental organizations in Africa rely on grassroots volunteers to provide critical health services. Considering context and the interplay of individual, organizational, and societal influences on the experience of volunteers, this paper addresses three questions: What do grassroots volunteers contribute? What organizational processes promote volunteer engagement? What are the positive and negative consequences of volunteering? Eighteen members and staff of the Tanzanian HIV and AIDS NGO, KIWAKKUKI, were selected from 6000+ women volunteers to be interviewed. The interviews were recorded, transcribed, and analyzed for themes. Within KIWAKKUKI, volunteers contributed time and local knowledge, leading to an indigenous educational approach building on local norms and customs. Volunteers’ engagement was motivated by the desire to support family members, reverse stigma, and work/socialize with other women. Benefits to volunteers included skills acquisition and community recognition; yet some volunteers also reported negative experiences including burnout, conferred stigma, and domestic violence. Positive organizational processes built on cultural practices such as collective decision-making and singing. The findings point to important considerations about context, including the synergistic effect training can have on local traditions of caring, complications of gender inequity, and how community health planning processes may need to be modified in extremely poor settings. This research also suggests good utility of the research framework (the Bergen Model of Collaborative Functioning) that was used to analyze volunteer engagement for service delivery in sub-Saharan contexts.
The failure to simultaneously address two objectives (increasing the average health of the population and reducing health inequalities) may have led to what has been observed in France so far: an overall decrease in mortality and increase in inequality.
The Apprendre et Agir pour Réduire les Inégalités Sociales de Santé (AAPRISS) methodology is to analyze and modify interventions that are already underway in terms of their potential impact on health inequalities. It relies on partnership between researchers and actors in the health field, as well as policy makers. In this paper, we describe the program and discuss its feasibility and acceptability.
This program is not a single intervention, but a process aiming at assessing and reshaping existing health programs, therefore acting as a kind of meta-intervention. The program develops scientific and methodological support stemming from co-construction methods aimed at increasing equity within the programs. Stakeholders from prevention policy-making and the health care system, as well as researchers, collaborate in defining interventions, monitoring their progress, and choosing indicators, methods and evaluation procedures. The target population is mainly the population of the greater Toulouse area. The steps of the process are described: (1) establishment of AAPRISS governance and partnerships; (2) inclusion of projects; and (3) the projects’ process.
Many partners have rallied around this program, which has been shown to be feasible and acceptable by partners and health actors. A major challenge is understanding each partner’s expectations in terms of temporality of interventions, expected outcomes, assessment methods and indicators. Analyzing the projects has been quite feasible, and some modifications have been implemented in them in order to take inequalities in health into account.
This paper presents a global health education program using a ‘Teleconference’ approach. It provides examples of how technology can be used to deliver health education at the international level. Two international teleconferences about public health issues were conducted in 2013 and 2014 involving universities and public health institutions in Colombia, Dominican Republic, Costa Rica, Uganda, and the United States. More than 400 students, faculty, and community members attended these educational events. These teleconferences served as the medium to unite countries despite the geographical distances and to facilitate collaborations and networking across nations. Teleconferences are an example of effective technology-based health education and health promotion programs.
Health promoters who use the mass media to encourage people to change their health behaviours usually underestimate the importance of audience’s mental predispositions, which may determine their susceptibility to such influences. This paper presents research findings that show how some elements of an audience’s mentality are related to their attitudes towards healthy lifestyle promotion in the mass media (HLPMM). The research project, undertaken between 2007 and 2009, comprised: a qualitative study using in-depth interviews (N=30); a self-administered survey on a purposive sample (N=237) and a computer-assisted personal interview or interviewing (CAPI) survey on a representative sample of Polish adult population (N=934). The findings from the first two studies were used to construct a scale to investigate the attitude towards HLPMM. This scale was applied in a nation wide survey and, as a result, four dimensions of the attitude were identified: (1) appraisal of the idea of HLPMM; (2) appraisal of HLPMM practice; (3) propensity to receive media messages promoting healthy lifestyle and (4) propensity to avoid such messages. Moreover, the survey results confirmed the hypotheses whereby a higher degree of individualism, a higher degree of authoritarianism, a weaker demanding orientation and generalised trust are related to a more positive attitude towards HLPMM. The aforementioned relationships indicate that producers of media messages promoting a healthy lifestyle need to take account of their audience’s mentality, since knowledge of mental predispositions of the target audience may help them make the message more suitable for specific recipients.
Belgaum district of Karnataka state is well known for high production and consumption of tobacco in Southern India. This study aimed to investigate the rural population’s awareness of oral cancer, precancerous lesions and their risk factors. Data were collected via face to face interviews using a pretested and validated questionnaire. The questionnaire comprised two parts: part one had questions concerning socio-demographic data and part two consisted of 25 questions pertaining to people’s attitudes to and awareness of risk factors for oral cancer and precancerous lesions. One researcher interviewed participants and recorded the responses verbatim. Of the participants, 17% identified all the symptoms of oral cancer and 27.8% identified all the symptoms of oral precancerous lesions. Approximately 90% of the participants had never noticed statutory warnings on tobacco and alcohol products. Awareness was especially poor in people of lower socio-economic status. This study highlights a need for education concerning the risk factors for oral cancer, its clinical manifestations and the impact of adverse habits on long term health. Health education campaigns emphasizing oral cancer need to be integrated with broader public health messages.
The control of noncommunicable diseases (NCDs) was addressed by the declaration of the 66th United Nations (UN) General Assembly followed by the World Health Organization’s (WHO) NCD 2020 action plan. There is a clear need to better apply evidence in public health settings to tackle both behaviour-related factors and the underlying social and economic conditions. This article describes concepts of evidence-based public health (EBPH) and outlines a set of actions that are essential for successful global NCD prevention. The authors describe the importance of knowledge translation with the goal of increasing the effectiveness of public health services, relying on both quantitative and qualitative evidence. In particular, the role of capacity building is highlighted because it is fundamental to progress in controlling NCDs. Important challenges for capacity building include the need to bridge diverse disciplines, build the evidence base across countries and the lack of formal training in public health sciences. As brief case examples, several successful capacity-building efforts are highlighted to address challenges and further evidence-based decision making. The need for a more comprehensive public health approach, addressing social, environmental and cultural conditions, has led to government-wide and society-wide strategies that are now on the agenda due to efforts such as the WHO’s NCD 2020 action plan and Health 2020: the European Policy for Health and Wellbeing. These efforts need research to generate evidence in new areas (e.g. equity and sustainability), training to build public health capacity and a continuous process of improvement and knowledge generation and translation.
The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health ‘ignorance’ has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes ‘ignorance’, and that correcting such ‘ignorance’ will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization.
South Africa desperately needs a comprehensive approach to fight HIV/AIDS. Education is crucial to reach this goal and Internet and e-learning could offer huge opportunities to broaden and deepen the knowledge basis. But due to the huge societal and digital divide between rich and poor areas, e-learning is difficult to realize in the townships. Community health workers often act as mediators and coaches for people seeking medical and personal help. They could give good advice regarding hygiene, nutrition, protection of family members in case of HIV/AIDS and finding legal ways to earn one’s living if they were trained to do so. Therefore they need to have a broader general knowledge. Since learning opportunities in the townships are scarce, a system for e-learning has to be created in order to overcome the lack of experience with computers or the Internet and to enable them to implement a network of expertise. The article describes how the best international resources on basic medical knowledge, HIV/AIDS as well as on basic economic and entrepreneurial skills were benchmarked to be integrated into an e-learning system. After tests with community health workers, researchers developed recommendations on building a self-sustaining system for learning, including a network of expertise and best practice sharing. The article explains the opportunities and challenges for community health workers, which could provide information for other parts of the world with similar preconditions of rural poverty.
We aimed to provide process and effectiveness evaluations of a sex education intervention realized with interactive techniques in high schools of Pavia (Italy).
Six public high schools, divided into ‘treated’ and ‘control’ units, voluntarily joined this mixed-methods study. Only second-year classes were enrolled: treated adolescents followed a sex education course, performed by trained ‘near-peer educators’ (undergraduate medical students) with interactive techniques. All adolescents compiled an anonymous effectiveness evaluation questionnaire at baseline (pre-test) and 3 months later (post-test). Sexual knowledge and reported behavioural changes were compared between the two groups through linear mixed-effects models. The process was assessed through a satisfaction questionnaire for treated students, monitoring cards for working group members and cards/diaries for educators.
The final sample consisted of 547 treated and 355 control adolescents (mean age = 15.28 ± 0.61 years). Highly significant changes (p < 0.001) from pre-test to post-test, with strong improvements of treated adolescents, were evident for all knowledge items. No significant changes for behavioural items were reported. Process evaluation showed positive results in adolescents’ satisfaction, highlighting the need for more youth gathering places. Working group members and educators generally provided positive evaluations, although difficult communication was perceived.
The intervention was effective in improving adolescents’ sexual knowledge. The present work highlighted that in Italy sex education in adolescence is still neglected: this could encourage misinformation and health-risk behaviour. Young people perceive the need for a serious health-promoting action in which they could play an active role, spreading educational messages with organized interactive methods.
For some young people, nightclubs and other music venues are a major source of noise exposure, arising from a combination of very high noise levels; relatively long attendance duration; and frequent, sustained participation over several years. Responsibility for hearing protection is largely left to individuals, many of whom choose not to wear earplugs. In order to encourage earplug use in these settings, a new approach is needed. The aim of the study was to examine whether presentation of hearing health information would result in increased use of earplugs, or whether provision of earplugs alone would be sufficient to change behaviour. A total of 51 regular patrons of music venues were allocated to either a low-information (lo-info) or high-information (hi-info) group. Both groups completed a survey about their current noise exposure, earplug usage and perceived risk of hearing damage. Both groups were also provided with one-size-fits-all filtered music earplugs. The hi-info group was also provided with audio-visual and written information about the risks of excessive noise exposure. After 4 weeks, and again after an additional 12 weeks, participants were asked about their recent earplug usage, intention to use earplugs in the future, and perceived risk of hearing damage. The results showed that after 4 weeks, the hi-info group’s perceived personal risk of hearing damage was significantly higher than that of the lo-info group. After 16 weeks, these differences were no longer evident; however, at both 4 and 16 weeks, both the lo- and hi-info groups were using the earplugs equally often; and both groups intended to use earplugs significantly more often in the future. This suggests that the information was unnecessary to motivate behavioural change. Rather, the simple act of providing access to earplugs appears to have effectively encouraged young at-risk adults to increase their earplug use.
En Afrique, une part importante de la population est encore confrontée à plusieurs barrières pour accéder aux soins. Les mutuelles de santé (MS) sont mises en place pour réduire la barrière financière et assurer à leurs membres un accès à des soins de qualité. Les MS établissent des relations avec les prestataires de soins sous forme de contrat, dont certaines clauses peuvent contenir des notions de qualité des soins (QS). A travers une vue d’ensemble de la typologie de 180 MS de 14 pays (dans Afrique Ouest et Centrale), cet article vise à analyser dans quelle mesure les caractéristiques des MS influencent la mise en œuvre de mécanismes contractuels susceptibles de faciliter la discussion sur la QS. L’hypothèse de cette association a été étudiée avec trois types de caractéristiques (taille, utilisation des services et volume des soins achetés) et huit variables relatives à la contractualisation et la QS (existence d’un contrat, organisation de rencontres, fréquence de ces rencontres, présence de notions de QS dans le contrat, négociation du contrat, révision du contrat, révision des clauses spécifiques à la QS et organisation de rencontres pour discuter de QS).
Les MS de type communautaire représentent 80% des mutuelles étudiées (60% d’entre elles sont localisées en zone rurale). Les MS professionnelles représentent 17% et se concentrent principalement au Mali et en Côte d’Ivoire.
La quasi-totalité des MS disposent de contrats écrits et contenant des notions relatives à la QS. Bien que les MS de grande taille ayant des résultats financiers importants négocient plus les aspects liés à la qualité des soins lors de l’élaboration de la convention, les MS de taille et aux performances financières plus modestes mettent en œuvre des mécanismes plus réguliers de concertation avec les prestataires. Ces rencontres sont susceptibles de créer un espace de prise en charge de la QS.
The aim of this cross-sectional school-based study was to assess smoking prevalence, indicators for the smoking epidemic and determinants of smoking among Saudi adolescents.
The study included 695 male adolescents from 11 to 16 years of age who filled out self-report questionnaires based on the European Smoking Framework Approach questionnaire, which uses the I-Change model to assess attitude, social influence and the self-efficacy of the participants. Smokers were 275 (39.6%) adolescents. Smokers tended to receive more daily pocket money, live in more affluent families and show lower academic performance. Non-smokers were inclined to believe that smoking may help people to feel relaxed and confident, encountered less social influences to smoke than smokers, but reported low self-efficacy not to smoke when with smoker friends and when offered a cigarette. Smokers reported the lowest self-efficacy not to smoke in all situations assessed.
The results suggest the smoking epidemic among male Saudi adolescents may still be in the early stages, providing ample opportunity for preventive actions aimed at halting the further progress of this epidemic. Secondly, smoking prevention programs in Saudi Arabia need to reinforce non-smoking attitudes, address how to resist pressure to smoke, and how to develop high self-efficacy towards non-smoking in various situations.
To determine the effectiveness of a pragmatic health promotion program to improve the metabolic disorders in older workers in Taiwan, we conducted a 24-week quasi-experiment in three worksites in southern Taiwan in 2010. Among 1,245 workers, 108 met the inclusion criteria (full-time workers aged over 50 years) and agreed to participate in the study. They were assigned to either the intervention (n = 58) or the reference group (n = 50) according to their availability to participate in health-promoting activities. The intervention group received training in behavioral modifications to improve diet, time-use, stress management and physical activity. Motivational lectures, group activities, and team competitions were used to improve participants’ knowledge and skills in managing own health. Subjects in the reference group received no intervention. Lifestyle, anthropometric and biochemical indicators were measured at baseline and end-point. Mixed effects linear models were used to determine the intervention effects. The intervention significantly lowered body weight (intervention vs. reference = –1.22 vs. –0.30kg, p = 0.026), BMI (–0.46 vs. –0.02kg/m2, p = 0.006), and waist circumference (–2.68 vs. +0.79cm, p <0.001), but had no effect on biochemical parameters. These findings suggest the workplace-based health promotion can be effective and useful in reducing the risk of metabolic disorders in older workers in Taiwan.
This article introduces moral distress – the experience of painful feelings due to institutional constraints on personal moral action – as a significant issue for the international health promotion workforce. Our exploratory study of practitioners’ experiences of health promotion in Australia and Canada during 2009–2010 indicated that practitioners who work in upstream policy- and systems-level health promotion are affected by experiences of moral distress. Health promotion practitioners at all levels of the health promotion continuum also described themselves as being engaged in a minority practice within a larger dominant system that does not always value health promotion. We argue that health promotion practitioners are vulnerable to moral distress due to the values-driven and political nature of the practice, the emphasis on systems change and the inherent complexity and diversity of the practice. This vulnerability to moral distress poses significant challenges to both workers and organisations and the communities they seek to benefit. We propose that further research should be undertaken to fully identify the causes and symptoms of moral distress in health promotion. Extensive existing research on moral distress in nursing provides ample resources to conduct such research.
Many randomized controlled trials (RCTs) are conducted each year but only a small proportion is specifically designed for Indigenous people. In this review we consider the challenges of participation in RCTs for Indigenous peoples from New Zealand, Australia, Canada and the United States and the opportunities for increasing participation.
The literature was systematically searched for published articles including information on the barriers and facilitators for Indigenous people’s participation in health-related RCTs. Articles were identified using a key word search of electronic databases (Scopus, Medline and EMBASE). To be included, papers had to include in their published work at least one aspect of their RCT that was either a barrier and/or facilitator for participation identified from, for example, design of intervention, or discussion sections of articles. Articles that were reviews, discussions, opinion pieces or rationale/methodology were excluded. Results were analysed inductively, allowing themes to emerge from the data.
Facilitators enabling Indigenous people’s participation in RCTs included relationship and partnership building, employing Indigenous staff, drawing on Indigenous knowledge models, targeted recruitment techniques and adapting study material. Challenges for participation included both participant-level factors (such as a distrust of research) and RCT-level factors (including inadequately addressing likely participant barriers (phone availability, travel costs), and a lack of recognition or incorporation of Indigenous knowledge systems.
The findings from our review add to the body of knowledge on elimination of health disparities, by identifying effective and practical strategies for conducting and engaging Indigenous peoples with RCTs. Future trials that seek to benefit Indigenous peoples should actively involve Indigenous research partners, and respect and draw on pertinent Indigenous knowledge and values. This review has the potential to assist in the design of such studies.
Inspired by Photovoice, a participatory research methodology, I WAS HERE was a photoblogging workshop in Toronto, Canada, for young mothers who, when they joined, were either homeless or had past experience of homelessness. A participatory qualitative analysis process was developed to support workshop participants in collectively conducting qualitative analysis on a selection of their photoblogs exploring how they view their lives. Five mothers engaged in the participatory qualitative analysis process to categorize their photoblogs into themes. Participants selected over 70 of their personal photoblogs, discussed the meaning of their photoblogs, and categorized them into qualitative themes. One of the mothers continued work on the research by contributing to the write-up of the themes for publication. Participants, through the reflective dialogue, developed nine themes from the photoblogs that describe how they experience motherhood. The resulting nine themes were as follows: ‘Family’, ‘Reality Check’, ‘Sacrifice for Positive Change’, ‘Support’, ‘Guidance’, ‘Growth and Transition’, ‘Proud of Becoming/Being a Mother’, ‘Passing on/Teaching Values’ and ‘Cherished Moments/Reward for Being a Mother’. These themes illustrate the satisfaction that comes from motherhood, strengths and goals for the future, and the desire for support and guidance. The themes developed from this participatory analysis illustrate that young mothers have a positive view of themselves and their ability to be mothers. This constructive view of young mothers provides an alternative to the negative stereotypes commonly attributed to them. This paper also discusses the strengths and challenges of using a participatory analysis approach. As a research methodology, incorporating procedures for participatory qualitative analysis into the Photovoice process provides an effective mechanism to meaningfully engage participants in qualitative analysis. From a health promotion perspective, using the participatory analysis process expanded the Photovoice methodology to facilitate self-reflection and an empowering collective dialogue among a group of women whose strengths and assets are rarely showcased.
Aaron Antonovsky wrote extensively, although disjointedly, about the roles of culture in salutogenesis. This paper provides a synopsis of his work in this arena. A literature review identified those of his English language writings in which culture was a subject, and relevant text segments were analysed using an inductive followed by a deductive method. Using thematic network analysis, text segments were sorted inductively by open coding and then analysed. This was followed by deductive text segment coding guided by the constructs of the salutogenic model of health. The analysis revealed that Antonovsky had an expansive interest in the roles of culture in salutogenesis. His writings included attention to the role of culture in: (a) shaping life situations; (b) giving rise to stressors and resources; (c) contributing to life experiences of predictability, load balance and meaningful roles; (d) facilitating the development of the sense of coherence and (e) shaping perceptions of health and well-being. Antonovsky’s writings about culture were sometimes conjectural, as well as being obviously influenced by his life experience in the USA and then in Israel, and by the spirit of the times in which he lived. However, he also drew extensively on his own and others’ empiricism, leading him to view culture as an integral aspect of the salutogenic model of health. The present analysis provides salutogenesis scholars with a roadmap of Antonovsky’s reflections, ponderings and conclusions about culture in the context of salutogenesis. It provides assistance in the form of an overview of Antonovsky’s treatment of culture in the context of salutogenesis.
Over the last 25 years, the language of empowerment has been woven into the guiding missions and descriptions of institutions, funding and projects globally. Although theoretical understandings of empowerment within the domain of health promotion remain contentious, we have little idea of how a shift toward an empowerment agenda has affected the daily work of those in the field of health promotion. A systematic examination of the implementation of the empowerment agenda is important as it can help us understand how redistributive agendas are received within the multiple institutional contexts in which health promotion work is carried out. The goal of this study, therefore, was to try to understand the empowerment agenda within the context of everyday health promotion. We conducted semi-structured interviews with health promoters from a variety of geographical regions, institutional backgrounds, and job capacities. Essentially we found that empowerment remains conceptually dear to health promoters’ understanding of their work, yet at the same time, mainstreaming empowerment is at odds with central trends and initiatives that govern this work. We argue that many of the stumbling blocks that have hindered this specific agenda are actually central stumbling blocks for the wider field of health promotion. We examine some of the barriers to implementing transformational change. Overcoming the primary limitations uncovered in this exploration of empowerment is actually crucial to progressive work in health promotion in general, particularly work that would seek to lessen inequities.
Training health professionals in leadership and management skills is a key component of health systems strengthening in low-resource settings. The importance of evaluating the effectiveness of these programs has received increased attention over the past several years, although such evaluations continue to pose significant challenges. This article presents evaluation data from the pilot year of the Afya Bora Fellowship, an African-based training program to increase the leadership capacity of health professionals. Firstly, we describe the goals of the Afya Bora Fellowship. Then, we present an adaptation of the transtheoretical model for behavior change called the Health Leadership Development Model, as an analytical lens to identify and describe evidence of individual leadership behavior change among training participants during and shortly after the pilot year of the program. The Health Leadership Development Model includes the following: pre-contemplation (status quo), contemplation (testing and internalizing leadership), preparation – (moving toward leadership), action (leadership in action), and maintenance (effecting organizational change). We used data from surveys, in-depth interviews, journal entries and course evaluations as data points to populate the Health Leadership Development Model. In the short term, fellows demonstrated increased leadership development during and shortly after the intervention and reflected the contemplation, preparation and action stages of the Health Leadership Development Model. However, expanded interventions and/or additional time may be needed to support behavior change toward the maintenance stages. We conclude that the Health Leadership Development Model is useful for informing health leadership training design and evaluation to contribute to sustainable health organizational change.
La politique actuelle de lutte contre le sida qui repose sur l’extension de l’accès aux traitements et à la prévention exige qu’une proportion élevée de la population connaisse son statut en matière de VIH. Pour cela, l’OMS a proposé le développement de stratégies communautaires délivrant le dépistage et le conseil au-delà des services de soins, comme le test à domicile ou les campagnes de sensibilisation et dépistage de grande envergure, appliqués en Afrique australe et de l’Est. Pour définir les stratégies pertinentes dans des régions de basse prévalence comme l’Afrique de l’Ouest, les expériences communautaires de promotion du dépistage doivent y être évaluées. Cet article présente une évaluation des campagnes au Burkina Faso du point de vue des usagers. Dans le cadre d’un projet sur les pratiques et l’éthique du dépistage dans quatre pays africains (MATCH), une enquête qualitative spécifique a été menée pendant la campagne de 2008, auprès de personnes ayant fait le test pendant la campagne, ayant fait le test hors campagne ou n’ayant pas fait le test. Les appréciations sont globalement très favorables aux campagnes, notamment à cause de l’information dispensée, l’accessibilité des sites, la gratuité du test, la qualité des services et l’effet d’entrainement. Les limites ou critiques sont essentiellement liées à l’affluence ou à la crainte de ne pas être soutenu en cas de résultat positif. La démarche de recours au test ne fait plus l’objet de suspicion, au moins pendant la campagne. Cette « normalisation » du recours au test et la mobilisation collective facilitent des pratiques en groupe, ce qui peut rendre difficile de garder son statut VIH secret. L’évaluation des campagnes par les usagers les présente comme une opportunité pour accéder facilement au test et pour communiquer à ce sujet dans divers espaces sociaux à partir des informations délivrées sur le VIH.
Drinking raw date palm sap contaminated with infected fruit bat saliva or urine is an important mode of Nipah virus transmission to humans in Bangladesh. Bamboo skirts are an effective way to interrupt bat access to the sap. We conducted a study from November 2008 to March 2009 to explore the effectiveness of higher- and lower-intensity interventions by promoting bamboo skirt preparation and use among sap harvesters (gachhis). We spent 280 person-hours in two villages for the higher-intensity intervention and half that amount of time in two other villages for the lower-intensity intervention. To evaluate the interventions we followed up all gachhis once a month for three months. A high percentage of gachhis (83% in higher-, 65% in lower-intensity interventions) prepared and used a skirt of bamboo or other materials – jute stalk, dhoincha (Sesbania aculeata), or polythene – at least once after intervention. In general, 15% of gachhis consistently used skirts throughout the sap collection season. The intensive nature of this intervention is very expensive for a large-scale programme. Future efforts should focus on developing a low-cost behaviour change intervention and evaluate if it reduces the human exposure to potentially contaminated fresh date palm sap.
Malgré un vif intérêt pour la participation des patients à la gestion et à la prestation des soins de santé primaires, il n’existe aucune revue de la littérature sur le rôle des personnes vulnérables dans les projets de recherche participative menés dans le domaine des soins primaires. Une revue de la littérature de type narrative a été menée afin de combler cette lacune. L’objectif principal de cette revue a été d’évaluer le rôle des personnes vulnérables au sein de projets de recherche participative. Notre revue a recensé 26 articles et analysé 33 projets de recherche ou d’intervention en soins primaires. Elle révèle de nombreux écueils concernant l’implication des personnes vulnérables. Ces personnes ont joué un rôle varié, mais surtout modeste ou limité au sein des différents projets. Leur implication a surtout eu lieu à l’étape de la collecte des données. Peu de projets ont permis aux personnes vulnérables de prendre part à l’analyse des données ou à la diffusion des connaissances. Les tensions entre les chercheurs et les personnes vulnérables et la tendance à intégrer des acteurs organisés au sein des projets ont contribué à affaiblir le degré de participation des personnes vulnérables, et ce, à diverses étapes du processus de recherche et du développement d’intervention. Malgré tout, plusieurs retombées positives ont été identifiées, tant pour la communauté et les personnes vulnérables que pour les chercheurs. Entre autres, les projets ont permis aux chercheurs non universitaires d’acquérir de nouvelles compétences. De plus, certains projets ont favorisé la mise en place de nouveaux modèles de prestations de soins. Enfin, différents mécanismes permettant de rehausser la réciprocité entre les chercheurs et les personnes vulnérables sont proposés comme solutions pour réduire les inégalités et les tensions et, ultimement, favoriser l’implication des personnes vulnérables.
L’évaluation d’un programme sanitaire est souvent réalisée de manière linéaire, associant moyens mis en place et performance réalisée. Nous avons pris une autre perspective : celle d’analyser l’hôpital en tant qu’un système adaptatif complexe, partant des effets du programme santé 9ème Fond Européen de Développement sur la production hospitalière, en vue de comprendre l’adaptation de l’hôpital au changement apporté par le programme.
Étude de cas rétrospective (2006 à 2010) ciblant l’hôpital de Logo en Ituri couvrant 208 716 habitants en 2010. L’approche a été mixte, combinant des données quantitatives issues des statistiques hospitalières de routine et des informations qualitatives collectées au travers de la revue documentaire et des entrevues. La triangulation des données a permis de générer des théories explicatives sur le lien entre l’évolution de la production des soins et deux activités importantes du programme.
Quinze événements et interventions ont été identifiés et validés lors des entrevues. La variation ou la stabilité de la production n’a pas été systématiquement associée aux interventions du programme.
La stabilité de la production de l’hôpital de Logo ne dépendait pas seulement des interventions du programme mais également d’autres facteurs comme des arrangements institutionnels préexistants ou la nature de l’interaction entre acteurs. L’analyse de l’hôpital en tant qu’un Système complexe adaptatif permet de mieux comprendre son adaptation à un contexte changeant et offre des perspectives de mieux améliorer sa gouvernance.
Les infirmières qui ont reçu une formation en cessation tabagique ont tendance à intervenir davantage auprès des fumeurs que celles qui n’ont pas été formées. Il est démontré qu’une intervention même très brève conduit à une diminution de la prévalence du tabagisme. Or, les programmes qui préparent à l’exercice de la profession infirmière laissent actuellement peu de place à la formation en cessation tabagique. Les objectifs de la recherche sont de décrire les pratiques d’enseignement de la cessation tabagique dans les programmes de formation infirmière et de comparer en tenant compte de la formation en cessation tabagique reçue par les professeures.
Un devis descriptif-comparatif a été choisi.
Au total, 278 professeures (20,8 %) ont répondu à un sondage en ligne effectué à l’aide d’un questionnaire validé. Celles-ci avouent offrir en moyenne une heure en cessation tabagique par année. Les aspects physiopathologiques sont couverts au détriment de l’intervention professionnelle en cessation tabagique. Les obstacles identifiés par les professeures sont le manque de temps, de connaissances et de pertinence avec le cours enseigné. Seulement 11,9 % des sujets mentionnent avoir reçu une formation spécifique en cessation tabagique. Or ce sont ces dernières qui enseignent davantage d’éléments reliés à l’intervention en cessation tabagique.
Une meilleure intégration de l’intervention en promotion de la santé, incluant la cessation tabagique, dans la formation initiale devrait amener la future infirmière à réaliser davantage d’interventions personnalisées en cessation tabagique.
In 2011, Morehouse School of Medicine convened a summit in San Juan, Puerto Rico, to discuss issues related to the health status of people and communities in the Caribbean region. The summit provided a forum for transparent dialog among researchers, policymakers, and advocates from the Caribbean region and the United States. The summit’s theme—improving the region’s health outcomes through the adoption of effective practices linking health promotion and primary care, within the context of social and cultural determinants—called for a comprehensive and integrative model or a triangulation of methodologies to improve health outcomes. This article summarizes the recommendations of two workgroup sessions examining the challenges to improving health outcomes in the region and the opportunities to meet those challenges. The recommendations seek to develop action-oriented agendas that integrate research, practice, and policy. Outcomes of the summit highlight the importance of (a) community participation in planning interventions, (b) policymakers’ commitment to prioritizing health, and (c) Caribbean governments’ commitment to addressing the underlying social factors responsible for poor health outcomes.
Only a few countries have introduced health education (HE) as a stand-alone school subject. In Finland every pupil in basic education grades 7–9 takes three obligatory courses in HE. This study investigated Finnish pupils’ perceptions of the teaching and learning of HE. It also explored how school- and family-related background variables are associated with these perceptions. Nationally representative data were obtained from a 2010 school-based study on Health Behaviour in School-aged Children (HBSC). A total of 4262 pupils from 7th and 9th grades (13 and 15 years old) responded anonymously to the questionnaire. Logistic regression analysis was performed to identify the associations between perceptions of HE and school- and family-related background variables. The majority of the pupils had positive perceptions of HE. In terms of their own learning, girls’ perceptions were more positive than boys’: 86% of 13- and 15-year-old girls agreed that HE classes had taught them to think about the advantages and disadvantages of various health behaviours, whereas only 79% of boys shared this opinion. School engagement had the strongest association with perceptions of HE: the more positive the attitudes towards school, the more positive were the perceptions of HE. Older girls perceived their learning and their participation in class discussions more positively than younger ones, and older boys were more critical of the teaching than younger ones. The pupils’ educational aspirations were not associated with their perceptions of HE, and perceived family affluence was associated only with girls’ perceptions of participation in HE classes. The pupils’ feedback on HE was positive and encouraging. There is a demand for the subject in society, and HE seems to have the potential to augment young people’s positive attitudes towards health issues, and to enhance their health literacy.
The literature contains many reports on cigarette smokers and smoking cessation, but there are fewer qualitative studies on smokers’ and ex-smokers’ experiences with smoking cessation and health care professionals. The aim of the present study was to give voice to ex-smokers’ own experiences with smoking cessation through the health care system. The study collected data from focus group interviews with 28 informants divided into four groups. Results from this study do not point to one particular reason for successful smoking cessation, but instead to the combination of pressures from several factors. The informants seem to have reached a point where external pressure made them receptive to: the fear of diseases, legislation, taking advice from health care personnel, views of children and grandchildren and providing a new identity as ex-smoker. Factors that helped to quit were: recent efforts to make it difficult to smoke in Norway, encouragement to seek help to change their tobacco habits, smoking cessation programmes that are integrated into health care practice, health professionals who demonstrate sensitivity and genuine interest during their meetings with smokers. Health professionals in specialized health care must be made aware of their role as the first important step in their patients’ road to quitting smoking.
La recherche en santé mondiale s’inscrit dans une volonté de mobiliser des connaissances au service d’interventions et de politiques publiques pour l’atteinte équitable du bien-être commun, notamment en matière de santé. Elle joue un rôle primordial en ce sens, en favorisant l’implication des communautés et leur autonomisation et de nombreuses lignes directrices supportent un tel partenariat. Néanmoins, certains enjeux éthiques sont liés au financement de la recherche, aux environnements de recherche, à la priorisation des problématiques de recherche, aux mécanismes d’évaluation éthique posent souvent un problème de justice sociale au niveau de la redistribution des ressources et de la reconnaissance des différences culturelles. Comment alors déterminer quelle est la façon « idéale » d’agir en tenant compte de la globalité des individus et du pluralisme culturel des sociétés pour « bien faire », pour satisfaire l’exigence de l’équité? Une réflexion et une démarche éthique demeurent essentielles, ainsi qu’un dialogue entre les chercheurs du Nord et du Sud, et leurs autres partenaires que sont les décideurs, les responsables locaux et les communautés. Un tel dialogue, établi dans un continuum du développement de projets de recherche à leur pérennité, peut grandement contribuer à limiter les problèmes de justice sociale et à viser un développement plus égalitaire des savoirs scientifiques. Plusieurs chercheurs se sont déjà engagés dans cette voie, et leurs initiatives devraient être encouragées pour mettre les nouveaux savoirs au service des populations.
In 2007 an amendment to the law restricting smoking in pubs and bars (P&Bs) was enacted in Israel. However, a year after the ban only slight decreases in airborne smoke in P&Bs in one city have been reported.
We aimed to assess levels of airborne nicotine in Israeli P&Bs and to measure ifself-reported enforcement of the law by local officials was associated with levels of airborne nicotine in P&Bs.
Airborne nicotine levels were measured in 72 P&Bs in 29 towns in Israel; this consisted of 90% of eligible towns. In addition, 73 local authority officials were interviewed in 25 of these towns. The officials were asked to assess the local authority’s level of enforcement of the law banning smoking in P&Bs. The association of levels of airborne nicotine with the levels of enforcement of the law was calculated. Data were collected during 2009–2010 and analyzed in 2010–2011.
Levels of airborne nicotine were comparatively high in P&Bs. No association was detected between levels of nicotine and the P&Bs’ characteristics. In the larger towns, levels of airborne nicotine were higher. In 16% of towns the local authority officials reported high levels of law enforcement. Generally, levels of reported enforcement by local authorities were low and did not predict levels of airborne nicotine in the P&Bs.
Self-reported local authorities’ law enforcement was not associated with levels of airborne nicotine in P&Bs in these towns. There is a need to develop ways to increase law enforcement by the local authorities or other agencies.
Research has identified that perceived weight status is a better predictor of weight control behavior than actual weight status. The purpose of this study was to examine whether the accuracy of weight status perception varies across schools, and to identify the student-level characteristics associated with inaccurate weight status perception among 25,060 grade 9 to 12 students attending 76 schools in Ontario, Canada. Although the majority of adolescents (60.4%) had accurate weight status perceptions, multi-level logistic regression analyses revealed significant between-school variability in the accuracy of weight status perceptions for both males and females. School location and school-level socioeconomic status were the school-level variables analyzed. We identified that males attending urban or suburban schools were more likely to overestimate their weight status compared with males attending rural schools. Important student-level characteristics included grade, weight status, sports participation and social influences. Additional research is required to better understand both the school- and student-level characteristics associated with the accuracy of weight status perceptions among adolescents.
More than 25 years have passed since the release of the Ottawa Charter for Health Promotion. This document represented a substantial contribution to public health in its emphasis on the economic, legal, political and cultural factors that influence health. With public health renewal underway across Canada, and despite overwhelming support in the public health community for the Ottawa Charter, how much its principles will be included in the renewal process remains unclear. In this paper, we present the historical understanding of health promotion in Canada, namely highlighting the contributions from the Lalonde Report, Alma Ata Declaration, the Ottawa Charter for Health Promotion and the more recent population health movement. We discuss public health renewal, using the province of British Columbia in Canada as an example. We identify the potential threats to health promotion in public health renewal as it unfolds.
Defining research career paths that enable Africans to address local and global health issues is essential for population health. This study was conducted to better understand how international health training programs contribute to human resource capacity building in health research. Research career motivations, decision-making and experiences were explored among a small group of Kenyan HIV/AIDS researchers who had completed an international training program. We found that intersecting social dynamics within specific geographic spaces influenced individual training decision-making and motivated research career decisions over time. The concept that ‘geo-social motivation’ is an important determinant of success for an African considering a research career developed from this study, and may be used to tailor future health research human resource capacity-building programs.
Global market integration over the past three decades has led to labour market restructuring in most countries around the world. Employment flexibility has been emphasized as a way for employers to restructure their organizations to remain globally competitive. This flexibility has resulted in the growth of precarious employment, which has been exacerbated by the global financial crisis and resulting recession in 2007/2008, and the ongoing economic uncertainty throughout much of the world. Precarious employment may result in short and long-term health consequences for many workers. This presents a deeper and more structural determinant of health than what health promoters have traditionally considered. It calls for a different understanding of workplace health promotion research and intervention that goes beyond enabling healthier lifestyle choices or advocating safer workplace conditions to ensuring adequate social protection floors that provide people with sufficient resources to lead healthy lives, and for advocacy for taxation justice to finance such protection.
We assessed the differences in overall use of tobacco and in the use of various tobacco products, by sex and by frequency of use across various demographic groups.
We used data from the Global Adult Tobacco Survey (GATS), conducted in 2009 in Egypt. The data consist of answers to GATS by 20,924 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older from all regions of Egypt. Current tobacco use was defined as current smoking or use of smokeless tobacco products, either daily or occasionally. We analyzed the differences in current cigarette, shisha, and smokeless tobacco use by sex and frequency of use (daily or occasional); and by demographic characteristics that included age, region, education level and employment status.
Overall, 19.7% of the Egyptian population currently use some form of tobacco. Men (38.1% [95% confidence interval (CI) 36.8–39.4]) are much more likely than women (0.6% [95% CI 0.4–0.9]) to use tobacco. Almost 96% of men who use tobacco, do so daily. Men are more likely to use manufactured cigarettes (31.8% [95% CI 30.6–33.1]) than shisha (6.2% [95% CI 5.6–6.9]) or smokeless tobacco (4.1% [95% CI 3.4–4.8]). Few women use tobacco (cigarettes (0.2%), shisha (0.3%) and smokeless tobacco (0.3%)); however, all women who currently smoke shisha, do so daily. Lower educational status, being between ages 25–64 and being employed predicted a higher use of tobacco.
Egypt has implemented several initiatives to reduce tobacco use. The World Health Organization (WHO) MPOWER technical package, which aims to reverse the tobacco epidemic, is implemented at various levels throughout the country. Our findings show that there is significant variation in the prevalence of tobacco use and types of tobacco used by adult men and women in Egypt. GATS data can be used to better understand comparative patterns of tobacco use by adults, which in turn can be used to develop interventions.
In 2008, the Centers for Disease Control and Prevention (CDC) and the World Health Organization developed the Global Adult Tobacco Survey (GATS), an instrument to monitor global tobacco use and measure indicators of tobacco control. GATS, a nationally representative household survey of persons aged 15 years or older, was conducted for the first time during 2008–2010 in 14 low- and middle-income countries. In each country, GATS used a standard core questionnaire, sample design, and procedures for data collection and management and, as needed, added country-specific questions that were reviewed and approved by international experts. The core questionnaire included questions about various characteristics of the respondents, their tobacco use (smoking and smokeless), and a wide range of tobacco-related topics (cessation; secondhand smoke; economics; media; and knowledge, attitudes, and perceptions). In each country, a multistage cluster sample design was used, with households selected proportionate to the size of the population. Households were chosen randomly within a primary or secondary sampling unit, and one respondent was selected at random from each household to participate in the survey. Interviewers administered the survey in the country’s local language(s) using handheld electronic data collection devices. Interviews were conducted privately, and same-sex interviewers were used in countries where mixed-sex interviews would be culturally inappropriate. All 14 countries completed the survey during 2008–2010. In each country, the ministry of health was the lead coordinating agency for GATS, and the survey was implemented by national statistical organizations or surveillance institutes. This article describes the background and rationale for GATS and includes a comprehensive description of the survey methods and protocol.
We assessed the differences in exposure to secondhand smoke (SHS) among adults at home, in indoor workplaces, and in various public places in the Philippines across various socio-demographic groups.
Data from the Global Adult Tobacco Survey conducted in 2009 in the Philippines were used. The data consist of survey answers from 9705 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older. We considered that respondents were exposed to SHS if during the previous 30 days they reported that they lived in a home, worked in a building, or visited a public place where people smoked. The public places included in our analysis were indoor workplaces, public transportation vehicles, restaurants, government buildings or offices, and healthcare facilities. The differences in various socioeconomic and demographic groups’ exposure to SHS in these places were also examined.
Of respondents who reported working indoors, 36.8% were exposed to SHS. Men (43.3% [95% CI 39.7–46.9]) were more likely than women (28.8% [95% CI 25.4–32.4]) to be exposed to SHS (p < 0.001). Of those working in sites where smoking was not allowed, 13.9% were exposed to SHS, whereas 66.5% were exposed where smoking is allowed in some enclosed areas, and 90.7% were exposed where smoking is allowed everywhere. During the 30 days preceding the survey, more than 50% of those who took public transportation were exposed to SHS; exposure for those who visited public buildings was 33.6% in restaurants, 25.5% in government buildings or offices, and 7.6% in healthcare facilities.
Despite a national law passed and several local government ordinances that have promulgated smoke-free workplaces, schools, government offices, and healthcare facilities, our findings show that a large proportion of adults were exposed to SHS at work and in public places, which offers opportunities to strengthen and improve enforcement of the smoke-free initiatives and ordinances in the Philippines.
The World Health Organization (WHO) MPOWER is a technical package of six tobacco control measures that assist countries in meeting their obligations of the WHO Framework Convention Tobacco Control and are proven to reduce tobacco use. The Global Adult Tobacco Survey (GATS) systematically monitors adult tobacco use and tracks key tobacco control indicators.
GATS is a nationally representative household survey of adults aged 15 and older, using a standard and consistent protocol across countries; it includes information on the six WHO MPOWER measures. GATS Phase I was conducted from 2008–2010 in 14 high-burden low- and middle-income countries. We selected one key indicator from each of the six MPOWER measures and compared results across 14 countries.
Current tobacco use prevalence rates ranged from 16.1% in Mexico to 43.3% in Bangladesh. We found that the highest rate of exposure to secondhand smoke in the workplace was in China (63.3%). We found the highest ‘smoking quit attempt’ rates in the past 12 months among cigarette smokers in Viet Nam (55.3%) and the lowest rate was in the Russian Federation (32.1%). In five of the 14 countries, more than one-half of current smokers in those 5 countries said they thought of quitting because of health warning labels on cigarette packages. The Philippines (74.3%) and the Russian Federation (68.0%) had the highest percentages of respondents noticing any cigarette advertising, promotion and sponsorship. Manufactured cigarette affordability ranged from 0.6% in Russia to 8.0% in India.
Monitoring tobacco use and tobacco control policy achievements is crucial to managing and implementing measures to reverse the epidemic. GATS provides internationally-comparable data that systematically monitors and tracks the progress of the other five MPOWER measures.
In 2008, Turkey became one of 26 countries with a complete ban on all forms of direct and indirect tobacco marketing. We assessed the level of exposure to anti- and pro-cigarette advertising and to cigarette promotions and sponsorships among various demographic groups in Turkey.
We used the data from the Global Adult Tobacco Survey (GATS), conducted in November 2008 in Turkey. The data consist of answers to GATS questions by 9030 respondents from a nationally representative, multistage probability sample of adults 15 years of age or older. To find differences in exposure to the advertising by sex, age, education level and smoking status, we analyzed responses to GATS questions about cigarette advertisements and anti-cigarette smoking information in various forms and through various advertising channels, during the 30 days before the survey, using bivariate analysis.
Overall, 13.3% of respondents aged 15 years or older noticed some type of cigarette marketing during the 30 days before the survey: 7.1% saw advertisements, 5.3% saw promotions and 3.3% saw sports sponsorships. Men were more likely than women to have seen cigarette promotions (7.8% versus 3.0%) and sports sponsorships (5.3% versus 1.4%). Respondents aged 15–24 years were more likely than those aged 25 years or older to have seen cigarette advertisements (10.2% versus 6.2%), promotions (8.7% versus 4.4%) and sponsorships (6.6% versus 2.3%), respectively. Respondents were most likely to have seen cigarette advertisements on television (3.4%) or in shops (2.7%). In addition, 2.8% of respondents reported seeing a clothing item with a brand name or logo, 2.5% reported that they received free samples of cigarettes and 0.3% received gifts along with the purchase of cigarettes. Almost 9 of 10 survey respondents (88.8%) reported having noticed some anti-cigarette information during the 30 days before the survey. Most anti-cigarette information was seen on television (85.5%). The anti-cigarette information was seen by slightly more cigarette smokers (91.6%) than nonsmokers (87.6%). Persons with less than a primary education were less likely to notice anti-cigarette information than those with a higher level of education, in all examined media channels.
Our findings showed a low prevalence of noticing cigarette marketing, which indicates high compliance with the Turkish law banning such marketing. GATS data provide an in-depth understanding of the level of exposure to pro- and anti-cigarette information in 2008 and they are of practical assistance to those who implement policies to reduce the demand for tobacco. The challenge now is to maintain rigorous enforcement. To do so requires ongoing surveillance to produce data on the effectiveness of the enforcement efforts.
Owing to errors made at SAGE, the article ‘The ‘Ossébo’ intervention for the prevention of injurious falls in elderly women: background and design’ by Patricia Dargent-Molina, Fabienne El Khoury and Bernard Cassou, Global Health Promotion, Volume 20, Supp. 2, June 2013, pp. 88–93, DOI: