Between 2013 and 2014, past 30-day use of e-cigarettes increased from 4.5% to 13.4% among US high school students aged 9–19 years. We sought to examine the influence of perceived addiction and harm of e-cigarettes on e-cigarette use among adolescents.
Self-reported use and perception of harm of e-cigarettes were assessed using a cross-sectional design.
Data were collected from the 2014 National Youth Tobacco Survey.
Multivariate logistic regression models were employed regressing lifetime e-cigarette use and past 30-day use on established covariate factors.
Perceiving e-cigarettes as less harmful than conventional cigarettes increased students’ odds of lifetime use (odds ratio [OR] = 2.40, 95% confidence interval [CI] = 1.98–2.90) and past 30-day use (OR = 2.18, 95% CI = 1.63–2.92) of e-cigarettes. Perceiving e-cigarettes as less addictive than conventional cigarettes also increased students’ odds of lifetime use (OR = 2.11, 95% CI = 1.82–2.45) and past 30-day use (OR = 1.93, 95% CI = 1.57–2.38) of e-cigarettes; however, perceiving e-cigarettes as more addictive than conventional cigarettes also increased students’ odds of lifetime use (OR = 1.85, 95% CI = 1.37–2.49) and past 30-day use (OR = 2.68, 95% CI = 1.84–3.90) of e-cigarettes. Other influencing factors of e-cigarette use among youth included race, grade level, living with a smoker and lifetime use of regular cigarettes.
The perception that e-cigarettes are less addictive and harmful than their conventional counterparts may be an important risk factor for the use of e-cigarettes. Factors influencing young people’s perceptions need to be examined further.
Drawing on the concepts of the cosmopolitan person and democratic health education, this article explores the merits of primary school–based, cross-cultural dialogues for global health education.
A qualitative study of the learning outcomes of the Move|Eat|Learn (MEL) project. MEL facilitates cultural meetings, primarily Skype-based, between students from Kenya and Denmark, with the aim of promoting reflection on differences and similarities in everyday living conditions and their impact on health practices.
Three Danish and one Kenyan primary schools.
Qualitative analysis of 18 focus group discussions with 72 Danish and 36 Kenyan students.
Cross-cultural dialogues promoted students’ engagement and reflections on their own and peers’ health condition, access to education, food cultures, gender and family structures.
Findings indicate the merits of cross-cultural dialogues as a means of educating students to become global health agents with a cosmopolitan outlook.
This pilot study sought to better understand what can be achieved by an evidence-based classroom social and emotional education programme.
A 10-lesson, classroom-based programme that taught about emotional literacy, personal strengths, coping and problem-solving strategies, stress management, emotional regulation and support seeking was provided to 56 students in Years 7 (13 years) and 8 (14 years) in an Australian middle school. Teachers were trained to deliver the programme, with participatory modelling of each activity. Before and after delivery of the programme, students were surveyed for their social and emotional wellbeing using the Kessler 10 (K10) instrument for non-specific psychological distress; the ‘Internal Assets’, ‘School Resources’ and ‘Cooperation and Communication’ questions from the Resilience and Youth Development Module (RYDM) of the California Healthy Kids Survey (CHKS); and questions developed for this study on class connectedness and social and emotional skills. Subsequent to programme completion, focus groups were conducted with teachers and participating students to gauge programme fidelity, utility and engagement.
There was an improvement in psychological distress that approached significance (t = 2, df = 42, p = .053), although the symptomatic score remained in the range indicative of medium-level distress. Cooperation and communication improved significantly (t = –2.34, df = 42, p = .024) as did class connectedness (t = –2.46, df = 43, p = .018). There was no change in individual resilience factors, school protective factors, or social and emotional skills. The focus groups were generally positive about the programme, but indicated fidelity was compromised, mainly because the lesson periods were too short.
While this small-scale pilot study has a number of limitations, it does indicate the need to improve the psychological wellbeing of middle school students. The findings also provide evidence that brief social and emotional education programmes can have some positive effects.
This study took the form of an intervention examining change in physical activity and quality of experience among students in an introductory health course who were asked to wear a Fitbit activity monitor throughout the semester.
College students (N = 56) took part in this controlled trial. Students enrolled in an introductory health course (Education + Fitbit; n = 24) were asked to purchase a Fitbit and wear it throughout the semester. This activity monitor purchase replaced the textbook requirement to reduce the financial burden for students. Change in objectively measured physical activity within this group was compared to students enrolled in a traditional introductory health course (Education Only; n = 14) and students enrolled in an introductory humanities course (Control; n = 18). To assess objectively measured physical activity, all participants wore a sealed pedometer for one week at the beginning and end of the semester. Students in the Education + Fitbit group also provided written feedback on their experience with the Fitbit.
A 2 x 3 repeated-measures analysis of variance (ANOVA) revealed a significant interaction between time and group, F(2, 53) = 3.957, p = .025. Post hoc analysis of this interaction indicated that students in the Education + Fitbit group significantly increased (p = .014) objectively measured physical activity by 1,078 steps/day, whereas physical activity in Education Only and Control groups did not significantly change. Qualitative data demonstrated that student experiences with the Fitbit were resoundingly positive.
Replacing a textbook requirement with requiring a commercially available activity monitor in an introductory health course may be an effective and enjoyable strategy to increase physical activity among US college students.
This study examined the relationship between three heuristic cues (consistency, liking and social proof) and condom use in casual sex relationships utilising the theory of planned behaviour.
Totally, 388 US college students were surveyed.
Three vignettes for each cue primed students to project their willingness to use a condom during casual sex encounters.
Repeated-measures multivariate analysis of covariance (MANCOVA) revealed that the cues exerted significant main effects on attitude (F(5, 1,935) = 6.16, p < .001), subjective norms (F(5, 1,930) = 5.626, p < .001), perceived behavioural control (F(5, 1,935) = 8.51, p < .001) and behavioural intentions (F(5, 1,930) = 2.44, p = .033). Post hoc analysis revealed condom avoidance behavioural intentions were more likely for the vignette depicting social proof (M = –1.26, standard deviation [SD] = 1.08).
Findings indicate that heuristic cues influence college students’ condom use intentions, and prevention programmes should incorporate cues to increase effectiveness.
Health care is far from reaching the goal of people being part of their own care, and research is lacking on how to understand their perspective. This study explores people’s intentions with the act of learning before attending a health education programme at a Learning and Mastery Centre (LMC) in Norway. The aim of this study was to understand participants’ learning strategies for learning about their own health care in a health education setting.
Data were collected through five group interviews and analysed using qualitative content analysis.
Findings revealed that participants’ intentions of how and what to learn were influenced by their life experiences and interactions with the health care system. Three main categories of experience emerged: (1) sharing experiences, (2) second opinion and (3) capturing the news, brought together under the comprehensive theme: searching and dealing, confirmation and feeling, which reflects the underlying meaning of the categories.
Results encourage us to see learning as an active construction process underpinned by health literacy, including both people’s competencies and the health care system. If LMCs and similar health education initiatives are to make an important contribution to improving people’s health literacy, significant attention should be given in the planning and implementation of initiatives.
Increased emphasis on academic outcomes has reduced the amount of time spent in physical education and other school physical activity opportunities in many schools in the USA. However, physical fitness is a positive predictor of academic performance on standardised tests, and students who perform better on fitness measures may earn higher grades. The purpose of this study was to evaluate the relationship between physical fitness and teacher-assigned grades in fourth-grade students and examine whether the relationship is moderated by body composition, gender or ethnic background.
Cross-sectional design. Students’ fitness levels were assessed mid-way through the spring semester, and their third-quarter grades were obtained from the schools.
Fourth-grade students (N = 80; 38 female students; 65 non-Hispanic or Latino) from two elementary schools in the south-western USA.
Students completed physical fitness measures using standard procedures from the FITNESSGRAM protocol, and standardised teacher-assigned grades in reading, writing, mathematics, social studies and science were compiled. Linear regression and multivariate analysis of variance (MANOVA) were performed to examine the relationship between physical fitness measures and average grades, and examine whether differences in fitness and grades existed between gender, ethnic background and body mass index (BMI) percentile rank.
Aerobic fitness, as measured by the number of 20-m Progressive Aerobic Cardiovascular Endurance Run (PACER) laps completed, had a significant influence on reading, writing, mathematics and science grades. There were no significant interactions between aerobic fitness and ethnic background, gender or BMI percentile rank, meaning that aerobic fitness was the largest specific influence on average teacher-assigned grades.
Positive associations exist between physical fitness and academic performance, suggesting activities that help children improve their physical fitness ought to be a central component of physical education and broader school physical activity programmes.
Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged in the USA. Free clinic patients may have health education needs, but experience barriers to attending health education programmes. In an attempt to reach out to free clinic patients who might not otherwise attend health education classes, this project examined the efficacy of student-led health education classes conducted in the waiting room prior to a patient’s appointment with a provider.
The classes had two areas of focus: women’s health and health information. Health educators and Spanish interpreters were graduate and undergraduate students.
This study was conducted in the waiting room of a free clinic in the Intermountain West region of the USA.
The health education classes were held 22 times in total from late August to early December 2014.
While the survey-based assessment of the programme did not show a difference in levels of health consciousness, health information seeking and health attitudes, the programme potentially increased interest in attending the health education classes.
There were some challenges associated with the implementation of a health education class in the waiting room setting, particularly in regards to environments, evaluation and interpretation services. Future projects are needed to address challenges associated with conducting a health education class in a waiting room setting. In addition, a variety of health topics, evidence-based evaluation and interpreter services are key for future success.
A critical evaluation of a salutogenic, wellness education programme was conducted with a group of first-year socioeconomically disadvantaged higher education students, in order to assess the value they placed on health information and wellness priorities.
This study took a mixed-methods approach utilising a quantitative–qualitative design. Quantitative analysis regarding the values placed by the students on 22 aspects of health-related information and qualitative analysis of their health priorities drew on findings from a semi-structured researcher-generated questionnaire, administered pre-, post- and 15-week post-post-intervention.
The setting was a higher education institution in the Eastern Cape Province of South Africa. Participants were 34 first-year consumer science students, who engaged in a year-long, salutogenic wellness programme.
Findings revealed an increase in the participants’ value of health information for a number of wellness variables. Future planning, positive thinking and nutrition ranked high among wellness priorities, the reasons for which were disease prevention, as well as the impact of various aspects of health on participants’ future success.
A holistic, salutogenic, wellness education programme increased student values for information with regard to a number of health variables.
The Immortal Life of Henrietta Lacks by Rebecca Skloot is an award-winning biography engaging its readers on important topics ranging from race, science and ethics to the social determinants of health. However, the multiple pedagogic impacts of this book on the public health classroom setting have yet to be comprehensively explored.
A qualitative, pre/post-test study design assessed the perceptions of 17 Master’s of Public Health students on topics of health disparities and medical ethics. A total of 14 students were assigned to an intervention (book-based seminar course; Cohort A) and 3 students acted as the non-intervention group (Cohort B) over a study period of 10 weeks.
A thematic analysis uncovered more profound changes in the perceptions of the intervention group. All students were aware of health disparities over the course of the 10-week class; however, significant traction was gained on more complex issues linked to the social determinants of health. Specifically, students in the intervention group showed deeper perceptions about health inequalities with a particular focus on racial disparities.
Although graduate students in the public health discipline were well aware of health inequalities, a seminar course surrounding a popular book about Henrietta Lacks afforded students a more concrete understanding for why and how race and racism in health disparities exist.
This study aimed to examine the association between parental socioeconomic status (SES) and children’s physical activity (PA) behaviour during after-school hours.
Cross-sectional study.
Participants included 663 schoolchildren (aged between 10 and 13 years) and their parents from nine primary schools in Hong Kong. Parental SES status and the after-school PA levels of children were assessed using self-administered questionnaires. Analysis of variance (ANOVA) was conducted to examine the association between parents’ education and income level and the type of activities in which children participated during after-school hours.
Results indicated that children with mother in the higher education group engaged in fewer time blocks of sports-type activity (high = 0.72 time blocks; medium = 1.04 time blocks; low = 1.17 time blocks). Compared with their counterparts, children with mothers in the higher income group were more engaged in sedentary activity (high = 5.33 time blocks; medium = 5.02 time blocks; low = 4.73 time blocks) within the eight 30-minute time blocks during after-school hours.
The study describes how parental SES influences children’s after-school PA participation and highlights the importance of including a family perspective when designing a PA promotion programme targeting after-school hours.
Text message–based interventions may provide sexual health information to young people through a number of service types, from sending information on a regularly scheduled timeline, to providing an automated menu, to allowing young people to connect directly with health educators. While such service types exist, it is not clear which features young adults feel are most effective at allowing them to engage with sexual health information.
This study used a mixed-methods design (survey and focus groups) to assess perceptions of three types of sexual health text message services with young adults, a population particularly at risk of negative sexual health outcomes.
College students from the US Pacific Northwest participated in the project.
Participants heard about three sexual health text message services, completed questionnaires and discussed each type. Focus groups were gender-separated.
Participants reported that services that allowed them to connect with a health educator would be highly useful, but automated services would be beneficial in bringing new topics to their attention. Participants perceived the purpose of the service types as different and felt each could be a useful resource, depending on the situation. Regardless of service type, participants wanted to personalise their experience. Participants wanted messages tailored to them and options to interact with the systems, from influencing topic selection to message timing.
Each of the service types can be useful for young adults. Young adults perceive services that provide the opportunity to tailor information and interact with the system as beneficial.
This study evaluated the impact of a one-day mental health Wellness Workshop on participants’ mental health and attitudes towards mental health.
Convergent, longitudinal mixed-methods approach.
The study evaluated Wellness Workshops which took place throughout the Republic of Ireland.
Questionnaires measuring hope, mental health self-efficacy, attitudes towards mental health and perceived impact on wellbeing were administered to participants before the workshop (n = 415), 1 week after (n = 221) and 3 months after (n = 110). Semi-structured interviews were carried out with 24 participants to generate a more in-depth understanding of the impact of the workshop.
Quantitative findings relating to hope, mental health self-efficacy and attitudes towards mental health did not identify statistically significant changes; however, participants’ perceptions of the effect of the workshop on wellbeing suggested a positive impact which was maintained over time. Qualitative findings, however, suggested that hope and self-efficacy were improved and the simplicity and utility of the wellness strategies disseminated in the workshop, in addition to the warmth and openness of the narrative approach used by the facilitators, were central to the perceived positive impact.
This evaluation demonstrates the potential for wellness interventions to have a subjective improvement in wellbeing in members of the general public.
It has been suggested that students are healthier in schools where more students are committed to school. Previous research has examined this only using a proxy measure of value-added education (a measure of whether school-level attendance and attainment are higher than predicted by students’ social profile), finding associations with smoking tobacco, use of alcohol and illicit drugs, and violence. These findings do not provide direct insights into the associations between school-level aggregate student commitment and health behaviours, and may simply reflect the proxy measure being residually confounded by unmeasured student characteristics. We examined the previously used proxy measure of value-added education, as well as direct measures at the level of the school and the student of lack of student commitment to school to see whether these were associated with students’ self-reported smoking tobacco, alcohol use and school misbehaviour.
Cross-sectional survey.
A total of 40 schools in south-east England.
Multi-level analyses.
There were associations between school- and student-level measures of lack of commitment to school and tobacco smoking, alcohol use and school misbehaviour outcomes, but the proxy measure of school-level commitment, value-added education, was not associated with these outcomes. A sensitivity analysis focused only on violent aspects of school misbehaviour found a pattern of associations identical to that found for the measure of misbehaviour.
Our study provides the first direct evidence in support of the Theory of Human Functioning and School Organisation.
Existing literature indicates that young people in state care have particular sexual health needs that include addressing their social and emotional well-being, yet little has been published as to how these components of sex education are actually delivered by service-providers.
The aim of this study was to analyse the processes involved in delivering relationship and sexuality education to young people in state care from the perspectives of a sample of service-providers with a role in sexual health-care delivery.
Qualitative methodological strategy.
Service-delivery sites at urban and rural locations in Ireland.
A total of 22 service-providers were interviewed in depth, and data were analysed using a qualitative analytical strategy resembling modified analytical induction.
Participants proffered their perceptions and examples of their practices of sex education in relation to the following themes: (1) acknowledging the multi-dimensional nature of sexual health in the case of young people in care; (2) personal and emotional development education to address poor self-esteem, emotional disconnectedness and an inability to recognise and express emotions; (3) social skills’ education as part of a repertoire of competencies needed to negotiate relationships and safer sex; (4) the application of positive social skills embedded in everyday social situations; and (5) factual sexuality education.
Insights into service-providers’ perceptions of the multi-dimensional nature of the sexual health needs of young people in state care, and the ways in which these service-providers justified their practice make visible the complex character of sex education and the degree of skill required to deliver it to those in state care.
The high incidence of foodborne disease among children suggests the value of health promotion. Children are a high-risk group so far as foodborne disease is concerned, although they may be hard to reach with training programmes. This research investigated the use of drawings, compared with questionnaires, to evaluate the impact of a health promotion programme to improve knowledge and habits in the context of food handling and personal hygiene.
Children (184) attending primary school and living in the north of Italy were enrolled in the programme.
Qualitative and quantitative tools: pre- and post-intervention questionnaires were administered, and children were asked to produce pre- and post-intervention drawings about microorganisms and their effects on humans. An observation grid was built to code key features in the drawings.
Results clearly showed that some drawing features correlated with and predicted high scores in the questionnaire on knowledge of microorganisms. These were the use of captions, the representation of a natural context and the presence of a causal link between depicted elements.
Study findings highlight the potential of the use of drawing as an effective evaluation tool. The use of drawing can support the design of strategies for the validation of health campaigns aimed at the amelioration of children’s food contamination–related (and perhaps other) risks.
To identify the influence of parental autonomy support, basic need satisfaction and motivation on emerging adults’ physical activity level and exercise behaviours.
Cross-sectional survey.
This study convenience-sampled approximately 435 college students identified as emerging adults – aged 18–25 years, who did not have a child, own a home, or have sufficient income to be fully independent.
Survey responses were used in a path model to investigate how parental autonomy support, psychological mediators and motivational processes influenced emerging adults’ exercise behaviour.
The hypothesised model was supported with minor modifications. Most notable was the influence of parental physical activity level and autonomy support on psychological mediators, motivational processes and exercise behaviour.
Results indicate that parents influence their children both directly and indirectly. The impact of autonomy and competence support was found to promote emerging adults’ intrinsic motivation, which consequently influenced actual physical activity and behaviour.
Research has shown that developing health literacy in early life is critical to reducing lifestyle-related diseases, with schools being identified as central settings for this purpose. This paper examines how one classroom-based health educational programme, IMOVE, helped Danish primary school pupils develop health literacy related to physical activity. It discusses curriculum-integrated health education’s contribution to promoting health literacy.
Qualitative classroom observation.
IMOVE was implemented in 12 school classes (grades 5–7) in four public schools in Copenhagen, Denmark, during the autumn and winter of 2013–2014. Participants numbered 281 pupils and nine teachers.
We used Nutbeam’s conceptualisation of health literacy as a theoretical framework to assess which levels of health literacy the programme would promote; we assessed these using data derived from 59 IMOVE lesson transcripts.
IMOVE primarily contributed to the development of functional health literacy by building a relational understanding between everyday practice and step numbers. We observed the presence of interactive health literacy in discussions about how pupils and teachers could change their daily practices. Only a limited number of discussions supported the development of critical health literacy.
Our findings suggest that educators can successfully integrate health literacy development into classroom-based curriculum teaching, with pupils’ own step counts and associated reflections positively influencing learning. However, in this study, classroom teaching was limited to a focus on cognitive skills and only partially supported the development of more critical health literacy skills. Our findings call for further research into approaches to support classroom-based critical health literacy development.
Most reports of adaptations to evidence-based prevention programmes for delivery to specific cultural groups describe formal adaptation procedures. In this paper, we report on how practitioners identify and manage issues of perceived cultural mismatch when delivering a scripted, evidence-based intervention.
We used grounded systems theory methodology to plan, conduct and interpret facilitator narratives.
Interviews and focus groups with 16 facilitators who delivered the Strengthening Families Programme 10-14, a widely disseminated intervention targeting families with young adolescents, to Latino and American Indian families in the Pacific Northwest region of the USA.
Interviews and focus groups were conducted at programme facilitators’ worksites or other location of their choice.
Facilitators described important cultural adaptations related to programme format and timing, family composition and dynamics, acculturation challenges and language. Nearly all adaptations reported were consistent with the programme’s stated goals and were designed to retain families or clarify programme concepts.
We recommend training practitioners in the importance and understanding of programme logic models and in culturally sensitive approaches to programme adaptation, including an awareness of differences between assimilation and acculturation.
Less than half of young people in the USA are meeting the daily physical activity requirements of at least 60 minutes of moderate or vigorous physical activity. A mixed-methods pilot feasibility assessment of Move it Move it! was conducted in the Spring of 2014 to assess the impact of a before-school physical activity programme on student academic measures and behavioural health.
Move it Move it! encourages students and families to run/walk laps in the recess yard. Student miles are tracked and incentives are awarded at several benchmarks
Launched in 2012, Move it Move it! is a voluntary morning running/walking programme at the Integrated Arts Academy (IAA) elementary school designed to build community, increase fitness and prepare students for learning.
Self-reported surveys were administered to all consented students in grades 3–5 (N = 129). Semi-structured interviews were conducted with school personnel (N = 11).
Average Move it Move it! miles ran/walked were significantly positively associated with commitment to school and The New England Common Assessment Program (NECAP) mathematics testing scores. Interviews with school staff/faculty further explained quantitative results including the perceived impact of the programme on academic success and school engagement and the perceived impact of the programme on student behaviour and school climate.
Results from this pilot assessment of a community-based initiative suggested that positive academic and behavioural outcomes were associated with engagement in a before-school incentive-based physical activity programme.
Drawing on the perceptions of various key stakeholders, the paper explores the strengths and limitations of involving civil society organisations in the delivery of HIV and AIDS and sexuality education in South African schools.
Qualitative study with a cross-sectional design.
Research was conducted at 16 public secondary schools in KwaZulu-Natal, Gauteng and Mpumalanga provinces in South Africa.
Focus group discussions were held with Grade 9 and 11 learners, aged 14–18 years, and interviews with Life Orientation educators, Heads of Department and local civil society organisations.
School engagement with civil society organisations may include (1) the delivery of life skills programmes and talks, (2) assisting learners with accessing support services, and (3) the provision of teaching resources for Life Orientation educators and schools. The involvement of external organisations was often favoured for the youthful age of facilitators, shared personal experiences, novel learning activities and the overall separateness from schooling structures whereby personal disclosure or the provision of services were unlikely to influence school functioning. On-site Life Orientation educators were favoured for their consistent availability and familiarity, discipline, teaching experience and classroom management skills.
Opportunities exist for collaboration between Life Orientation educators and civil society organisations in the future delivery of sexuality education. Potential partnerships may allow mutual expertise to be harnessed and alleviation of time and resource pressures. However, collaboration requires dialogue to clarify roles and to minimise resistance in schools. Effective monitoring and evaluation at a national or provincial level is also needed to help schools assessing the suitability of particular civil society organisations.
To describe the process of developing a Health Qigong programme for stressed children using a formative evaluation approach.
A multi-step formative evaluation method was utilised. These steps included (1) identifying programme content and drafting the curriculum, (2) synthesising effective and age-appropriate pedagogies, (3) consulting an expert panel, (4) teaching pilot lessons and soliciting feedback from students and (5) revising and finalising the programme.
A total of 16 theme-based lessons were generated in order to help children manage stress by imitating interesting plants and animals, such as sunflowers, pine trees, white cranes, tigers, sleeping lions and deer. Five age-appropriate teaching strategies were synthesised to make the programme fun and enjoyable for children. These included (1) using theme-based lesson plans, (2) building mind–body connections, (3) balancing repetition and creativity, (4) interweaving pictures, stories, volunteers and teamwork and (5) involving parents and school teachers. Modifications based on feedback from the expert panel and students were incorporated to make the programme relevant to elementary school settings.
This Health Qigong for Stressed Children programme appears effective in reducing stress over a 16-week period. Future studies should explore the efficacy and wider applicability of the programme with a larger and more diverse population of children.
Men’s health has been subjected to diverse approaches to research over the past two decades. Much of the literature has focused on specific medical and health issues. Other contributions have focused more broadly on masculinities and its relationship to health. It is arguable that there has not been a lot of attention paid to Australian rural men’s health and even less on their understanding of health as it relates to physical activity and dietary behavior.
To gain a better understanding of these issues this paper provides rich, descriptive qualitative data from men living on Kangaroo Island, which is 13.5 kilometres off the South Australian mainland and is regarded as a rural and remote area.
Qualitative data is used to develop greater understanding of the men’s attitudes and behaviours as they relate to physical activity and dietary behaviours. The semistructured interviews and focus groups were conducted with 40 men aged between 23–64.
The results indicated that the locality in which the men lived provided them with an excellent opportunity to be physically active and eat fresh, locally produced, foods. However, it was identified that many of the men did not have a comprehensive understanding of health and seemingly displayed low levels of health knowledge. As a result for many of these men, their physical health was left to chance. There was little evidence of any planned health promotion to assist them with making improvements to their nutrition and physical activity levels as they aged. Recommendations and population-based strategies are provided to assist men living in remote rural settings to enhance not only their health ultimately their health knowledge. This will positively impact community health.
To determine whether Hannover Medical School’s Patient University, which was developed as the first university-based health education institution in Germany, offers a valuable means of conveying health-related knowledge, competencies and the ability to reflect on health information to its participants.
Participatory health education formats included interactive lectures, learning stations and practical training with tutors.
The Patient University was conducted at the facilities of Hannover Medical School, a major German maximum-care hospital and research institution.
To evaluate the programme, data were prospectively collected from participants from 2007 to 2009 using standardised and anonymous questionnaires. One questionnaire included information on sociodemographic data, such as health status, age, gender and post code. A second questionnaire evaluated levels of participant satisfaction, new knowledge and skills gained and understanding of the information provided.
Approximately 1,935 participants enrolled in at least one of 60 events from 2007 to 2009. The response rate from the questionnaire collecting sociodemographic data was 61.4%. A total of 35.2% of participants responded to the event evaluation. After matching both questionnaires, 1,188 person-specific data sets were available for analysis. Most respondents were women (74.7%), and the median age was 62 years (range: 16–88 years). Satisfaction with the events was rated very positive (average 1.7 on a scale of 1 = excellent to 6 = poor). Nearly two-thirds of the participants acquired new health-related knowledge and were highly satisfied with the quality of the information received. Participants who self-rated their health status as ‘poor’ tended to be more critical of what they had received than those in good health.
We consider the approach a viable health education advance, and future Mini-Med School programmes may benefit from its methodological and evaluative insights. The development of target group-specific information should be the focus of prospective initiatives and related research.
Human papilloma virus (HPV) vaccination is recommended for all men who have sex with men (MSM) in the USA until the age of 26 years. Despite this recommendation, vaccine uptake remains low. The purpose of this study was to (1) describe salient beliefs related to HPV vaccination among young MSM; (2) determine factors that underlie these beliefs; and (3) describe a model for HPV vaccine decision-making.
Qualitative descriptive study.
Central Florida, USA.
Semi-structured interviews (N = 22).
The majority of respondents had heard of the HPV vaccine, but generally perceived HPV as a women’s health issue. Salient behavioural beliefs about HPV vaccination described physical (such as lowering risk and promoting overall health) and psychological benefits (such as protecting sex partners and providing peace of mind). There was some concern regarding the risks of vaccination including contracting HPV from the vaccine, not knowing if it would be effective, and side effects. Normative influences on decision-making were minimal. Availability, cost and convenience were among the most salient external control factors discussed. Issues surrounding disclosure of sexual orientation, as well as the competence and sensitivity of healthcare providers in dealing with issues of sexuality, were key factors in HPV-related beliefs.
Addressing the specific beliefs and concerns expressed by MSM can help to improve the effectiveness of health education interventions promoting vaccination.
Early childhood is considered a window of opportunity for lifestyle interventions, as this is a critical life-stage at which children accumulate knowledge and skills around behaviours such as eating and physical activity. This study examined how exposure to a settings-based healthy lifestyle programme influences knowledge and preference of food and physical play in preschool children.
Quasi-experimental, pre–post intervention design.
Pre- and post-impact evaluation of a healthy lifestyle intervention using an innovative computerised photo-pair food and exercise questionnaire and an age-appropriate test of executive function. The study included 82 children aged 3–5 years and was structured with an intervention and a control group. Quantitative data were analysed using SPSS v22.
For the intervention group, there was a significant improvement in overall knowledge of healthy lifestyle behaviours post-intervention, particularly in the identification of healthy and unhealthy food choices. There was no associated change in behavioural preferences.
The study highlighted that age-appropriate lifestyle interventions with preschool-aged children can lead to improved knowledge of healthy lifestyle choices. However, improvement in knowledge of healthy lifestyle behaviours does not necessarily lead to positive changes in food and activity preferences that inform choices.
The aim of this study was to measure possible impacts of a salutogenic lifestyle education programme on wellness and academic outcomes in a group of socioeconomically disadvantaged students in the first year of higher education.
University in the Eastern Cape Province, South Africa.
A mixed-methods approach was utilised to assess the relationship between wellness and academic outcomes. Data were gathered using the Wellness Questionnaire for Higher Education, a semi-structured researcher-generated questionnaire and transcripts of academic results. Data were analysed using SPSSv20 and NVIVOv8.
Findings revealed that all students showed modest improvements in overall wellness scores. A correlation was found between student wellness and academic success (r = .362, p = .049), which was stronger for students who gained the highest marks (r = .610, p = .004) and who made two to three lifestyle changes.
A holistic, salutogenic, wellness education programme shows potential to increase student wellness, which may then translate into student academic success.
Condom distribution programmes are an important means of preventing sexually transmitted infections (STIs); yet little research has examined their perceived and actual impact on college campuses.
Quantitative, cross-sectional study.
Large public university in the Southeastern USA.
Approximately 2 months after a campus-wide condom distribution programme began, we utilised intercept surveys with 355 students (68% women; 43% racial/ethnic minorities) to examine their perceptions of the availability, accessibility and acceptability of condoms, and their perceptions and use of the newly installed condom dispensers.
Students perceived condoms to be available and accessible on campus after implementation of the condom dispensers. Students had heard about the dispensers from other people (36%), through social media (18%) and the campus newspaper (15%). Most students (71%) had seen the dispensers. Almost one in four students (23%) had taken a condom from the dispensers; among those who were sexually active during the 2 months that the dispensers were available, 33% had used them. More than one-third of students (37%) – and 53% of sexually active students – indicated intentions to use the dispensers in the next 6 months. Multiple regression analysis controlling for age, gender and race revealed that prior condom use, attitudes about the dispensers and comfort with the dispensers were significant predictors of sexually active students’ intentions to use the dispensers (p < .001).
Overall, results indicate that over a short time period, this condom distribution programme was successful in reaching students and providing free condoms. Implications for implementing condom distribution programmes on college campuses as well as future directions for research are discussed.
Peer education is a much-used approach to health education with young people and marginalised groups. Rarely, however, has the concept been interrogated for its meaning and usefulness, despite pleas for the importance of doing so going back several decades.
Against this background, this paper offers a specifically educational analysis and critique of existing conceptualisations and descriptions of peer education.
The paper responds to the challenge of opening up the ‘black box’ of peer education with respect to teaching and learning, using the pedagogical frameworks offered by Basil Bernstein, critical pedagogy, feminist post-structuralism and Robin Alexander.
Findings point to the value of theories of pedagogy as conceptual and analytic lenses through which to interrogate what peer education is (and might be) and to better account for the uneven effectiveness of the approach.
Comprehensive School Health models offer a promising strategy to elicit changes in student health behaviours. To maximise the effect of such models, the active involvement of teachers and students in the change process is recommended.
The goal of this project was to gain insight into the experiences and motivations of teachers and students involved in a choice-based Comprehensive School Health model – Health Promoting Secondary Schools (HPSS).
School communities in British Columbia, Canada.
HPSS engaged teachers and students in the planning and implementation of a whole-school health model aimed at improving the physical activity and eating behaviours of high school students. The intervention components were specifically informed by self-determination theory. A total of 23 teachers and 34 school committee members participated in focus group interviews. The minutes of planning meetings were collected throughout the intervention process.
Analysis of the data revealed five themes associated with participants’ experiences and motivational processes: (a) lack of time for planning and preparation; (b) resources, workshops and collaboration; (c) teacher control impacts student engagement; (d) teacher job action inhibited implementation of HPSS action plans; and (e) choice-based design impacts participants’ experiences.
Findings from this study can facilitate future school-based projects by providing insights into student and teacher perspectives on the planning and implementation of school-based health promotion programmes and implementing choice-based educational change initiatives.
Young people in urban areas are often the focus of pregnancy and sexually transmitted infection (STI) prevention programmes because of their high risk of unwanted pregnancy and contracting an STI. Young people in rural areas are far less studied but also have a high risk of similar outcomes. This study evaluates Giving Our Girls Inspiration & Resources for Lasting Self-Esteem (GO GIRLS), an after-school pregnancy and STI prevention programme, in a sample of high-risk middle school girls living in rural areas using quasi-experimental methods.
GO GIRLS was assessed using the same survey administered at three time points: prior to the start of the programme, directly following completion of the programme and at the end of the school year. The sample for this study was drawn from a larger evaluation of a multi-faceted health initiative conducted over the course of the school year in three rural counties in South Central Florida.
The GO GIRLS programme was implemented in a rural area of South Central Florida. This area has higher rates of teenage pregnancy and poverty and lower educational attainment in comparison with state averages.
Propensity scores and nearest-neighbour matching without replacement were used to select a group of girls who did not participate in the programme but were comparable to participants. Programme participants were compared to the propensity score–selected controls on key outcomes using hierarchical linear regression.
Findings indicate that at follow-up, girls who participated in GO GIRLS had attitudes more accepting of delaying sexual intercourse than controls. However, participants did not differ in their levels of sex refusal skills at follow-up.
This study shows that the GO GIRLS programme has promise for at-risk, rural girls and highlights where future evaluation research is needed.
Sweden is one of three countries worldwide which has a legal requirement to ensure that pupils in compulsory school should be offered free, nutritious school meals. Furthermore, the law states that school meal provision should be included in schools’ internal quality management (IQM) system. The objective of this study was to examine to what extent schools in Sweden are following the legal requirement to include school meals in IQM and the relationship between this inclusion and the application of government advisory guidelines regarding school meals.
Cross-sectional study.
Head teachers evenly distributed across all regions in Sweden representing municipality schools, independent schools and Sami schools.
Web-based questionnaire completed by 216 head teachers.
About half of the schools did not meet the legal requirement to include schools meals in the IQM. Furthermore, familiarity with and use of the National Food Agency (NFA) guidelines and the web-based tool School Food Sweden, as well as activities considered as part of a pedagogical school meal and the inclusion of school meals in interdisciplinary work, were reported to be less common in schools not including school meals in their IQM system.
Findings suggest that when there is inclusion of school meals in a school’s quality management system, the school is also more likely to include school meals as part of educational activities. By acknowledging school meal provision as part of the educational process, possibilities are opened up for health-promoting activities to prevent non-communicable disease.
This study aimed to explore the motives of young people in multicultural suburbs for participating in youth-centre activities.
The study employed practice-based research with a focus on collaboration and methodological diversity. Data on motives for participation were collected in spring 2013 at two non-governmental organisation (NGO)-run youth centres located in the suburbs of two cities in Sweden using surveys and focus-group interviews.
The study used mixed methods, with qualitative data being used to help explain initial quantitative findings. Statistical analysis was conducted using measures of competence and social motives. Qualitative analysis used both deductive and inductive content analysis.
Study findings suggest that motives concerning competence development and socialising are insufficient to account for why young people in multicultural, socially disadvantaged suburbs participate in youth-centre activities. The study highlights the importance of additional motives influencing participation in leisure-time activities. The additional motives of ‘fun/undemanding’ and ‘support’ were found to be important to most young people in this study.
Study findings suggest that motives for participation in youth-centre activities have to do with characteristics of the participants, of the neighbourhood in which the centre is located and the specific type of unstructured leisure-time activity. Future motive measurement scales should include items concerning socioeconomic status, activities provided and young people’s degree of influence over the activities in which they participate.
To (1) describe barriers to diabetes prevention and self-management, (2) explore how religious beliefs inform diabetes prevention and self-management and (3) describe community action strategies to address the problem of diabetes locally.
Qualitative, descriptive design.
Three Moravian Churches located, respectively, in Bluefields, Pearl Lagoon and Tasbapounie on Nicaragua’s Southern Atlantic Coast.
Using convenience sampling procedures, local church pastors or leaders, health professionals and local lay adults with or at-risk for type 2 diabetes were recruited. Structured by an interview guide, focus groups were conducted. Data were analysed using Krippendorff’s content analysis method.
Barriers to diabetes prevention and self-management behaviours included financial constraints, inconsistent availability of diabetes medications and testing supplies, and limited diabetes knowledge. Religious faith was identified as central in coping with the daily demands of preventing or self-managing diabetes. Community action strategies to address diabetes included (1) the formation of interdisciplinary diabetes teams, (2) church-based diabetes care and (3) public health announcements.
Findings informed culturally sensitive diabetes prevention and self-management education through the identified community action strategies.
To compare physical activity and sedentary time among young children whose schools adhere to traditional (i.e. three outdoor playtimes = 70 minutes) versus balanced day (i.e. two outdoor playtimes = ~55 minutes) schedules within Ontario full-day kindergarten classrooms.
The project was part of a larger, 2-year cross-sectional study.
Full-day kindergarten classrooms across London, Ontario, Canada.
Participants included 113 young children (mean age = 4.69 years; standard deviation [SD] = 0.66 years) from eligible full-day kindergarten programmes. Participants’ physical activity and sedentary data were collected using Actical accelerometers worn for five consecutive days during school hours only. Type of school schedule and periods of outdoor play were captured using the Environment and Policy Assessment and Observation tool.
Participants mean activity rates (i.e. sedentary time, light physical activity, moderate-to-vigorous physical activity [MVPA] and total physical activity [TPA]) during school hours were similar across both formats. Participants’ overall daily physical activity and sedentary time did not significantly differ across school schedule type (p > .05); however, participants adhering to the traditional schedule accumulated significantly more TPA outdoors than those following the balanced day schedule.
Neither schedule format appeared to be superior with regard to supporting overall daily physical activity nor minimising sedentary time in school, although children adhering to the traditional schedule format did accumulate more physical activity during periods of outdoor play. Regardless of schedule type, steps are warranted to encourage additional movement (and minimise sedentary behaviours) in the school setting by school and public health officials.
Several studies have shown that workplace health promotion leads to better health, increased productivity, as well as reduced absenteeism and presenteeism among employees. The objective of this study was to describe how managers in small companies (10–19 employees) perceive their company as an arena for promoting employees’ health.
A sample of 10 managers (four women) was strategically selected. Semi-structured interviews were conducted with each person. Interviews were transcribed and analysed using qualitative content analysis. The analysis focused on both manifest and latent content.
Three main categories emerged from the analysis: the potential to promote employees’ health, responsibility as an employer and the need for external support. An arena for workplace health promotion is created when managers prioritise health at the workplace.
Small companies often lack the knowledge and resources to manage health and safety problems and also have less access to occupational health services. This paper highlights the importance of the views of small company managers as resources for the development of health promotion.
The purpose of this study was to investigate teachers’ perspectives on factors influencing their involvement in a Whole-of-School initiative.
A survey was administered to participating teachers/school personnel (N = 81) and 30 of the teachers/school personnel also participated in mostly individual interviews. The survey was informed by Lohrmann’s Ecological Model of Coordinated School Health Programs focusing on individual, interpersonal, community, organisation and policy factors. Category mean values were calculated for the survey data (along with t tests to explore differences by participant role in the schools), and interview data were analysed via analytic induction using several trustworthiness measures.
Findings revealed that all survey categories ranked 3.5 or higher on a 5-point scale and there were significant differences by participant role. Interview data provided specific examples of each of the school health ecology factors.
Results provide support for the model Whole-of-School programme efforts, insights into teacher and school personnel involvement and resistance to a school health change initiative. The project may serve as a model for other schools/districts interested in Whole-of-School health programming. The transformation that took place is especially important in this Indigenous community with significant health concerns.
Given the wealth of research identifying how schools are in a strong position to promote physical activity (PA) among children, it would be reasonable to suggest that initial experiences of physical education and school sport are critical factors influencing whether a student will develop a healthy relationship to PA. However, research in Australia equally identifies how secondary school-aged young people are increasingly failing to meet national guidelines concerning PA levels and participation rates, with adolescent girls displaying the most disturbing trends.
This paper examines how the recent Australian Curriculum Assessment and Reporting Authority (ACARA) Health and Physical Education (HPE) structure aims to address such concerns as poor PA levels and participation rates by adolescent girls.
A theoretical approach, consisting of document and literature analysis, was undertaken to develop insights into the current developments surrounding the ACARA HPE implementation, in an attempt to address identified socio-cultural issues within contemporary HPE practices. Such an approach is aimed at heightening effective pedagogy.
This paper provides a vision for supporting future student inclusion in HPE, by acknowledging potential barriers to the adoption of PA by adolescent girls and identifying strategies that will collectively promote curriculum priorities and classroom practices accordingly.
Food security is a topical issue but one that can be difficult to measure.
To develop a community-approved food basket tool and use this to investigate the availability and affordability of a healthy diet in a multicultural urban setting.
A 7-day healthy food basket (HFB) containing 96 foods for six household types was developed through focus groups (n = 6) with local residents recruited via the local health service and community organisations. A total of 41 stores were surveyed against the recommendations of the HFB. The availability and price of core food groups and energy dense discretionary foods were analysed.
A multicultural area in Central London with a high concentration of socially and economically deprived households.
Healthy food for a variety of minority ethnic diets was available in the study area, although only one supermarket and three online stores stocked the full basket. Discretionary foods were readily available and often cheaper than healthier options. The largest proportions of cost were attributed to protein foods (30%–38%) and fruit and vegetables (20%–27%). Most foods in the HFB were cheaper at larger supermarkets, although fruit and vegetables cost less at markets and local stores. Total basket price varied greatly between stores, with cost savings achieved when buying from at least three stores.
Economically disadvantaged members of the community may be excluded from accessing a healthy diet rather than cheaper foods that are energy dense and low in nutrients, particularly if they are unable to shop around. These findings provide insight for the development of voluntary sector partnership programmes, community education and local policy planning.
To assess an intervention to familiarise parents with children’s books for use in primary (5–11 years) sex and relationship education (SRE) classes.
Case study of a 7-week programme in one London primary school, using ethnographic observation, semi-structured interviews and focus groups with parents (n = 7) and key stakeholders (n = 4), and pre- and post-programme self-completion questionnaires (n = 9).
Parents reported increased understanding of the SRE curriculum and awareness of relevant children’s books, enhanced interactions with their children on SRE topics and some positive effects on partners and attitudes towards the school. There was increased confidence in addressing issues in the SRE curriculum for parents of 8- to 10-year-olds, although reduced confidence for one mother.
Familiarising parents with materials has the potential to enhance SRE, by improving coherence between educators’ and parents’ messages to children about sex and relationships, increased discussion of SRE topics in parent–child conversations and reduced parental anxiety about topics such as sexual orientation. Future challenges of involving fathers, scalability and sustainability highlight the dilemma of how best to enable parental choice or make equalities interventions.
The worldwide growth of non-communicable diseases requires important lifestyle adaptations. The earlier a healthy lifestyle is adopted, the better. Enabling a healthy lifestyle for children during the preschool years ideally involves the cooperation of parents and teachers. Health promotion with parents and teachers is most effective if it takes into consideration their views and opinions, as well as context.
The aim of this study was to explore perceptions of health and healthy lifestyle from the perspective of preschool children’s parents, and the staff caring for children attending preschools in three diverse settings.
Qualitative in-depth study.
Preschools in Western Cape Province, South Africa.
Data were collected through six focus group discussions and analysed using qualitative content analysis.
Parents and staff shared a holistic view of health, agreeing that children and their health were primarily the responsibility of the parents. Informants described their own health and that of children as affected by a variety of interconnected factors, including environmental, economic, social and individual influences.
When tailoring a health-promoting education programme, it is important to consider the pre-existing knowledge the participants have and the context in which intervention will take place. There is also a need to structurally address social determinants of health that may be beyond the control of the individuals.
Advances in electronics, the Internet and telecommunication have pushed the field of health care to embrace information technology (IT). However, the purposeful use of technology is relatively new to the field of health promotion. The primary objective of this paper is to review various applications of health IT, with a focus on its use in health promotion and its evolving impact on the healthcare system in the USA. It also emphasises on the potential benefits of introducing different applications of health IT in health care and health education.
A detailed review and synthesis of recent literature in the area of health IT was conducted to reflect and describe the recent trends related to health promotion influenced by IT in the USA.
This review reveals that despite initial reluctance, health providers and patients are accepting and even crediting health IT for providing patients with resources to educate themselves on their health status and actively participate in their health care by enabling them easy access to health information.
Health-related IT can facilitate a paradigm shift from a system-centred disease prevention model of care to a more patient-centred health promotion approach. Furthermore, like most other changes in health care, health IT is facing its share of challenges, yet evolving to be one of the fastest growing trends in the US healthcare system.
The purpose of this study was to investigate whether making fruit boxes available in the workplace is a successful health promotion strategy.
A quasi-experimental study involving three conditions – free fruit, 50c per piece of fruit and $1 per piece of fruit – to investigate the effect of a contribution scheme on employees’ fruit purchase/consumption behaviours and willingness to contribute when in the paid conditions.
Perth, Western Australia.
In total, 36 workplaces participated and were randomly assigned to one of the three conditions. The results were analysed using generalised linear modelling. A qualitative follow-up was conducted with workplace representatives 6 weeks after the completion of the trial to investigate how many workplaces implemented the provision of fruit boxes after the trial and the factors influencing the decision to implement fruit boxes.
A significant difference in average fruit purchasing/consumption per person was found with respect to condition (p < .001), with businesses in the free condition purchasing/consuming a significantly greater amount of fruit than businesses in the 50c contribution condition or $1 contribution condition. Following the trial, 13 workplaces continued providing their own fruit box, of which 7 were initially in the free condition. Qualitative findings revealed that management support, a receptive culture and sufficient resources were key to the implementation of fruit boxes.
Having a fruit box may be a feasible health promotion strategy, and the financial burden of this strategy could be alleviated by asking employees to contribute to the cost of fruit.
This paper explores the extent to which curriculum infusion (CI) impacted undergraduate students’ alcohol use, perceived peer alcohol use, use of protective behavioural strategies, academic performance and course engagement.
Two faculty members infused content on norms and protective behavioural strategies into selected academic courses.
This study was conducted in a small liberal arts university in the northeastern part of the USA.
A sample of 215 undergraduates from research design and statistics courses in the fall semester of 2013 and the spring and fall semesters of 2014 were selected. CI was experienced by 100 students and 115 students comprised the comparison group. Surveys were distributed at the end of each semester to these selected groups and the results were analysed.
Students who witnessed CI showed no improvement in alcohol use outcomes; however, there was a trend level effect for frequency of use. CI students reported higher expected final grades and similar levels of course engagement to comparison group students.
CI is a topic that requires in-depth scientific research to assess its value on positively affecting college drinking consequences. From a pedagogical standpoint, CI was successful since it did not negatively impact on students’ engagement and it was associated with higher expected final grades.
To ascertain the activities undertaken by children’s centres to prevent unintentional injuries in the under-fives and, in particular, the prevention of falls, poisoning and scalds.
A questionnaire was posted to managers of 851 children’s centres, using stratified cluster sampling. The questionnaire included questions on injury prevention activities undertaken by the centre, knowledge and attitudes to injury prevention, partnership working, and barriers and facilitators to injury prevention.
England.
A response rate of 61% was achieved. Most respondents (98%) agreed that children’s centres can be effective in preventing accidents. Over half of the respondents (59%) did not know whether there was an injury prevention group in their area, and 22% did not know whether there was a home safety equipment scheme. Only 12% knew the major cause of injury deaths in children under five. A variety of activities were being undertaken including one to one advice and issuing leaflets. However, for some important topics such as baby walkers and disposal of unwanted medicines, no advice was being provided in some areas. Lack of funding (52%) and lack of capacity (39%) were the most common reasons cited as barriers to injury prevention activities.
Injury prevention is an important activity undertaken by children’s centres. Given their position in the heart of the community, their potential as an agency to prevent injuries has been highlighted and recommended. Further support and resource will be needed if they are to fully develop their potential in preventing unintentional injuries in the home.
To describe a successful approach to teaching principles and practices of behaviour change through a behaviour change plan (BCP) initiative to improve personal health while advancing health knowledge and general education intellectual skills. Students’ perspectives of obstacles, behaviours important towards goal attainment and the benefits of the BCP were also explored. The paper illustrates the feasibility, utility and various challenges of theory-based BCPs within a limited context.
A one-group posttest-only design was utilised to conduct quantitative analysis of reported BCP success and qualitative evaluation of students’ perspectives. Participants were 145 students enrolled in eight sections of a required freshman-level health education/general education course.
Students set and tracked a nutrition, fitness, sleep, smoking cessation or spirituality goal. They strategised to mitigate anticipated challenges, established support systems, rewards, self-assessed progress, described corresponding implications, reviewed evidence-based research and wrote reflections. Goal achievement data were tabulated for each focus area, and report narratives distilled into common themes.
Among 145 students, 71 set fitness goals (55% achieved, 39% partially achieved, 11.3% did not achieve) and 63 set nutrition goals (63.5% achieved, 27% partially achieved, 8% did not achieve). Commonly reported barriers were lack of time, laziness/apathy/boredom, discouragement, temptations and sickness/injury/pain. Behaviours important to goal attainment were utilising time management, enlisting support or competition, using visual cues, trying something new, re-adjusting expectations, removing temptations and using rewards. Benefits included physical, psychological and financial types. Final reflections showed students would use the BCP process again.
This approach to teaching health behaviour change provides real-life opportunity for planning, practising and prioritising wellness. Grounded in behaviour therapy, and framed by the Transtheoretical Model for Behaviour Change and essential health education and general education intellectual outcomes, this BCP highlights the inherent link between personal health principles and liberal learning outcomes. It may be adopted or refined by health educators willing to engage in this type of student-centred learning.
The objective of this study was to investigate the relationship between classroom psychological climate and the physical and sedentary behaviour of primary school students after the implementation of an innovative education programme regarding nutrition and physical activity.
Randomised controlled trial.
Study participants were 729 students, aged 8–10 years, in the third and fourth grade of 30 public primary schools in the Athens Metropolitan Area.
Students were randomly assigned to three study groups: an Intensive Intervention Group (IIG) that underwent an intensive nutrition and physical activity education programme delivered by specialised personnel and teachers, an Intervention Group (IG) that underwent a less intensive programme delivered by their regular teacher and a Control Group (CG) that received no instruction. Classroom Psychological Climate (CPC) was measured in all groups, and the data regarding physical activity and sedentary lifestyle habits, such as the time spent viewing TV or video games (screen time), were recorded.
Friction declined and satisfaction increased significantly after the intervention in the IG compared with the CG. There was no significant difference in physical activity and screen time between the groups. Daily screen time was positively associated with increased friction, which is a measure of conflicts between students in the school environment.
A school nutrition and physical activity education programme was shown to decrease friction by decreasing daily screen time and increasing outdoor activities. These findings also suggest that teachers alone may be more effective in delivering optional health education programmes than specialised personnel and instructors.
The study aimed to design and evaluate a health behaviour change intervention for looked after young people, targeting sexual health, smoking, exercise, healthy eating and non-dependent alcohol and drug use.
A pre–post intervention evaluation was undertaken exploring health behaviours and wellbeing.
The one-to-one intervention was individually tailored to each person. Young people eligible for the intervention were aged 11 years and over and were ‘looked after’, meaning they were under a supervision order with a local authority in Scotland, or were a care leaver. A total of 144 young people referred to the intervention service between March 2009 and January 2014 were eligible for the evaluation. Evaluation data were analysed using standard statistical tests on SPSS.
Behaviour change techniques, including goal setting, action planning, barrier identification/problem solving and motivational interviewing contributed to improvements in all areas. Difficulties with consent and follow-up were highlighted as barriers to effective evaluation.
Improving the current health of looked after young people with a view to prevent future ill health using a tailored intervention with behaviour change techniques enables this group to improve health behaviours, despite numerous challenges in working with these vulnerable clients.
Considerable attention has been focused on the impact of young people’s alcohol use. To address this, schools often implement alcohol and drug education and there are many potential programmes to choose from.
The aim of this study was to identify evidence-based alcohol education programmes for schools.
A systematic review was undertaken of school-based programmes that targeted alcohol within a school setting and included at least one alcohol behaviour or knowledge change outcome. Six-hundred seventy-five abstracts were screened resulting in 454 studies assessed for eligibility, with 70 studies, evaluating 40 individual programmes, included in the final review.
Of the 40 programmes, 3 had good evidence of a positive effect. They included CLIMATE Schools (Australia), Project ALERT (USA) and All Stars (USA). Of the others, 4 showed some evidence of positive effect, 1 had no evidence of effect, 29 were inconclusive and 2 showed negative outcomes, such as increases in alcohol use. Although many programmes were evaluated, very few had sufficient evidence to be able to endorse their widespread implementation in schools.
Three programmes included in the review had sufficient positive outcomes to be recommended for implementation, and four showed good outcomes in some areas. Schools should consider these results when deciding on introducing alcohol education. Overall, the evidence base is broad but relatively weak and further research is required, focusing on programmes identified as having good or potentially good outcomes.
Among primary care patients with chronic physical conditions and comorbid depressive symptoms, to assess (1) the effect of lay telephone coaching on adherence to a psycho-educational intervention for depression, (2) demographic characteristics that predict adherence and (3) the association between adherence and 6-month outcomes.
Single blind randomised pragmatic trial of a lay telephone-supported depression self-care intervention compared to an unsupported intervention.
All patients received a multimedia toolkit of paper and audiovisual materials on depression that provided education on depression and on self-care for depression. Core tools included a cognitive-behavioural therapy (CBT)-based workbook and a mood monitoring notebook, with opportunities for written exercises and notes, and a video. Intervention group patients were additionally offered telephone coaching. Self-reported use of the materials was assessed at 3 and 6 months post-randomisation; 6-month outcomes were patient satisfaction and change from baseline in depression severity.
In all, 223 patients were randomised; 165 (74.0%) completed follow-up. Coached versus uncoached patients reported significantly greater use of the workbook, but not of other tools. Men used more audiovisual tools; women used more paper tools. Self-reported completion of written exercises and a greater number of coach contacts were associated with greater satisfaction, but not with improvement in depression.
Telephone coaching can increase adherence to CBT-based tools for depression self-care; however, use of these tools may not improve depression outcomes. Many patients are capable of self-directed use of self-care educational materials. Sex differences in patterns of tool use may be helpful in the targeting of tools.
The Precede–Proceed model has provided moral and practical guidance for the fields of health education and health promotion since Lawrence Green first developed Precede in 1974 and Green and Kreuter added Proceed in 1991. Precede–Proceed today remains the most comprehensive and one of the most used approaches to promoting health.
A decade after the most recent edition of the model was published in 2005, this paper examines the model’s theoretical underpinnings, history, and influence on the field of health promotion. Although the limited evidence for effectiveness of this and other models is discussed briefly, this review focuses on the socio-ecological and ethical implications of the model.
Theory and literature review.
Precede–Proceed has promoted public health and health promotion practice in five ethically and practically important ways: (1) by advancing the ecological perspective on health that, today, has come to dominate public health practice; (2) by remaining population-centred, rather than focusing on individuals; (3) by demanding democratic and participatory approaches to health promotion; (4) by setting quality of life, rather than behaviour change or even health, as the goal for health promotion; and (5) by being deeply grounded in practice.
Precede–Proceed guides practitioners in bridging health promotion goals of enabling people to control and improve their own health with larger public health goals of creating the conditions where people can be healthy. It also provides an ethical guide to promoting health in democratic and participatory ways.
This paper reports on a pilot study evaluating the feasibility and acceptability of a text- and mobile video–based intervention to educate women and men attending college about non-daily contraception, with a particular focus on long-acting reversible contraception (LARC). A secondary objective is to describe the process of intervention development.
Participants included undergraduate students attending a large urban US university between September and November 2011.
Using a participatory research strategy, investigators developed, delivered and evaluated a pilot mobile intervention using a texting interface, mobile videos and a contraceptive provider directory.
Descriptive statistics summarise the data collected from daily text-in analytics and web-based survey responses.
The texting interface received 1,203 visits; mobile videos were accessed 446 times. The provider directory was used by 10% of participants. Survey respondents’ (N = 82) motivation for choosing non-daily contraception included cost (57%), side effects (55%), effectiveness (55%) and low recall effort (23%). Most participants (88%) would/might recommend these methods to others.
This study demonstrated that text- and mobile video–based modalities are appropriate and feasible to deliver contraceptive education to college students. There is a critical opportunity to reach large numbers of potential users through mobile health (mHealth) interventions to disseminate accurate information and link to healthcare services.
To conduct a systematic review of effectiveness, and barriers and facilitators, of initial teacher training to promote health and well-being in schools.
Systematic review of the literature.
A total of 20 bibliographic databases were searched, including MEDLINE, EMBASE and the Social Science Citation Index. Studies were included if they reported research into the processes and/or outcomes of initial (pre-service) teacher training to promote health.
A total of 20 studies met the inclusion criteria, mainly from the UK and Australia. Twelve studies assessed outcomes, commonly using uncontrolled before and after assessment designs. Sixteen studies evaluated the processes of training. Training was diverse in terms of content, format and health topics. The studies demonstrated short-term increases in trainee teachers’ factual knowledge of health issues, a general increase in teachers’ confidence to teach about health and to identify and help children with specific health issues. There was an increase in teachers’ positive beliefs about their role in promoting children’s health. None of the studies assessed changes in pupil outcomes. The training was generally considered acceptable and adequate by trainee teachers. However, some of the trainees felt that they still lacked knowledge and confidence to address sensitive health issues on entering teaching practice.
This systematic review identified some evidence for the effectiveness of teacher training for health and highlighted factors which facilitate and inhibit effective training. Further evaluation, using controlled trial designs with long-term follow-up of teacher and pupil outcomes, may enable teachers to effectively address the health and education needs of school pupils.
To use a model of health learning to examine the role of health-learning capacity and the effect of a school-based oral health education intervention (Winning Smiles) on the health outcome, child oral health–related quality of life (COHRQoL).
Primary schools, high social deprivation, Ireland/Northern Ireland.
Cluster randomised controlled trial.
A total of 383, 7- to 8-year-old children were invited to participate and randomly allocated into intervention and control conditions. Baseline and 12-month follow-up assessments of COHRQoL, self-esteem, toothbrushing–fluoride toothpaste knowledge and unstimulated saliva samples were made. An 18-hour post-brushing, saliva fluoride concentration was used to assess toothbrushing with fluoride toothpaste (behaviour). The data were entered onto SPSSv22. Structural equation modelling was applied using AMOSv22 to test for the role of health-learning capacity (baseline self-esteem and COHRQoL) and simultaneous effects of Winning Smiles upon knowledge, behaviour and COHRQoL (at follow-up).
A total of 238 children participated at baseline and follow-up. A partial latent hybrid model fitted the data reasonably well (2 = 65.6, df = 50, p = .07) as shown in addition by a Comparative Fit Index of .97 and a Root Mean Square Error of Approximation (RMSEA) value of .042 (90% confidence interval [CI]: .00, .06). The intervention had a significant effect on toothbrushing–fluoride toothpaste knowledge (p < .03) and an effect on COHRQoL at the 6% level (p < .06). Knowledge was strongly associated with saliva fluoride concentration (p < .002).
The model of health-learning capacity assisted in explaining the effect of a school-based intervention upon knowledge, toothbrushing behaviour and tentatively on COHRQoL.
The aim of this study was to analyse experiences of a health promotion intervention implemented by the Therapeutic and Educational Unit at Villabona prison in Spain, which aimed to create drug-free spaces as part of a model of social rehabilitation.
As part of a larger participatory evaluation study concerning the efficacy of community education, qualitative data were collected from inmates and key informants associated with the unit.
Information was gathered from 68 informants via 32 in-depth interviews, 6 discussion groups and 4 life stories. Participants included 39 inmates, 10 prison professionals, 5 ex-prisoners, 11 stakeholders and 3 family members.
The unit provides a drug-free space that encourages healthy behaviours and strengthens formal and informal social ties to enhance protective factors.
The educational and therapeutic model employed may provide a successful methodology for the promotion of health in penal system institutions. Drug-free opportunities to promote good health may be provided through inmates’ participation in therapeutic spaces and the process of change, alongside effective social and community support. The intervention described here offers a successful new social model of health promotion and education for prison inmates.
The transition from high school to college or university is an important time to enhance mental health literacy for young people. This study evaluated the second edition of a resource entitled Transitions, a comprehensive life-skills resource with embedded mental health information available in book, e-book and iPhone app formats for post-secondary students.
In this cross-sectional/one-off study, students’ opinions about the impact of the resource were gained through in-person and online surveying.
The survey took place on a local university campus in Canada. Frequencies of responses and sex differences in answers were analysed using Predictive Analytics Software (PASW) 17. In total, 82 students from a large, Canadian research university completed the survey.
Reading Transitions (2nd edition) improved student knowledge about and decreased stigma towards mental health and mental illness and increased help-seeking efficacy. There were sex differences in response regarding discussion of the resource with others and help-seeking intentions.
Given the positive results of this study conducted at a single university, the resource could potentially be valuable in other post-secondary settings as well.
This study aimed to describe Discourses on vegetarian food in the Swedish school subject Home and Consumer Studies.
The study involved the observation of naturally occurring classroom talk, with audio recording and in some cases video-taping.
The study was conducted during Home and Consumer Studies lessons in five different northern Swedish schools.
Fifty-nine students and five teachers were observed, recorded and in some cases video-taped. The resulting data were analysed with a focus on big ‘D’ Discourses.
Results indicated that gendered Discourses of absence, deviance and unattainability restricted some students’ access to vegetarian food. The absence of meat was constructed as simultaneously healthy and unhealthy, a lack of cultural familiarity with vegetarian cooking made finding recipes difficult and students perceived the loss of taste as very negative. The vegetarian was seen as deviant, with vegetarianism being conceptually equated with sickness. Access to meat-free food required a commitment to a vegetarian lifestyle, and this was seen as a sacrifice and as too much work, not only for the individual but also for others.
To counteract the restricted access to vegetarian food, Home and Consumer Studies teachers can redesign activities in the subject with the help of critical food literacy. For example, cooking could focus on popular plant-based dishes instead of ‘empty’ vegetarian themes, all students could be allowed to share vegetarian dishes instead of reserving them for vegetarians, the possibly strict rules of vegetarianism could be relaxed for those who do not wish to commit to them and vegetarian food could be deliberately connected to strength and masculinity. However, this presupposes sufficient economic resources and ample food storage space.
In many low- and middle-income countries, access to health information during pregnancy is poor. The rapid adoption of mobile phones in these countries has created new opportunities for disseminating such information.
This paper reviews existing information on the use of short message services (SMSs) as a feasible tool to transmit health education information.
The PubMed, Cochrane library, EMBASE and Google scholar databases were searched for studies in which mobile phone SMSs were used to promote health education during pregnancy. Studies of adult women, from any setting, who received SMS health education messages during their pregnancy, were included, irrespective of study design.
The analysis of results followed a narrative synthesis approach, a textual approach involving a synthesis of findings from multiple studies. The synthesis was developed manually, based on the extraction of data. All studies demonstrated use or interest in SMS technology to facilitate health information messaging. Findings from several studies showed that pregnant women were both receptive and willing to use SMS technology to enhance their health. In Zanzibar, the effect of SMS on skilled delivery rates and access to emergency healthcare was assessed. The effects SMS alerts had on hospital deliveries and SMS interventions had on facility use during pregnancy were assessed in Rwanda.
The review highlights the practicality and willingness of utilising SMS technology to promote or enhance health education.
While driveway run-over incidents continue to be a cause of serious injury and deaths among young children in Australia, few empirically evaluated educational interventions have been developed which address these incidents. Addressing this gap, this study describes the development and evaluation of a paper-based driveway safety intervention targeting caregivers of children aged 5 years or younger.
Cross-sectional survey.
Informed by previous research, the intervention targeted key caregiver safety behaviours that address driveway risks. To assess the impact of the intervention, 137 Queensland (Australia) caregivers (95.0% women; mean age = 34.97 years) were recruited. After receiving the intervention, changes to a number of outcomes such as caregiver risk perception, safety knowledge and behavioural intentions were measured.
Findings indicated that the intervention had increased general and specific situational risk awareness and safety knowledge among a substantial proportion of participants. Close to one-quarter of the sample strongly agreed that the intervention had increased these outcomes. In addition, 71.6% of the sample reported that they intended to make changes to their routine in and around the driveway, as a result of reading the intervention material and a further, quarter of the participants strongly agreed that the information provided would be a help both to themselves (26.5%) and other caregivers (33.8%) to keep their children safe in the driveway.
While the educational intervention requires further validation, findings from this study suggest that intervention content and format increases driveway safety.
Maya women in Guatemala are disproportionately affected by poverty and negative reproductive health outcomes. Although social networks are valued in many Indigenous cultures, few studies have explored whether health education programmes can leverage these networks to improve reproductive health and economic wellbeing.
This qualitative study explored the role that social networks play in both health education and economic empowerment among women involved in a Maya reproductive health women’s group.
Western highlands region of Guatemala.
Semi-structured in-depth interviews, each lasting 2–3 hours, were conducted with 19 women (aged 18–40 years) who had participated in a formal women’s network. Topics addressed included personal experience with the group, aspirations for the future and attitudes towards reproductive health and economic wellbeing.
Respondents stated that by engaging in formal group activities and interacting with others in the network, they were able to find their voice. They described gaining self-confidence needed to speak about reproductive health with pre-adolescent and adolescent girls as well as other community members. Respondents also discussed learning new ideas/skills and detailed future aspirations of planning their family and reaching educational/career goals.
The study illustrates the potential of social networks to provide individuals with knowledge and skills, along with new ways of thinking about themselves and their futures. Health education programmes aspiring to improve the reproductive health and economic wellbeing of vulnerable groups, such as Maya women, should seek to leverage the benefits of such social networks.
The population of young people most vulnerable to low levels of physical activity (e.g. urban/minority/low socio-economic status/female/non-athletes) often has the least access to physical activity opportunities and resources. It has been suggested that a comprehensive, school-based approach, including prudent use of time before, during and after the school day may be an effective way to increase overall physical activity, but little is known about why urban students voluntarily participate in these extracurricular programmes. Using social cognitive theory as a framework, this study examines urban high-school students’ rationale for attending after-school physical activity clubs designed to provide fun, safe, supportive places to do physical activities with friends.
Qualitative study in an urban school district.
Over a 2-year period, adult leaders within 14 inner-city schools in a large urban district in the Midwest USA held 938 physical activity club sessions targeting traditionally inactive youth to promote non-competitive physical activity. Interviews with student participants (n = 278) and researcher field observations (n = 115) were used as primary data sources.
Three primary themes emerged to explain the voluntary participation of high-school students in after-school physical activity clubs: (a) social affiliation, especially group identification and establishing relationships with adult leaders and likeminded peers; (b) health and performance, including improving physical health and performance in other athletic endeavours; and (c) the ‘right’ types of activities and focus, including those that were student-centred, non-competitive and culturally relevant.
Creation and sustainability of successful inner-city physical activity clubs will largely hinge upon the capitalisation on an understanding of the motivations of an urban student population.
Australia has implemented a nation-wide programme providing a human papillomavirus (HPV) vaccine to girls and boys through school-based programmes. Previous research has identified three distinct areas for attention: (1) lack of understanding about HPV and HPV vaccination, (2) young people’s desire for involvement in decision-making about HPV vaccination and (3) fear of HPV vaccination. We aimed to develop an intervention to address young people’s low levels of understanding, to promote their involvement in consent and reduce vaccination-related fear and anxiety.
Formative qualitative research was conducted in six public, private and Catholic schools in the Sydney metropolitan area. Girls who were offered the vaccine in a school programme and aged 12–13 years were interviewed in focus groups. Piloting of materials was conducted in three private schools across Sydney with both girls and boys, and changes and additions were made to the materials in accordance with feedback.
We developed an educational intervention aimed at addressing gaps in young people’s knowledge and understanding, and offering strategies to improve confidence with vaccination and reduce needle-related anxiety. Components of the final intervention include film chapters, a magazine, a website, an app and teacher support materials. The intervention is designed for teachers and/or nurses to deliver and is linked to the school-based HPV vaccination programme.
This is the first educational intervention designed for young people in HPV school-based vaccination, to be developed from empirical data with the involvement of young people themselves.
In the light of the shortcomings of curriculum-based health promotion in secondary schools, group motivational interviewing provides a potential alternative approach. This two-phase study set out to establish the key components, feasibility and acceptability of a group motivational interviewing intervention, focused on alcohol consumption.
In phase 1, focus groups with 12 students and 8 teachers explored issues with existing health education in Wales. Phase 2 involved the development of a 1-hour group motivational interviewing session to address the issues raised. The session was delivered to two classes of students aged 13–15 years, facilitated by two motivational interviewing practitioners. Sessions were observed and audio-recorded and coded by two researchers using the Assessment of Motivational Interviewing Groups Observer Scale (AMIGOS). Student acceptability of the session was captured using a satisfaction questionnaire.
Sessions were consistent with motivational interviewing principles, providing empathic and focused discussion while maximising participants’ autonomy and strengths. The majority of students felt listened to during the session, considered it was helpful and felt that they could learn more from this kind of experience.
A group motivational interviewing session, developed based on key components identified during focus groups, was shown to be acceptable to students and feasible to deliver in secondary schools. The approach requires further research to establish sustainable delivery mechanisms.
High levels of obesity-related health disparities are common among US American Indian (AI) populations. AI public university students often face unique challenges that may contribute to weight gain and related consequences. Few weight maintenance interventions have been developed that meet the needs of AI public university students. The goal of this study was to determine how to tailor Project Y.E.A.H. (Young Americans Eating and Active for Health), a web-delivered, weight maintenance tool developed for college students to make it culturally relevant for AI public university students.
Three mini focus groups (N = 15) and five in-depth interviews (N = 11) were conducted with self-identified AI college students on the campus of South Dakota State University. Participants were recruited with assistance from the American Indian Education and Cultural Center and through campus publicity. Recorded sessions were transcribed and multistep coding was used to assess the aesthetic appeal of the website and determine variations of certain health-related factors.
AI public university students have specific and culturally influenced aesthetic, food and physical activity exposures and preferences. AI students may perceive unique stressors compared to non-AI students and practise cultural forms of stress relief.
Specific and culturally relevant psychographic information regarding AI college student preferences is needed for the development of effective weight maintenance tools.
The objective of this study was to assess knowledge of metabolic syndrome (MS) among Chinese adults and provide directions for designing healthcare promotion schemes for improving MS awareness in the community.
The study adopted a cross-sectional design and a convenience sampling method.
Chinese adults aged 18–65 years and living in the community completed a self-administered questionnaire, providing socio-demographic information and indicating their knowledge of MS using a validated knowledge of MS (K-MS) scale comprising 10 multiple-choice questions. The scores of K-MS can range from 0 to 100.
A total of 297 participants were recruited (mean age = 51.3 ± 8.9 years), 66.7% of whom were women. More than half of all participants (n = 154) were identified as having MS and numerous participants were obese (n = 158). The mean K-MS score was 44.9 out of 100; most participants (61%) scored below 50, indicating a poor level of MS knowledge. Participants who were older, had a lower level of education or were unemployed scored the lowest.
Acquiring knowledge of MS is crucial for preventing the development of type 2 diabetes and cardiovascular diseases. However, Chinese adults in a community setting exhibited poor understanding of MS. Public health efforts regarding primary prevention of cardiovascular diseases should be targeted at improving MS knowledge. Additional measures are needed to assist people in the low socioeconomic classes.
Obsessive compulsive disorder (OCD) in children can be difficult to detect. Schools and families need to be made aware of the signs and symptoms of OCD in order to facilitate access to treatment. Parents of children with OCD may require support as well as knowledge. This study evaluated two initiatives aimed at increasing knowledge and support for parents and teachers.
This study was carried out in two parts. First, to raise awareness of the signs and symptoms of OCD, 266 schools in London were supplied with information packs. Knowledge of OCD was evaluated using a quiz before and after the dissemination of the packs. Second, groups of parents were given the opportunity to log into specially designed webinars that made it possible for them to learn about OCD and interact with other families. Feedback on webinars was collected through a survey.
Both the information packs and webinars were well received. One hundred and twenty seven teachers completed the quiz on OCD; knowledge of OCD increased after reading information packs. Twenty six parents attended webinars; parents reacted positively to being able to ask specialists questions and receive support from other families.
Overall, the initiatives evaluated in this study appeared to lead to an increase in knowledge of OCD in teachers and provided access to further support for parents of children with OCD.
The purpose of this study was to determine the proportion of skateboarders who owned and who wore a helmet and which constructs from the Health Belief Model predicted helmet ownership and helmet use among undergraduate skateboarders.
From March 2013 through March 2014, 83 skateboarders completed a helmet attitude and use survey.
Among participants, 47% owned a helmet while 18% wore a helmet on their most recent ride. Skateboarders who did not own a helmet were compared to skateboarders who owned a helmet but did not wear it and to skateboarders who wore a helmet. Positive trends for emotional benefits, friends and family cues to action and parental rules cues to action were observed. A negative trend for vanity and discomfort barriers was observed. Friends and family cues to action, parental rules cues to action and lower perceived danger were associated with helmet ownership. Friends and family cues to action were associated with helmet use.
The findings are consistent with the thrill seeking culture of skateboarding. Implications for interventions to increase helmet use among undergraduate skateboarders are discussed.
The objective of this study was to identify theory-based psychosocial and environmental determinants of parental monitoring practices related to child sugar-sweetened beverage consumption.
Cross-sectional design.
Data were obtained from a convenience sample of parents (n = 270) with children attending an after-school programme (ages 7–12 years old), in a small, southwestern community in the USA. Parents were approached and asked to complete a valid and reliable survey based upon the Integrative Behavioural Model.
Using structural equation modelling, a final model proved to have a good fit (Comparative Fit Index = .986, Tucker–Lewis index = .947), and results indicated 28.5% of the variance of parental monitoring was explained by intentions, skills and the home environment, with 56.3% of the variance of intentions being explained by attitudes, injunctive norms and perceived behavioural control.
Results suggest that the Integrative Behavioural Model offers a useful framework for predicting parental monitoring of sugar-sweetened beverage consumption and can be useful when planning future health promotion programmes. Future researchers should consider applying the Integrative Behavioural Model to other obesogenic behaviours.
The value of workplace wellness programmes (WWPs) has been established in the literature. Such programmes, however, have an increased likelihood for success when both management and non-management employees’ perspectives and needs are incorporated into development and implementation. This study aimed to identify the perspectives of each of these two employee groups as a means of informing the future development and implementation of WWPs.
Nine focus groups (N = 56) were held in western Canada with participants employed at four diverse organisations consisting of >100 employees. Each participating organisation provided two separate groups, consisting of one management group and one non-management group. Participants were asked to share their perceptions, attitudes and beliefs concerning WWPs. Thematic inductive analysis was conducted to elicit emergent areas of focus.
Three areas of focus were identified: (1) role of the company in WWPs, (2) elements of successful WWPs and (3) mandatory participation in WWPs. Providing a clear indication of the roles and responsibilities of both employee groups, making these initiatives part of the organisational strategic plan, demonstrating a long term commitment to such programmes, and having employees play participatory roles in the design, implementation and decision making process, are components that need consideration.
Both employee groups agreed that their organisation played a role in employee health. Similarities and discrepancies of the beliefs between groups are highlighted and key considerations are presented. Findings have implications for the future development and implementation of WWPs.
Motivating clients to change the health behaviour, and maintaining an interest in exercise programmes, is an ongoing challenge for health educators. With new developments in technology, simulation and gaming are increasingly being considered as ways to motivate users, support learning and promote positive health behaviours. The purpose of the present study was to develop an exercise simulation called BringItOn, which is targeted towards individuals who need to increase their physical activity for health, recovery or rehabilitation. BringItOn is a video-based simulation in which individuals use a Kinect system to capture their movements as they exercise.
A usability study was conducted to examine software ease of use and perceived usefulness. An expert heuristic evaluation was completed by a software engineer, and user testing was conducted using the think-aloud method, observation, survey and interviews.
The majority of participants were very enthusiastic about the exercise simulation’s potential to encourage exercise and activity. Three major benefits of the simulation were identified: (1) it promotes proper exercise technique; (2) individualised feedback similar to that received from a personal trainer was viewed as very motivating; (3) the software was ‘game like’, and made exercising fun.
The simulation system has considerable potential as a component in an integrated rehabilitation programme for patients or as a health promotion activity for individuals. The results shed light on key components that health educators should look for in simulations if they hope to maximise user motivation and encourage a positive changes in health behaviour.
To review the characteristics of effective health promotion interventions for reducing chronic diseases and their risk factors in truck drivers.
MEDLINE (PubMed), SCOPUS, Web of Science Conference Proceedings, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the National Transportation Library were searched using keywords related to ‘truck driver’, ‘commercial driver’, and ‘health promotion’. Reference lists of relevant documents were hand-searched.
The search strategy identified 2,372 non-duplicate citations, of which nine met the inclusion criteria. These nine articles represented eight unique interventions. No studies measured chronic disease as an outcome. Six interventions incorporated multiple components and reported positive findings on various intermediate health outcomes (i.e. body mass index [BMI], % body fat) or health behaviours (i.e. nutrition, physical activity). The other two interventions modified work practices only, and found no significant improvements on fatigue and psychosocial measures.
Health promotion interventions for truck drivers can improve both intermediate health outcomes and health behaviours over the short term. The small body of literature on health promotion interventions is a concern given that truck drivers are an at-risk population and their health impacts the safety of the driving public. Studies primarily focused on changes at the individual level and this is also a concern as environmental and work organisation factors are important determinants of both chronic disease outcomes and health-related behaviours in truck drivers. Future research should also include economic evaluations as well as methods to determine facilitators and barriers to programme participation and continuation.
Increasingly clinical and health research awareness is a priority for health and medical research communities. Translational research, including the prevention and treatment of conditions, relies upon proper funding as well as public participation in research studies. This requires executing more effective communication strategies to care for recipients and the community at large – providing the downstream benefit to improved public health and patient care. Without new and improved approaches, recruiting research volunteers will remain a significant challenge for clinical research teams, particularly as limited funding necessitates smaller budgets and shorter timelines to engage participants.
This community-based project partnered the complementary strengths of a public library (the Library) located in the same city as an academic research centre (the University): The University’s research infrastructure and the Library’s community and information delivery expertise combined to impact awareness of clinical research in the local population.
This project utilised a multi-method approach to assess interest in health research, to deliver relevant information on community-relevant health topics and to increase awareness of health research in general. It was designed with the community to identify a sustainable, affordable model to deliver health information and illuminate the role of research in the process.
The project demonstrated a successful community-based model, utilising Health Research Forums and online resources to increase the connection between health research information and health research participation opportunities.
By linking researchers with community members, providing related resources to augment linkage between health information and research, the project demonstrated an increased awareness regarding opportunities that exist for community participation in research through a sustainable model.
Health-promoting schools (HPS) constitute an internationally recognised approach that connects health and education in a planned, integrated and holistic way. There is considerable variability, however, in how HPS is implemented and recent research has attempted to clarify the key functions of implementation. A provincial HPS strategy in Nova Scotia (NS) (Canada) provided a unique research opportunity to examine implementation related to emerging theory. The purpose of this exploratory research was to describe a provincial case study of HPS implementation using theoretical components identified in the literature.
Collective case study approach using qualitative research methods.
The study was situated within a larger province-wide school-based research project examining the relationships between health, nutrition, physical activity, mental health and school performance of children in NS. As a follow-up to the provincial study, nine schools (n = 9) that varied in their HPS implementation strategies and characteristics (i.e. size and region) were invited to take part as case study schools.
Data collection included observations, interviews and documents from nine schools (n = 9). Data were analysed for emerging themes and using the a priori theoretical components.
The results revealed that schools assembled into three sequential categories based on the functioning of theoretical components. Higher level visioning and school-level leadership were critical in sustaining the adoption and implementation of HPS across schools and appeared to enable and integrate organisational processes, such as distributed leadership and a collaborative school culture, to enhance HPS implementation at school level.
This study confirmed other reports that it is imperative to integrate HPS work with educational values so as to enable partnerships in both the health and education sectors, thereby promoting both health and prosperity among students.
This study aimed to test the predictive validity of the Theory of Planned Behaviour (TPB) when applied to the oral health-related behaviours of parents towards their preschool children in a cross-sectional and prospective design over a 5-year interval.
Data for this study were obtained from parents of 1,057 children born between October 2003 and July 2004 in two regions in Flanders, Belgium. Three behaviours related to oral health (dietary habits, oral hygiene habits, dental attendance) as well as their psychological determinants based on the TPB (attitude, subjective norms, perceived behavioural control (PBC), intention) were measured using validated self-report questionnaires when the children were 0 (2003–2004), 3 (February–June 2007) and 5 years old (March–June 2009).
Multiple linear regression analyses indicated cross-sectionally that the contribution of attitudes, subjective norms and PBC towards intention, and of intention and PBC towards the frequency of consumption of sugared snacks and drinks, tooth brushing and dental attendance was significant (p < .001). The combined determinants explained 27%–37% of the variance in intentions and 7%–39% of the variance in the behaviours. Across time, only parental PBC as measured at birth could significantly predict dietary and oral hygiene behaviours at children’s ages 3 and 5 years.
This study supports the validity of the TPB to predict intentions and oral health-related behaviours of parents of preschool children. Interventions should aim to improve parental attitudes towards diet and dental attendance, and their PBC towards tooth brushing.
Given the benefits of participating in sport, sports clubs have been recognised as health-promoting organizations. To examine health-promotion activities in Finnish sports clubs, Kokko et al. developed a set of standards for health-promoting sports clubs (HPSC).
The present study extends this line of research, by (1) measuring coaches’ perceptions of health- promotion activities in French sports clubs and comparing them to earlier Finnish results, (2) measuring coaches’ perceptions of the health-promotion aims of sports clubs and (3) examining the links between HPSC and coaches’ self-determined motivation.
Coaches (N = 125) completed a modified version of the HPSC questionnaire and a scale assessing their motivation to coach.
Coaches perceived French and Finnish sports clubs as fairly health promoting, but with wide variability between clubs. In both countries, sports clubs scores showed the same patterns: high scores for ideology and environment activities, and low scores for policies, practices and partnership. Coaches’ perceptions of clubs’ aims also followed the same pattern, but with higher scores for each dimension, meaning that coaches considered health promotion as a relevant aim for sports clubs. Finally, controlling for demographic variables, the HPSC index and sub-indices were related to coaches’ self-determined motivation.
This study strengthens the previous findings for health promotion in the setting of sports clubs and the positive role of these activities on coaches’ motivation to coach.
This paper summarises the context and rationale behind developing a European doctorate in health promotion and public health and its relevance to the international context. Since no Pan-European doctorate exists to date, a network of universities and higher education institutions across Europe has been working towards the establishment of a European doctorate in health promotion and public health. This paper describes the consensus-building process among this network of core stakeholders, combining key learning outcomes with the results of a scoping study. We critically examine some of the challenges encountered and discuss the potential need for such a doctoral level qualification.
The consensus-building process included several meetings as well as a qualitative scoping study, consisting of nine qualitative interviews with and two written responses from different stakeholders in the area of doctoral education.
We describe the different requirements, benefits and challenges linked to the development of a European doctorate in health promotion and public health that were identified within the consensus-building process and in the qualitative data.
Overall, the benefits identified suggest that a European doctorate in health promotion and public health would be a positive and progressive initiative. However, the potential added value and the demand for such a doctorate still need to be examined.
To develop and assess an innovative educational video package for improving HIV knowledge, attitudes and practices among company workers in Ecuador.
The design and development of the HIV prevention educational video was based on the results of a large-scale survey conducted in 115 companies (commerce, manufacturing and real estate) and among 1,732 workers in the three most populous provinces of Ecuador (Pichincha, Guayas and Azuay). Two focus groups (workers of different job categories and HIV experts from various domains) evaluated the video by means of an 11-item questionnaire scoring the concept, script, technical aspects, potential impact, content and quality of the digital production.
The video produced was 16-minutes long. The two focus groups indicated their overall satisfaction with the initial version of the video and their scores were high. They felt the video kept their interest, was easy to understand, and evidenced the good use of graphics, voice audio and narrative to impact on the audience. The experts were, however, slightly more critical than workers and made some minor suggestions about the content and the need to test the video’s cultural appropriateness and degree of comprehension, both of which improved the video prior to its final release.
Video-based HIV intervention programmes targeting company workers may have value in improving knowledge and reducing the risk of HIV transmission in Ecuador.
This paper examines key debates and perspectives on sex education in Health Education Journal (HEJ), from the date of the journal’s first publication in March 1943 to the present day. Matters relating to sexuality and sexual health are revealed to be integral to HEJ’s history. First published as Health and Empire (1921 – 1942), a key purpose of the journal since its inception has been to share information on venereal disease and its prevention within the UK and across the former British Empire. From 1943 to the present day, discussions on sex education in the newly-christened HEJ both reflect and respond to evolving socio-cultural attitudes towards sexuality in the UK. Changing definitions of sex education across the decades are examined, from the prevention of venereal disease and moral decline in war-time Britain in the 1940s, to a range of responses to sexual liberation in the 1960s and 1970s; from a focus on preventing sexually-transmitted infections, teenage pregnancy and human immunodeficiency virus in the 1980s, to the provision of sexual health services alongside sex education in the 2000s. Over the past 70 years, a shift from prevention of pre-marital sexual activity to the management of its outcomes is apparent; however, while these changes over time are notable, perhaps the most striking findings of this review are the continuities in arguments for and against the discussion of sexual issues. After more than 70 years of debate, it would seem that there is little consensus concerning motivations for and the content of sex education.
To investigate physical activity among older people living alone in Shanghai, People’s Republic of China, and key factors contributing to their physical activity.
A cross-sectional questionnaire survey was administered in nine communities in Shanghai, using a stratified random cluster sample: 521 community-dwelling older people living alone (aged 60 years and above) completed a structured questionnaire through face-to-face interviews. Their physical activity was measured using their self-reported frequency of engaging in different types of activities. Other data collected included self-rated health, number of chronic diseases, depression, functional ability, loneliness, social support and socio-demographic variables.
Only 16.7% of participants reported adequate physical activity, defined as performing at least 30 minutes of moderate/strenuous exercise on at least 5 days per week. A younger age, a lower level of education, better functional ability and walking outside the home 5 – 7 days per week increased the likelihood of adequate physical activity. Gender, self-rated health, number of chronic diseases, depression and social support also had relationships with physical activity levels.
The prevalence of adequate physical activity in older people living alone in Shanghai was low. In this population, appropriate health education interventions to promote physical activity levels are needed.
Objective: To assess the effectiveness of the FIFA 11 for Health programme in increasing children’s knowledge about communicable and non-communicable diseases in five countries of Sub-Saharan Africa.
Method: A prospective five-cohort study was implemented in schools in Ghana (17), Malawi (12), Namibia (11), Tanzania (18) and Zambia (11). The programme consisted of eleven 90-minute sessions consisting of two 45-minute halves of Play Football (football skills) and Play Fair (health issues). Participants were boys and girls aged 10–14 years: Ghana (906), Malawi (1098), Namibia (439), Tanzania (720), Zambia (651). The main outcome measures recorded were children’s attendances at each session, their health knowledge (30-item questionnaire) before and after the interventions and the children’s evaluation of the programme itself by means of a six-item questionnaire.
Results: Mean attendance by children during the programme ranged from 88% (Malawi) to 99% (Tanzania) of participants. Increases in the children’s overall level of health knowledge were recorded in all countries: range: 11% (Malawi) to 25% (Namibia). Children’s overall evaluation-rating of the programme was very positive in all countries, ranging from 93% (Zambia) to 98% (Namibia, Tanzania).
Conclusions: The FIFA 11 for Health programme produced significant increases in children’s health knowledge and their awareness of disease prevention using an in-school, football-based health education programme. This success was most likely linked to the very high satisfaction rating given to the programme by the children involved. The success of the interventions also demonstrated the benefit of collaborating with the Ministries of Education in each country.
Objective: Our aim was to evaluate a type 2 diabetes education programme for Chinese Australians, based on the experience of participants and by exploring the unique needs of Chinese patients, their health beliefs and their cultural behaviours.
Design and setting: We undertook a qualitative ethnographic study in a community health service setting in Southeast Melbourne, Australia.
Method: Eight semi-structured in-depth interviews were conducted with a purposive sample of past participants of a diabetes education programme for Chinese Australians. Data were thematically analysed, using both an ethnographic and a phenomenological lens.
Results: Although participants appreciated the delivery of diabetes education in their own language, many expressed frustration and confusion when applying education messages to disease management. They described the barriers imposed by their collectivistic orientation, whereby Chinese people accept health recommendations unquestioningly, often living in misery with an excessively rigid management plan, and highlighted their lack of understanding of self-management. Patients also felt helpless in trying to mix Western and Eastern medical practices without adequate professional support.
Conclusions: This qualitative study illustrates the complex and multifaceted challenges associated with diabetes management among Chinese Australians, and identifies many unique needs encountered by Chinese patients that were not addressed by the diabetes programme studied. There is an urgent need to identify optimal diabetes education models that will meet the needs of Chinese Australians.
Background and objective: The Good Behaviour Game (GBG) has been shown to be effective in preventing childhood disruptive behaviours and their long-term unfavourable health-related outcomes. Like many other evidence-based preventive health programmes, however, its current use in Dutch primary schools is limited, and knowledge of the factors influencing the adoption of the programme is scarce. This study aimed to provide a theory-based description of the GBG adoption process and to examine factors influencing this process in primary schools in Amsterdam.
Design and methods: In this mixed-methods observational study, semi-structured face-to-face interviews with decision makers from schools that did (n=11), and did not (n=6), adopt the programme were supplemented with structured telephone interviews with non-adopters (n=39). Based on Rogers’ Diffusion Theory, the qualitative data were analysed using a deductive approach.
Results: Factors facilitating the adoption of the GBG were specific school needs and problems, formulated in educational rather than health terms, and the visibility of the programme’s positive effects. Factors impeding adoption were competing programmes in schools and being unaware of favourable funding opportunities. In contrast to previous studies, ‘time investment’ did not play an impeding role.
Conclusion: Adoption of prevention programmes in schools may benefit from framing dissemination strategies in educational terms, and using self-assessment procedures to reveal specific needs/problems and to create a ‘readiness to change’. In addition, adoption may benefit from using active dissemination strategies, including opinion leaders reporting their positive experiences with the programme, and the termination of any ineffective programmes that schools currently use.
Objective: To investigate two risky behaviours (i.e. binge drinking and drinking and driving) and their individual- and college-level correlates among South Korean international college students in the USA
Design: Cross-sectional online survey (student response rate = 41.6%).
Setting: South Korean college students (N = 1201) were recruited from 52 different four-year universities in the USA in 2009.
Method: Self-reported binge drinking, drinking and driving, smoking, study-related stress, life dissatisfaction, region lived in, and type of university attended, were assessed using already-validated instruments.
Results: A total of 92% of the sample reported at least one occasion of binge drinking in the previous 30 days. Among those who had driven a motor vehicle in the previous 30 days (n = 950; 79% of the overall sample), 67% had engaged in drinking and driving. Students’ binge drinking was positively associated with current cigarette use and higher levels of life dissatisfaction at college and study-related stress. Students’ drinking and driving was also positively associated with higher levels of life dissatisfaction at college and study-related stress. These relationships were stronger among students attending private institutions than among those attending public institutions. While both college-level correlates (university region and university type) were significantly associated with drinking and driving, none of the college-level correlates were significant in the binge drinking models.
Conclusion: A very high proportion of South Korean international students attending colleges in the USA appear to engage in binge drinking and drinking and driving. Development of intervention programmes designed specifically for them is necessary.
Objective: Playground injuries result in over 200,000 US paediatric emergency department visits annually. One strategy to reduce injuries is improved adult supervision. The Stamp-in-Safety programme, which involves supervisors stamping rewards for children playing safely, has been demonstrated in preliminary classroom-based work to reduce child risk-taking and increase the quality of adult supervision. This study evaluated the efficacy of delivering Stamp-in-Safety to playground supervisors via the Internet.
Design: Pre-post design following a pragmatic trials approach.
Setting: Twenty-four preschools in the USA.
Method: Guidance for implementing the Stamp-in-Safety programme was delivered to preschool supervisors via the Internet. Supervisors and preschool directors completed online surveys concerning self-efficacy to keep children safe, playground supervision behaviour, perceptions about playground safety, and knowledge about playground supervision/Stamp-in-Safety both prior to and after the intervention was implemented. They completed a usability survey after using the online intervention.
Results: Ratings of usability and satisfaction with the programme were high, indicating feasibility. Paired-samples t-tests showed some improvement in supervisors’ self-efficacy, and improvement in most aspects of supervisory behaviours, perception of playground safety, and knowledge about playground supervision/Stamp-in-Safety.
Conclusion: Results suggest the Stamp-in-Safety programme can be delivered successfully via Internet. A public health challenge is translating effective interventions to broad dissemination. Internet delivery of Stamp-in-Safety holds the promise to overcome this challenge and improve playground supervision practices.
Objective: Health literacy is increasingly recognised as a potentially important patient characteristic related to patient education efforts. We evaluated whether health literacy would predict gains in knowledge after completion of patient education in cardiac rehabilitation.
Method: This was a re-post observational analysis study design based on Summa Health System’s Phase-II cardiac rehabilitation programme in Akron, Ohio, USA. The Medical Term Recognition Test, the Short Test of Functional Health Literacy in Adults, and the Newest Vital Sign were administered to 191 patients enrolled in cardiac rehabilitation between May 2010–April 2011. The Cardiac Knowledge Assessment Tool is routinely administered at the beginning and prior to discharge from cardiac rehabilitation. Consent was obtained in order to access patients’ cardiac rehabilitation medical chart for information such as age and education level.
Results: Participants were 72% men with a mean of 66.4 years of age, and with an average level of education of 13.7 years. Health literacy was strongly related to cardiac knowledge at both the beginning and end of cardiac rehabilitation (r=0.46, p<0.001; r=0.41, p<0.001). Controlling for cardiac knowledge at the beginning of cardiac rehabilitation, health literacy predicted gains in cardiac knowledge at the end of cardiac rehabilitation (p<0.01).
Conclusion: Health literacy can be used to predict gains in knowledge from patient education programming in cardiac rehabilitation. Health literacy screening may help to identify those who may struggle with patient-education portions of cardiac rehabilitation or who may need additional education to reach a desired knowledge level.
Objectives: This study sought to make the Brief Illness Perception Questionnaire (BIPQ) to be more informative about illness representation among older adults with hypertension. The authors developed categories for coding the open-ended question regarding cause of illness in the BIPQ – a pervasive quantitative measure for illness representation.
Methods: Using inductive thematic analysis, the authors described categories which emerged from analysing the open-ended question of the BIPQ applied to patients with hypertension. Then using deductive thematic analysis, we applied known categories in the literature to causes for hypertension elicited by the BIPQ. Our categories are: behavioural, natural, physical, psychosocial, supernatural, and other.
Results: We established inter-coder reliability by applying the coding scheme to a sample of suburban central Illinois (n=197) and urban Tucson, Arizona (n=299) older adults with hypertension (initial kappa=0.61, revised kappa after decision rules=0.987). To demonstrate the utility of the coding scheme we found that both Illinois and Arizona nonwhite patients differ from white patients in how they understand the cause of their hypertension.
Conclusion: A more complete illness representation can now be quantified and statistically analysed through the BIPQ using the categories we revised for cause of hypertension. Assessment of causal beliefs through the BIPQ and the authors’ coding scheme may enable tailored and efficient patient education, resulting in more effective provider–patient relationships.
Objectives: Physical inactivity is a major public health concern. At a population level, it is increasingly perceived to be a social problem which is global and multidimensional, and which requires attention by a diverse range of state, private and civil society organisations. Given the increasing attention to physical in/activity by a range of interest groups, this paper explores the political dynamics that are present within physical activity promotion discourse. Specifically, the paper examines the political dynamics associated with a recent physical activity lobby document entitled Designed To Move (DTM). DTM was written and produced by a variety of corporate, government, and health promotion organisations.
Method and analysis: This paper uses a critical policy framework to analyse the justifications for, and suggested techniques of, physical activity promotion. It examines the explicit and more subtle reasons used to justify physical activity recommendations, how causes of physical inactivity are conveyed, and who is identified as able to fix the problem.
Conclusions: While DTM appears to be a positive and inspirational call to action, several aspects of the document are problematic. Significantly, older adults receive scant attention in DTM, and are therefore removed from being potentially important agents in the proposed solution. DTM also frames the workplace milieu in a way that promotes ‘productivity’ and business ‘fortune’ above concern for and consideration of employees’ material conditions of existence. The paper concludes by encouraging health researchers, physical activity students and health promoters to look behind and beyond assumptions about the causes of, and solutions to, physical inactivity.
Objective: Childhood obesity represents a significant public health problem. This study examined physical activity and nutrition behaviours and attitudes of 9–11-year-olds, and factors influencing these behaviours.
Design: Study participants recorded pedometer steps for 7 days and completed physical activity enjoyment, food attitudes and food frequency questionnaires. Fruit and vegetable sales data were collected from schools. The setting for the study was elementary schools in metropolitan Denver, Colorado (USA).
Method: Logistic regression was used to determine significant predictors of meeting physical activity/fruit and vegetable intake recommendations.
Results: Overall, 42.0% of boys and 44.1% of girls met step count recommendations. Further, 30.9% of boys and 32.8% of girls met step count requirements associated with low risk for overweight/obesity. Enjoyment of physical activity significantly predicted achieving recommendations. Overall, 66.4%, 51.3% and 65.8% of 9–11-year-olds achieved adequate fruit, vegetable, or fruit and vegetable intake, respectively. Enjoyment of fruit/vegetable consumption, perceived parental intake and encouragement and cups of vegetables purchased predicted achieving adequate intake.
Conclusion: The majority of young people aged 9–11 years failed to meet step count recommendations to prevent the risk for overweight/obesity. A significant proportion also failed to achieve adequate fruit and/or vegetable intake. Future programmes and interventions should affect multiple environments in order to improve child enjoyment of physical activity and fruit/vegetable intake in order to improve the physical, mental and emotional health of children.
Objective: Leaving a portion of meals uneaten, known as plate waste, is a serious problem among children in Japan. Although children’s confidence that they can completely finish meals is related to plate waste, the circumstances that influence this confidence are not known. This study examined situations in which low self-efficacy for finishing their meal occurs among elementary school children in Tokyo, Japan.
Design: A survey using a cross-sectional self-reporting questionnaire was conducted in December 2009. This questionnaire included items about plate waste behaviour, self-efficacy for completely finishing meals in specific situations, sex, height and weight.
Methods: A total of 2659 Japanese 5th-grade students completed the questionnaire. Univariate logistic regression and multivariate logistic regression analyses were performed with the plate waste behaviour item, the not-completely-eaten group and the completely-eaten group as dependent variables, and with the self-efficacy items as independent variables.
Results: Significant correlations were found between plate waste and low self-efficacy for completely finishing meals ‘when portion size is too large’ (boys: Odds ratio (OR) = 3.94; 95% Confidence interval (CI) = 2.83, 5.49 and girls: OR = 2.68; 95% CI = 2.03, 3.54), ‘when food one dislikes is served’ (boys: OR = 3.74; 95% CI = 2.77, 5.04 and girls: OR = 2.89; 95% CI = 2.21, 3.76), and ‘when the time allowed to eat is too short’ (boys: OR = 1.57; 95% CI = 1.16, 2.14 and girls: OR = 1.49; 95% CI = 1.13, 1.97). Low self-efficacy ‘when a meal is not delicious’ (OR = 1.79; 95% CI = 1.32, 2.43) was a predictor of plate waste only among boys.
Conclusions: The results suggest that in Japan environmental improvement and nutritional education are related to children’s plate waste.
Objective: The objective of this study was to synthesise and describe adherence to intervention in published studies of supported self-care for depression or anxiety, and to identify participant characteristics associated with higher adherence.
Methods: We searched the databases EMBASE, MEDLINE, CINAHL, and PSYCINFO for the period from January 1986 until September 2010. Eligible studies reporting on adherence to supported self-care interventions for depression or anxiety symptoms were identified.
Results: We identified 40 studies of supported self-care interventions for depression and anxiety, of which 22 (55%) reported any measure of adherence to the intervention. Among these 22 studies, 18 (82%) reported the percentage of participants completing the entire self-care tool (20%–93%; Mean = 66%, SD 17), 13 studies reported the amount of self-care tools completed by the average participant (50.6%–96.4%; Mean = 80%, SD 11.6). Four studies (18%) reported the frequency of contacts with the self-care guide. Three (14%) studies reported participant characteristics associated with adherence.
Conclusion: Overall, reported adherence levels to supported self-care interventions for depression and anxiety indicate a significant amount of patient involvement in these interventions. Routine reporting of adherence will improve our understanding of adherence to supported self-care interventions, and will allow researchers to link adherence with intervention outcome.
Introduction: Sexual assault continues to be a pervasive health issue among college students in the USA. Prevention education initiatives have been implemented to address this concern. However, little is known about college students’ perceptions of such programming. The purpose of this study was to assess predictors of college students’ perceptions of the importance of sexual assault prevention education for themselves and for college students in general.
Methods: We recruited college students (n = 252) from undergraduate classes at a medium-sized, mid-western university to participate in a closed-ended, paper-and-pencil survey.
Results: The majority of participants perceived sexual assault prevention education as important for themselves (88.7%) and for college students in general (97.1%). Several characteristics emerged as predictors of students’ perceptions of the importance of sexual assault prevention education programmes.
Discussion: Gender and age were significant predictors of students’ perceptions of the personal importance in experiencing sexual assault prevention education. Gender, age, participation in a student organisation and previous experience of sexual assault emerged as significant predictors of students’ perception of the general importance of sexual assault prevention education.
Conclusion: Sexual assault prevention educators could seek out specific individuals whom think prevention education is important, in order to involve them in prevention efforts as peer-educators.
Objective: This paper reports on patients’ perspectives on the nurse management of hypertension following consultation training, elicited as part of a randomised controlled study.
Method: Telephone interviews were conducted with 16 patients in an intervention group (IG) and eight patients in a control group (CG), 3 years after nurses’ consultation training in primary health care. By means of a 3-day course, nurses were educated in patient centredness, Motivational Interviewing, the Stages of Change model, guidelines for cardiovascular prevention, lifestyle changes and pharmacological treatment. In addition, they took part in video-recorded consultation training with simulated patients. A specially designed educational booklet was developed for patients in the IG.
Results: Of the 16 patients in the IG, 13 reported that their views and former experiences were taken into account and all eight patients in the CG reported the same. Patients in the IG reported that the nurse listened and they had been guided and motivated to perform lifestyle changes. The booklet in the IG was reported to have been read several times, but a few patients did not remember receiving it. There were more informed thoughts about how to manage lifestyle in the IG. Patients in the CG were less detailed in their descriptions.
Conclusion: Patients in both IG and CG reported to have made efforts to change lifestyle, and patients in the IG reported that they had been coached and motivated by their nurses to do so.
Objective: Smokeless tobacco (SLT) use is associated with specific adverse health effects. Knowledge of student tobacco use, including SLT, may guide inquiry into other risky health behaviors, and provide opportunities for health education of students.
Design: An incentivized email invitation to complete a web-based survey was sent to students at 11 colleges and universities in North Carolina and Virginia.
Methods: In autumn 2010, emails were sent to all first-year students (n=29,536) at 11 colleges and universities in North Carolina and Virginia, inviting them to participate in a brief web-based survey to be used to establish a cohort for the parent study evaluating tobacco use over 4 years. Survey items elicited demographic characteristics, tobacco use and other health behaviors.
Results: A total of 10,520 (36%) students responded. Past 30 day smoking and SLT use were 12% and 3%, respectively. Logistic regression analysis revealed that male gender (Adjusted Odds Ratio [AOR] = 11.6, 95% Confidence Interval [CI] = 8.16–16.59); current smoking (AOR = 5.5, 95% CI = 4.21–7.10), ever use of alcoholic energy drinks (AOR = 4.8, 95% CI = 3.63–6.43), and ≥ 5 days vs. < 3 days of physical activity a week (AOR = 1.5, 95% CI = 1.07–2.01) predicted risk of past 30 day SLT use.
Conclusion: While SLT use is relatively uncommon, knowledge of significant correlations between student tobacco use, including SLT and other risky health behaviors, might guide clinicians’ inquiry and provide opportunities for health education of students.
Objective: Our aim was to develop written resource material for use in the Oral Health Information through Community Pharmacists project. Poor oral health is associated with cardiovascular disease and diabetes. Many people do not access dental services on a regular basis; however, they may access community pharmacies for help and advice about oral health problems. Community pharmacists may be a valuable point of oral health information for people with heart disease or diabetes.
Design: This paper reports the development of the written resource material for the project groups.
Methods: Brochure development was guided by Fishbein and Yzer’s integrative model, and pre-tested with seven focus groups representing the potential target groups. Feedback from the focus groups was analysed concurrently and modified versions of the brochures were presented to subsequent groups.
Results: The use of both written and visual messages enhanced the readability of the brochures for the focus groups with attendant Flesch Reading Ease scores of 77.4 and 79.4, while the ‘Make a plan’ section prompted future action planning amongst the participants.
Conclusion: Well-designed patient education materials with good content, aesthetics and readability are important to deliver health messages within the context of a planned intervention. The three final brochures will be used in the intervention trial of the project.
Objective: Participatory learning strategies are integral to the effectiveness of school-based health education programmes; however, use of such methods is not the norm in teaching. The omission of participatory learning strategies is a common form of programme breakdown leading to erosion of positive learning and behavioural outcomes. Based on a survey of 75 Australian high school health education teachers, the study’s objective is to examine teachers’ perspectives on the factors that influence their use of participatory learning strategies. Results: Whilst it is often presumed that training is the most significant factor, this study found that teachers identify understanding the educational rationale for the approach, student engagement, confidence in class control, and having positive relationships with the students, along with practicalities such as having time to adequately prepare a class as the most significant influences on their pedagogical choices. Conclusion: The study concludes that a better understanding of the reasons why teachers make particular choices in their delivery of programmes gives valuable insight into what teachers need in order to support uptake or maintenance of such approaches. This understanding may in turn contribute to health education programmes being delivered with a higher fidelity and better outcomes for students.
Objective: A recent economic approach suggests that people do not account for the long-term implications of unhealthy behaviours, preventing them from performing a fully rational trade-off between current benefits and future costs, leading to negative health outcomes. We examined whether the current allocation of time to physical activity among young people leads to outcomes that may affect their well being as youth and their longer–term life prospects.
Design: The study group comprised a random sample of 1692 high-school students (14.8±0.7 years old) from urban Santiago, Chile attending private and non-private schools.
Setting: We measured physical activity habits accounting for time spent in class, studying and screen-based entertainment, hours of daily recreational activity and hours of weekly scheduled exercise. Obesity and abdominal obesity were diagnosed according to CDC/NCHS 2000, NHANES III and IDF criteria, respectively.
Method: Logistic regression analysis was performed to assess the relationship between current physical activity habits, confounders and the likelihood of suffering from obesity and abdominal obesity.
Results: Young people reporting the lowest allocation of time to physical activity, scheduled exercise and active play showed a higher risk of obesity and abdominal obesity. Those reporting moderate allocation of time to physical activity, scheduled exercise and active play were more likely to suffer from central obesity as defined by IDF criteria. Study participants attending partially subsidized schools showed the highest risk of obesity and central obesity.
Conclusions: In this sample, young people appear not to be employing optimal strategies for making weight-related choices, since reduced physical activity, obesity and central obesity are proximate causes of metabolic and cardiovascular disorders.
Objective: The aim of this study was to investigate the use of stairways/moving stairways in shopping malls and examine the extent to which simple warning signs determined whether people took the stairs.
Design: Large posters that could readily be seen by mall visitors were situated between the stairs and moving stairways in shopping malls.
Setting: A total of 30,026 people who visited the shopping mall over an 11 week period were chosen consecutively for this study.
Method: Thirty-three counting operations (2 h/day) were undertaken using two positive posters and one negative poster on different days of the week. In the process of counting, four groups were examined: children, adults aged <55 years, adults aged ≥55 years, and overweight individuals. General observations conducted during the first 2-week period, and the 5th, 8th, and 11th weeks served as control periods.
Results: When posters were not shown, rates of stair use were lower among individuals in all age groups, but the ratio of stairway to moving stairway use tripled when positive-direction posters were displayed. Similarly, negative-direction posters decreased the ratio of stair to moving stairway use. Positive-direction posters were strongly associated with stairway use (p = 0.001).
Conclusion: This study showed that the use of stairs decreased when no poster was displayed, while positive posters increased stair use and negative posters decreased this behaviour. Individual preference, together with the comfort brought by moving stair technology, consciously or unconsciously causes individuals to avoid activities they can perform during the day.
Background: Immigrants, a fast-growing population in Canada, score below the national average in health literacy, but the reasons behind the low scores are largely unknown. Also, there is a need to understand the long-term impact of immigration by examining health literacy by generational status.
Objective: To examine health literacy differentials in Canada, comparing immigrants and non-immigrants; as well as immigrant sub-groups by their region of origin, recency of arrival and generational status.
Methods: A cross-sectional multi-stage representative sample of 22,818 respondents from the Canadian component of the 2003 International Adult Literacy and Skills survey. Data were collected in the home of each respondent. We used descriptive statistics and logistic regression in this study.
Results: Fewer immigrants (24%) than non-immigrants (44%) had the requisite health literacy level. After controlling for selected factors, health literacy was still significantly lower for immigrants compared to non-immigrants (OR = 0.51; 95% CI = 0.37 – 0.70). For the immigrant sub-groups and by generations, initial differences that were observed, disappeared after controlling for selected factors. Overall, health literacy was associated with economic, education, and literacy-related factors, but the association with literacy practices at home and at work was stronger for the immigrants than the non-immigrants.
Conclusion: Education and literacy practices at home and at work are important determinants of the population’s health literacy; however, education is more likely to be associated with acquisition, while literacy practices are more likely associated with maintenance of health literacy. This adds to our understanding of the factors associated with health literacy, by immigrant and generational status, and shows how different segments of the population in Canada process health information.
Objective: The objective of this paper was to assess students’ attitudes towards school-based sex and relationships education (SRE).
Design: This study featured a cross-sectional survey design.
Method: A sample of 715 students from two districts in Tanzania completed a survey questionnaire assessing various aspects related to their attitudes towards SRE.
Results: Results show that the overwhelming majority (more than 80%) of students supported the provision of SRE in schools and the inclusion of a wide range of SRE topics in the curriculum. The majority of students wanted the teaching of SRE in schools to begin early during primary education (ages 10–14). Nevertheless, the majority of students objected to the inclusion of some of the SRE topics that are commonly regarded as controversial, including homosexuality and masturbation. Students’ attitudes towards SRE and specific topics were associated with participants’ sex, age and religious affiliation.
Conclusion: The results of this study should encourage policy makers and researchers in Tanzania to advocate for the provision of comprehensive sex education in schools.
Objective: This review investigated how the three-phase model of critical pedagogy, based on the writings of Paulo Freire, can be put into practice in health education.
Design: The study considers literature related to the fields of health education, health promotion and critical pedagogy.
Setting: The study is a scholarly review completed as part of a larger academic study.
Method: A library search was conducted of relevant books, journal articles and theses using keyword searches including health education, health promotion, critical pedagogy and Freire. Ideas from the literature and from teaching experience were integrated to consider how the three-phase model of critical pedagogy might be of benefit to health education.
Result: The review makes a case for the use of critical pedagogy in health education and discusses how Freire’s ideas can be combined with pedagogical techniques to overcome the difficulties of encouraging students and teachers to be co-learners in a power sharing arrangement, negotiating the content of the learning, ensuring that discussion is inclusive of a range of voices, perspectives and points of view, and dealing with the conflict which may be caused by the political nature of the teaching and learning.
Conclusion: The three-phase model of critical pedagogy, based on the writings of Freire, is advocated for use in health education because it ensures that learners have an opportunity to critically engage with health information rather than to simply be passive recipients of it. It aims to focus learning on the problems, issues and real world experience of the learners, facilitates problem-posing education, and challenges the learner to question practices that support inequality. The three phases are: listening and naming; dialogue and reflection; the promoting of transformative social action.
Objective: Our aim was to evaluate a health education programme (TBIoptions: Promoting Knowledge) designed to increase public awareness and understanding about traumatic brain injury (TBI) through in-person (classroom) and computer-based (electronic) learning environments.
Design: We used a pre-post survey design with randomization of participants to classroom (N = 22) or electronic (N = 22) delivery of the programme, in classroom and computer laboratory settings on the campus of Kansas State University, Manhattan, KS.
Method: Forty-four participants rated areas of knowledge about TBI prior to and after the programme experience. They also rated health programme quality and instructional strategies (e.g. video vignettes). Written responses provided information for qualitative analysis.
Results: Participants reported significantly higher ratings of knowledge after the programme experience. Qualitative analysis of written responses provided further evidence to support quantitative outcomes. There were no significant differences in comparing the two methods of delivery (classroom versus electronic learning format). Participants rated the quality of the programme and various instructional strategies very highly.
Conclusion: TBIoptions: Promoting Knowledge offers a health education programme to increase understanding about TBI. Both modes of delivery, classroom and electronic, appeared equally effective in terms of self-report of change.
Objectives: This paper examines the context of health promotion actions that are focused on/contributing to strengthening social capital by increasing community participation, reciprocal trust and support as the means to achieve better health and more active ageing.
Method: The methodology employed was a literature review/research synthesis, and a thematic analysis.
Results: Four core themes emerged from the analysis: a) active ageing; b) the relationship between social capital and ageing; c) the importance of social capital in health promotion; and d) policy implications. The role of social capital in health promotion stresses empowerment, intergenerational support, the building of social trust, and the need to tackle loneliness among older adults. The importance of community/social participation emerged from the literature review as a key contributor to the maintenance and promotion of a healthier ageing population.
Conclusion: Supporting long-term social capital building within communities can lead to improved public health and well-being for an ageing population.
Objective: Rising inactivity has led to an increase in health promotion campaigns aimed at encouraging healthy behaviour change. While this has become common place, often practices advised by social marketing to maximise effectiveness are overlooked. This study investigates the development and effectiveness of one particular physical activity public health campaign implemented in Liverpool, United Kingdom (UK). A formative evaluation feedback session was included to communicate findings back to key stakeholders to reflect on the experience and identify learning points for future campaigns.
Design: Based on a pragmatic paradigm the study was conducted in three parts: (1) campaign designer interview; (2) public on-street survey; and (3) stakeholder formative evaluation feedback session.
Setting: The context of this study was Liverpool, UK.
Method: Deductive content analysis was guided by key themes of the campaign design, including the poster image, tagline, main text, and overall layout.
Results: The design team had aimed for a ‘tongue in cheek’ image and message on which to base the campaign. However, the public survey suggests that the campaign largely failed to translate the proposed message and reach the intended Liverpool population. Formative evaluation feedback highlighted a lack of application of social marketing principles in campaign development, in particular audience targeting and pilot assessment.
Conclusion: This study highlights the importance of the inclusion of social marketing principles in the development of health promotion campaigns in an attempt to aid audience understanding and adoption of the desired health behaviour.
Objectives: This study examined the knowledge, attitudes and practices of clinicians in promoting physical activity to prostate cancer survivors.
Design: A purposeful sample was used and cross-sectional data were collected using an anonymous, self-reported online questionnaire or an identical paper-based questionnaire.
Settings: Health services and online questionnaire.
Methods: Clinicians were invited to complete the questionnaire which measured their knowledge, attitudes and practices relating to physical activity for their patients.
Results: Thirty-one clinicians completed a questionnaire. Most participants were men (71%), aged 30–40 years (45.2%), and radiation oncologists (35.5%). Although clinicians recognized the benefits of physical activity for their patients, few always gave advice about physical activity. Advice was verbal in nature, very few provided written material and none referred patients to an exercise specialist. Older age, a belief that physical activity reduces side effects of treatment, higher confidence and disagreement that physical activity has risks were associated with higher frequency of providing physical activity advice. Over half of the clinicians (55%) reported that advising patients on physical activity was not part of their role.
Conclusions: This study provides preliminary evidence that physical activity advice may not be provided routinely to prostate cancer survivors. It is important for future research to address the involvement of clinicians in physical activity promotion so that holistic care is provided.
Objective: BeweegKuur (Exercise Therapy) is a Dutch lifestyle programme in which participants are referred by a general practitioner (GP) to a lifestyle advisor. To support participants, regional and local alliances are established. The present study explored the successes and challenges associated with collaboration processes in local BeweegKuur alliances.
Design: A qualitative explorative study.
Setting: The Netherlands Institute for Sports and Physical Activity (NISB) initiated the Building BeweegKuur Alliances project to support local alliances. The BeweegKuur intervention is implemented by over 30 regional and about 150 local alliances throughout the Netherlands.
Method: 12 in-depth interviews were held with coordinators of the alliances, and four focus groups were held with regional and local alliance partners.
Results: Collaboration within the alliances is perceived as successful in integrating prevention and care. Challenges include the participation of sectors such as the local municipality and the sports sector, and the transition of BeweegKuur participants to local sports facilities.
Conclusion: This study identifies three general conditions for successful coordinated action: (a) flexible protocols and management that allow for contextual adaptations; (b) making successes and challenges visible using facilitating methods and tools; and (c) time and funding to overcome differences of culture between different sectors, and to build trust.
Objective: Parents’ values about sexuality and about premarital sex play unique roles in the development of adolescents’ sexual attitudes and behaviours. However, research is scarce on the role of consistent versus inconsistent values transmission. The purpose of the present study was to examine the association between parental consistency/inconsistency of values toward adolescents’ premarital sexual activity and adolescents’ own premarital sex attitudes and behaviours.
Method: The full sample included 293 adolescents in the 9th through 12th grades (aged 13–19 years), primarily African American, Hispanic, and Caucasian, from three high schools in suburban and urban school districts in the Midwest of the USA.
Results: First, analyses of variance (ANOVAs) were run to see where differences between groups may lie. A multivariate analysis of covariance (MANCOVA) was then run with parental values as independent factor, and the six sexuality variables (sexual attitude, frequency of oral sex, frequency of sexual intercourse, age of first sexual intercourse, number of sexual partners and personal sexual values) as dependents, while controlling for gender, grade and race differences. Univariate analyses were run to determine direction of effects. Results indicated that adolescent sexuality outcomes varied by consistency of parents’ values. ANCOVA results revealed that adolescents’ sexual attitudes, frequency of oral sex, frequency of sexual intercourse, and number of sexual partners all varied by parents’ values status.
Conclusion: Parental sexual attitudes and consistency in parental communication contribute significantly to successful development in young people.
Objective: Malnutrition, secondary to decreased food intake, is a public health problem of epidemic proportions among older adults in the United States of America (USA). Compared to community-dwelling senior citizens, congregate (sheltered) housing residents are found to be frailer, with documented deficiencies in several major and minor nutrients, and associated health complications. While studies have quantified these problems, translational research examining the perceived factors influencing their daily food habits is lacking.
Design: Using a qualitative approach, this study was undertaken to further and enhance understanding of this complex, under-researched area, and to form the basis for better nutritional management of this group.
Setting: Participants (n = 46) were convenience sampled from four sheltered housing settings located in the suburbs of northern New Jersey, USA.
Method: Data were collected using a brief demographic questionnaire, and a focus group guide designed utilizing constructs derived from socio-ecological theory.
Results: Content analysis of the transcripts identified several themes suggesting that a repertoire of individual, interpersonal, and organizational factors may serve as barriers to optimum nutritional health among residents. With an emphasis on utilizing their perspectives to explain and interpret behaviour, the qualitative approach adopted offered a perfect vehicle for shifting the focus from measuring dietary outcomes to clarifying how participants arrive at the decisions they made.
Conclusion: This study is a step forward in providing the empirical foundations necessary to design a comprehensive intervention with effective strategies to motivate and encourage sheltered housing residents to make healthier food choices and improve their overall health.
Objectives: To assess the effectiveness of patient education in reducing falls, promoting behavioural change and the uptake of prevention activities in older adults during and after hospitalization.
Design: Systematic review and meta-analysis.
Methods: A systematic search of five health science databases was performed up to November 2012. Studies that investigated patient education as a single intervention or in a multifactorial falls prevention programme in the hospital and/or post-discharge community settings, were eligible for inclusion. Standard meta-analysis methods were used to assess the effectiveness of patient education compared to usual care. Tests for heterogeneity, subgroup meta-analyses and a priori subgroup meta-analyses were performed for primary outcomes where appropriate. Primary outcomes were incidence of falls, falls-related injury and healthcare use due to falls. Secondary outcomes were mechanisms of behavioural change in falls prevention. Qualitative data were analysed by narrative review.
Results: Falls prevention programmes that contained patient education were effective in reducing fall rates amongst hospital inpatients and post-discharge populations (risk ratio [RR] 0.77, 95% confidence interval [CI] 0.69 to 0.87), and in reducing the proportion of patients who became fallers in hospital (RR 0.78, 95% CI 0.7 to 0.87). Patient education generally increased knowledge about falls and awareness of prevention strategies. The uptake of strategies may be dependent on the activities being targeted.
Conclusion: Falls prevention education should be recommended for older adults while in hospital and following discharge. Falls education programmes should consider the use of intensive face-to-face patient education with multimedia materials in preference to provision of written information alone or brief amounts of interpersonal contact.
Objective: The use of pictorial warning labels on tobacco packets has gained almost universal international acceptance. In a public consultation exercise in 2006, the Department of Health in England, through a web-based answering system, asked people’s preferences of 42 images, asking which images might be effective to encourage tobacco cessation in smokers. On cursory inspection of the rank order of preference, a pattern appeared to suggest that effectiveness was associated with the level of disgust emotion generated; that is, the images rated the most likely to persuade smokers to quit tobacco consumption appeared revolting. The objective of this study was to confirm that disgust emotion generated by United Kingdom (UK) tobacco packet images was associated with the public’s selection of possible effective images.
Design: Three cross-sectional opinion surveys were conducted including students from medicine and psychology disciplines and a section of the public. In addition, a web opinion consultation database was made available for secondary analysis.
Method: A total of 291 participants were involved in the three convenience surveys and 19,812 participants gave complete replies to the public consultation website. Each individual rated every image on a five-category rating scale ranging from ‘extremely disgusting’ to ‘not disgusting’.
Results: Significant correlations (ranging from 0.91 to 0.94) existed between the image rank order aggregated preference ratings from the original public consultation and the average final score of the disgust ratings for specific items for the three groups.
Conclusion: The emotion of disgust may be a possible intervening variable to explain the initial reactions to health promotion materials and smoking cessation.
Background: Postpartum women are a population at risk for sedentary living. Physical activity (PA) prior to pregnancy may be effective in predicting similar behaviour in the postpartum period.
Objective: To test a composite version of the extended transtheoretical model (TTM) by adding ‘past behaviour’ in order to predict PA behaviour among postpartum Iranian women.
Methods: Participants were 300 primiparous postpartum women from health clinics in Arak, Iran who completed the Iranian versions of the TTM, past behaviour and PA behaviour questionnaires. The mean age of the participants was 24.85 years (SD = 4.4, range = 15–41). Data were analysed using bivariate correlation and path analysis.
Results: The first revised model accounted for 43% of the variance in current PA and represented a good data fit (² = 7.45, df = 4, p = 0.114). There were significant direct pathways between PA and stage of change (β = 0.51), pros (β = 0.30), and cons (β = –0.31), and significant indirect effects of self-efficacy (β = .39) and processes of change (β = 0.34). The final model, which included the direct effects of past behaviour (β = 0.28), explained 50% of the variance in PA and represented a good data fit (² = 8.30, df = 5, p = 0.14). Additionally, in this model pros (β = 0.25) and cons (β = –0.26) are directly related to PA, and self-efficacy (β = 0.39) and processes of change (β = 0.34) are indirectly related to PA.
Conclusion: The findings of this study support the application of TTM to PA behaviour change among Iranian postpartum women. However, adding past behaviour to the model increases our understanding of the population’s PA and may help the planning of more efficient interventions for promoting PA.
Objective: The purpose of this study was to determine if education about human immunodeficiency virus (HIV)/sexually transmitted disease (STD) and pregnancy prevention is dependent on professional preparation and/or class structure.
Design: A secondary data analysis of the 2006 School Health Policies and Programmes Study (SHPPS) was conducted.
Setting: Data were obtained from the health education classroom level questionnaire of the 2006 SHPPS.
Methods: A series of multivariable logistic regression models (N = 34) were computed to determine if instruction of HIV/STD and/or pregnancy prevention content was dependent on professional preparation and/or class structure.
Results: Professionally prepared health educators were found to be significantly more likely than their counterparts to teach about teenage age pregnancy risks, teenage pregnancy impacts, finding information/services related to pregnancy, finding information/services related to HIV, and HIV diagnosis/treatment. These topics and three others (methods of contraception, signs/symptoms of HIV and compassion for persons with HIV/AIDS) were significantly more likely to be taught in health-only classes versus combination classes.
Conclusion: Findings from the current study support the need for professionally prepared educators and stand-alone class structure in terms of providing the most effective sexual health education.
Objectives: To examine evidence from studies exploring the relationship between childhood obesity and educational attainment.
Design: A systematic review of secondary analyses and observational studies published in English after 1997 examining attainment as measured by grade point average or other validated measure, in children aged 6 to16 years, in high-income countries.
Methods: Eleven databases from the fields of public health, education and social science were searched, along with 19 specialist registers and catalogues. Hand searching of relevant journals, contacting of experts and citation searching were undertaken. Two reviewers used standardized tools to independently carry out data extraction and assess the quality of included studies. Evidence was synthesized in a narrative summary.
Results: Twenty-nine studies were identified for inclusion. Overall, the evidence suggested that higher weight is weakly associated with lower educational attainment among children and young people. Differences between average attainment of overweight and non-overweight children were marginal, with potentially negligible real-world implications for test scores. Limited evidence suggested that little variation in achievement was explained by weight status alone. Almost half the studies found that other factors, such as socioeconomic status, may better explain much of the negative association between obesity and attainment.
Conclusion: Theoretical and methodological inconsistencies were evident both within and between many of the studies. As such, the results of the included studies must be interpreted with caution. If the negative association between obesity and attainment is accepted, it still remains doubtful whether obesity is exerting a socially important effect upon educational attainment.
Objectives: We sought to determine the prevalence and distribution of state-level legislation regulating farm-to-school programmes throughout the United States of America (USA). The research is timely given national goals put forth by the Let’s Move Campaign and the Healthy, Hunger-Free Kids Act to reduce childhood obesity prevalence and improve access to local foods in schools by 2015.
Design and methods: The US Centers for Disease Control and Prevention’s (CDC) Database of State Legislative and Regulatory Action to Prevent Obesity and Improve Nutrition and Physical Activity and the national Farm-to-School Network’s database of legislation were used to conduct an online search of farm-to-school legislation in all 50 US states and the District of Columbia as of March 2012.
Setting: Schools.
Results: Our search identified a total of 43 bills (33 enacted bills, two pending bills, and eight vetoed or dead bills) that aimed to facilitate farm-to-school programmes. Of the enacted bills, their foci were described according to regional location and statewide or local impact, appropriation of funds, provision of other monetary incentives, establishment of a task force, and preference for purchasing local products.
Conclusions: Given the successes of state-level laws regulating injury- and disease-related risk factors such as seatbelt and helmet use, tobacco use, and water fluoridation, we conclude that state-level legislation regulating dietary risk factors and, importantly, school nutrition environments may hold significant public health promise.
Objective: To evaluate the level of cancer literacy among Korean American immigrants and to identify the most influential predictors of cancer literacy in this population.
Method: Using a quota-sampling strategy, 407 Korean American immigrants were recruited in the New York metropolitan area. The study was theoretically guided by the Andersen’s Health Behaviour Model and ordinary least squares regression analysis was used for data analyses.
Results: The cancer literacy level of this Korean American immigrant sample was much lower than that reported in studies of non-Latino whites and other racial/ethnic minorities. The results from the multiple regression models indicated that age was the only predictor of cancer literacy among predisposing factors. As for enabling factors, educational attainment and having a primary care physician were significant predictors. No need factors were found to be significant predictors in this study.
Discussion/implications: The findings reinforce a need for developing public health education and community interventions focused on Korean American immigrants and increasing cultural competence in healthcare professionals and partners.
Objective: In support of a whole-school approach to mental health promotion, this study was conducted to find out whether and how significantly teachers’ satisfaction with school and their subjective psychological well-being are related to the belief that they can help pupils with mental health problems.
Design: Cross-sectional data were collected as a part of the European Union’s, Seventh Framework Programme for Research (FP7) Saving and Empowering Young Lives in Europe (SEYLE) study. One of the elements of the SEYLE study was to evaluate teachers’ attitudes and knowledge related to pupils’ mental health issues and their own psychological well-being, as well as their satisfaction with the school environment.
Setting: The sample of schools from the SEYLE study sites representing 11 European countries was randomly chosen according to prior defined inclusion and exclusion criteria. The final cross-sectional database used for analysis in the current study comprised 2485 teachers from 158 randomly selected schools.
Method: Respondents’ belief that teachers can help pupils with mental health problems served as the outcome variable in our predictions with probability of the positive answer being modelled in the logistic regression analysis. Teachers’ subjective psychological well-being and school satisfaction were included as independent variables in the logistic regression model and several other relevant variables were added to statistically control for them. Multiple models were tested in order to obtain the final model.
Results: Logistic regression models showed that better satisfaction with general school climate, higher psychological well-being, and the ability to understand pupils’ mental health problems increased the odds of teachers’ readiness to help pupils with mental health problems.
Conclusion: By providing a good school environment, by valuing the subjective psychological well-being of the teachers, and by providing adequate training to fulfil their ‘gatekeeper’ role, the preconditions to improve the mental health of the pupils they teach will be achieved. These suggestions are in line with a whole-school approach to mental health promotion.
Objective: To assess the effects of a health and nutrition educational intervention on maternal knowledge, attitudes and practices.
Design: Pre- and post-test design using structured interviews of pregnant women.
Setting: Thirty-nine villages in Central Java Province, Indonesia.
Method: Pregnant women (N = 252) at 12–20 weeks of gestation were randomly allocated at the village level into education intervention and control groups. Women in the intervention group received health and nutrition education, while those in control group did not. Educational sessions were provided monthly until delivery.
Results: After the intervention, women in the education group had better knowledge about the risks and consequences of getting worm infection and the causes, consequences and prevention of anaemia during pregnancy; expressed stronger intentions to feed colostrum (91.9% vs. 78.2%, P = 0.003); to breastfeed within one hour of birth (80.4% vs. 68.9%, P = 0.004); to breastfeed exclusively for six months (77.2% vs. 62.7%, P = 0.014); to breastfeed for 24 months (P = 0.06); and also had better knowledge of practices related to the early initiation of breastfeeding (0.5 hour [25th–75th 0.5–6] vs. two hour [0.5–17.5], P = 0.052); of 24-hour exclusive breastfeeding (51.2% vs. 31.1%, P = 0.006); of giving birth at health facilities (71.9% vs. 58%, P = 0.024); and of birth assisted by skilled birth attendants (90.1% vs. 81.5%, P = 0.057) than their control counterparts.
Conclusion: The reported change in knowledge, attitudes and reported practices may be attributable to the health and nutrition education provided during pregnancy.
Objective: To identify levels of moderate-intensity physical activity (MPA) and vigorous-intensity physical activity (VPA) in a representative sample of college students in six East Asian economies and examine their relationship with weight, alcohol consumption and cigarette smoking.
Design: Cross-sectional survey.
Setting: College students recruited from 21 different colleges in six East Asian economies.
Method: Self-reported physical activity, weight, height, alcohol consumption, and smoking were assessed using already-validated instruments. Multiple logistic regression models of MPA and VPA were separately performed for each economy, controlling for age, gender, living area before college, military experience, paid employment, and religion. All the analyses were performed using SAS 9.2 with clustering effects accounted for.
Results: Being a heavy drinker increased the odds of engaging in VPA in five economies (adjusted odds ratio [AOR] = 1.56 to 2.65). Cigarette smoking was not associated with MPA in any economy and was only associated with VPA in China (AOR = 1.54) and Taiwan (AOR = 1.48), indicating that smokers are more likely to engage in VPA than non-smokers.
Conclusions: The relationship between college students’ VPA and alcohol consumption and between MPA and cigarette smoking is similar across the East Asian economies, whereas the relationship between VPA and smoking varies substantially.
Objective: To present results from a district-wide diabetes prevention programme involving health education for school children and the local community.
Method: The model of health education that was utilized aimed to secure lifestyle changes and the identification of diabetes risk by school children (aged 9–12 years). The children acted as health messengers in their families as well as in the neighbouring community. Health education sessions were also held for school teachers, non-governmental organizations, primary health centre physicians, self-help groups and laypeople in the district. All were trained in diabetes risk assessment by using the standardized Indian diabetic risk score and were trained to estimate urine glucose.
Results: Over a four-year period (2005–2009) the programme trained 8288 teachers and 119,743 schoolchildren in 679 schools and 30,915 people working in the health and development sectors. Trained school children reached out to 2.4 million people in over 500,000 families, covering 80% of the district population (3 million). The project identified 83,907 (3.5%) people as being at high risk of developing diabetes and these were counselled regarding risk reduction and lifestyle modifications. Among those identified with diabetes risk, 15,868 (19%) people were identified as having positive urine glucose. There were 10,522 (0.4%) people with known diabetes who were referred to identified diabetes care centres in the district.
Conclusion: This child-to-family-based lifestyle change and health education intervention, along with community participation, offers a novel approach with substantial coverage of district populations in India.
Background: Coronary heart disease (CHD) patients require monitoring through ECGs; the 12-lead electrocardiogram (ECG) is considered to be the non-invasive gold standard. Examples of incorrect treatment because of inaccurate or poor ECG monitoring techniques have been reported in the literature. The findings that only 50% of nurses and less than 20% of cardiologists correctly place leads V1 and V2 of a standard 12-lead ECG is of great concern.
Objective: The review discusses the evidence base underpinning the use of 12-lead ECG electrode placement on patients with suspected heart disease and summarizes the results of 10 research papers.
Methods: The Cumulative Index to Nursing and Allied Health Literature (CINAHL), the British Nursing Index (BNI), Embase and Medline were searched, from 2000 up to May 2012 using the key words ‘electrocardiography’, ‘positioning’, ‘electrodes’, ‘electrocardiogram’, ‘lead placement’ and ’12-lead ECG’. The search was limited to studies in the English language. The quality of each study was rated against set inclusion and exclusion criteria.
Results: All the studies found that the incorrect connection of the electrode cables can alter ECG patterns simulating or concealing abnormalities, such as myocardial infarction (MI). Adherence to correct anatomical precordial lead placement methodology continues to be limited, especially with respect to leads V1 and V2 at the fourth intercostal space (ICS), which can potentially yield recorded waveforms that mimic the ECG diagnosis of septal MI.
Conclusions: False ECG diagnosis of MI resulting from improper lead placement has the potential to trigger the wasteful use of healthcare resources and even cause harm to patients.
Objective: This study collected on from all research relating to health education and hypertension in China and, with the aid of meta-analysis tools, assessed the outcomes of such health education. The analysis provides a basis for the further development of health-education programmes for patients with hypertension.
Methods: Literature searches were carried out to identify studies that had evaluated the impact of health education on hypertension in China. The time interval searched was from 1 January 1991 to 31 December 2010. We searched the databases of PubMed, CBM, CNKI and VIP. Strict inclusion and exclusion criteria were used to screen the literature. We generated meta-analyses, using Cochrane RevMan 5.0 software, of outcomes of systolic blood pressure (SBP) and diastolic blood pressure (DBP).
Results: Fourteen studies met the inclusion criteria. Results show that, after health education for patients with hypertension, SBP and DBP is substantially lowered; the effect was statistically significant (P < 0.001). We extended subgroup analyses of the separate effects on SBP and DBP with respect to follow-up time, intervention site, intervention method and age.
Conclusion: This review confirms that health education plays an important role in blood pressure control in hypertensive patients (especially the elderly): short-term follow-up intervention was more effective, and the effects were similar whether intervention was at the hospital or at the community level.
Objective: This paper examines Black adolescents’ experiences and views on the interrelationships between their families’ parenting practices and their wellbeing.
Method: The material is drawn from a community-based qualitative study on the health and wellbeing experiences of Black African families and adolescents. A total of 53 adolescents of Black African origin residing in a county in the north of England participated in the study. Data were collected by means of semi-structured in-depth interviews conducted in participants’ homes and youth clubs. Data were subjected to thematic analysis with the aid of a qualitative data analysis software package.
Results: While the adolescents acknowledged receiving health-promotion messages from sources such as their peers and the media, they also identified the continued significance of their parents and family network in shaping their behaviours and facilitating their wellbeing. These included specific health-promotion messages such as not to use illegal drugs and cigarettes, and on the dangers and effects of excessive alcohol. In addition, the adolescents believed that their parents’ values, beliefs and child-rearing practices had helped them to cope with social discrimination.
Conclusion: Knowledge and understanding of Black families’ child-rearing practices, socio-economic circumstances and life experiences can provide health-promotion practitioners with sound background information for the design and implementation of specific effective health-promotion strategies directed at adolescents.
Objective: The aim of this study was to explore parental perceptions of adolescent health behaviours and to examine to what extent parents’ perceptions of their children’s health behaviours are determined by the family’s socio-demographic characteristics.
Method: Participants in the study were 605 parents. They completed questionnaires in which they rated whether different health-risk behaviours were present in their children (i.e. smoking, alcohol consumption, drug use, risky sexual behaviour, insufficient physical activity, unhealthy eating habits and obesity). Parents also provided information on the family’s socio-demographic characteristics.
Results: The results show that parents rate insufficient physical activity and unhealthy eating habits as the most pronounced problems in their children, while they rate risky sexual behaviour and drug use as the least pronounced. Parents estimate that insufficient physical activity and unhealthy eating habits are significantly more pronounced among girls than among boys. The results of factor analysis reveal that, from the parents’ perspective, adolescent health-risk behaviours can be grouped into those pertaining to unhealthy habits and those connected to addictive and risk behaviours. Parents rate that behaviours reflecting unhealthy lifestyle are significantly more present among girls than among boys. Regression analyses showed that a family’s living standard is the only significant predictor of unhealthy habits and addictive and risk behaviours.
Conclusion: When observed from a parental perspective, adolescent health-risk behaviours can be grouped into different categories, and parents claim to observe certain differences in these behaviours between boys and girls. The most important determinant of adolescent health behaviours is a family’s living standard.
Objective: To determine the associations between health literacy, the reasons for seeking health information, and the information sources utilized by Taiwanese adults.
Method: A cross-sectional survey of 752 adults residing in rural and urban areas of Taiwan was conducted via questionnaires. Chi-squared tests and logistic regression were used for data analysis.
Results: Health literacy was found to be lower among adults who were older, with lower educational attainment, with lower household income, with blue-collar occupation, and living in rural areas. After socio-demographic characteristics were controlled for, adults with adequate health literacy were significantly more likely than adults with inadequate or marginal health literacy to report desires for health-related information, autonomous medical decision making, and finding information on their own, as reasons for seeking health information. Adults with inadequate or marginal health literacy were more likely to cite recommendations from medical professionals and hesitation to ask medical professionals questions as their reasons for seeking health information. Adults with adequate health literacy were significantly more likely than those with inadequate or marginal health literacy to obtain health information from the Internet, books, newspapers, and magazines, and were less likely to seek health information from alternative care providers.
Conclusion: The findings suggest the need to consider target groups’ health literacy when developing health education programmes. More attention must be focused on providing interventions that motivate information seeking and improve information-seeking skills for adults with limited health literacy.
Objective: The aim of this study was to compare the effectiveness of cooperative learning and traditional learning methods on the development of drug-calculation skills.
Design: Final-year nursing students (n = 85) undergoing internships during the 2010–2011 academic year at a nursing school constituted the study group of this quasi-experimental study.
Setting: Students were divided into two groups: an experimental group and a control group. A cooperative learning method was introduced to the experimental group (n = 32) and a traditional learning method was applied to the control group (n = 40). Pre-test and post-test scores of drug-dose calculation skills were compared.
Method: Data were obtained using data collection forms which were developed by the researchers. Statistical analysis was performed using the Statistical Package for the Social Sciences for Windows version 15.0. T-test and Wilcoxon’s signed rank test with Bonferroni correction were used for comparison of drug-dose calculation skill scores between groups and within groups before and after training.
Results: No statistically significant difference was found between drug-dose calculation pre-test scores of both groups (p = 0.144). After training, while the post-test mean score of the control group was 92.00 ± 7.90, this score was 87.03 ± 9.98 in the experimental group and the difference was statistically significant (p < 0.05).
Conclusion: After training, drug-dose calculation skills of students were increased in both groups. But the traditional learning method was found to be more effective than the cooperative learning method in the development of drug-dose calculation skills.
Objective: Current data on sexually transmitted disease (STD) infections among African Americans show significant racial/ethnic disparities. The purpose of this study was to explore knowledge, attitudes, beliefs, and behaviours related to STD risk, prevention, and testing among African American adults to help inform the development of a health communication intervention to address the high rates of STDs in this community.
Design: Cross-sectional survey.
Setting: Four United States communities with high cumulative incidence of STDs.
Method: We administered a 44-item structured survey.
Results: Participants were 185 sexually active heterosexual African Americans aged 18 to 45. Most participants (84.2%) had been tested for an STD at least once. Most participants (75.8%) perceived STDs to be a problem in their community, and almost all (91.2%) felt that people needed education to learn how to avoid STDs. Nonetheless, only half of participants (49.5%) agreed that they should get tested for STDs because they may be at risk. Misconceptions related to STD prevention and testing were identified. Results suggest that STDs remain highly stigmatized with concerns related to social and interpersonal consequences. Participants’ perceived personal risk was low, despite acknowledging high STD rates in their communities.
Conclusion: Findings suggest that health communication may play an important role in addressing STD disparities by increasing perceptions of personal risk, minimizing STD-associated stigma, and marketing STD prevention and testing behaviours.
The breakdown of care transitions between various healthcare facilities, providers, and services is a major issue in healthcare, and accounts for over US$15 billion in healthcare expenditures annually. The transition between inpatient care and home care is a very delicate period where, too often, chronically ill patients get worse and wind up back in the hospital. This re-admission roller coaster is due in part to weak transitional care planning compounded by poor communication and coordination between healthcare providers, patients, and caregivers. The lack of a health information network and the resulting gap in transitional care exacerbates the incidence of preventable errors, increases the number of inpatient re-admissions, and adds to the rising cost of healthcare. Care navigation models provide a viable solution to address the unique characteristics of each patient transition and to prevent the current gap in care delivery. These models provide a framework for patient information exchange, interdisciplinary provider services, resource integration, and multifaceted interactive programmes for patient education. Currently, payment structures and procedural disagreements between the various service providers hinder the widespread implementation of care navigation models. In order to address the escalating cost of re-admissions and medical errors resulting from inadequate healthcare transitions, every effort should be made to dismantle these internal barriers, standardize goals, and assess and customize navigation models.
Objective: This study aimed to determine women’s reported health behaviours (physical activity, diet, weight management) before and during pregnancy, and to identify sources of health information.
Design: Retrospective study incorporating quantitative (a self-completed survey) and qualitative (one-on-one interviews) methods.
Methodology: Participants were women aged 18 or over; had no pre-existing medical condition that might be exacerbated during pregnancy (e.g. diabetes, heart condition); and had given birth in the last 12 months. Nineteen women agreed to one-on-one interviews and 100 women agreed to complete a mailed questionnaire. Qualitative data and quantitative data were analysed using a descriptive qualitative methodology and by using McNemar’s test for correlated proportions, respectively.
Results: Participants reported a significant reduction in their level of physical activity during pregnancy; a significant increase in consumption of fruit, vegetables and fibre, and a decrease in fast food consumption (all p < 0.05). Medical practitioners are the preferred source of health information but seem to provide insufficient information about health behaviours during pregnancy in relation to physical activity, diet and weight management.
Conclusion: Women reported eating a healthier diet and reducing their level of physical activity during the antenatal period, compared to pre-pregnancy. There is a need to improve the provision of health information on physical activity, diet and weight management in the antenatal period.
Objective: Although welfare in childhood and adolescence is of great public concern, individual or other resources have not been extensively studied in relation to wellbeing in schools. In this longitudinal study, factors that may promote girls’ or boys’ school wellbeing as well as factors that may have an adverse effect were assessed.
Methods: Altogether, 149 boys and 119 girls in public primary and secondary schools completed questionnaires twice, two years apart (T1 and T2). The impact of potentially promoting and potentially adverse factors at T1 were investigated in relation to school wellbeing at T2 using logistic regression.
Results: No gender differences were revealed in self-rated school wellbeing whereas factors associated with school wellbeing showed substantial gender differences. Boys who experienced necessary academic help from teachers were 2–3 times more likely to report good school wellbeing compared to other boys. For girls, perceived loneliness at school demonstrated a strong and negative association with school wellbeing both in crude and multivariable analyses.
Conclusions: There may be gender differences in predictors of students’ school wellbeing that health-promoting strategies need to take into account. Academic support from teachers, an example of resources in close surroundings, appears to be of great importance for boys. Among girls, perceived loneliness may indicate reduced school wellbeing. Later research must aim at identifying resources that prevent loneliness in school or ease the burdens of lonely students.
Objective: We conducted a randomized controlled crossover trial to evaluate the effects of a new worksite weight-control programme designed for men with or at risk of obesity using a combination of nutrition education and nutrition environmental interventions.
Subjects and methods: Male workers with or at risk of obesity were recruited for this study at five worksites in Niigata City, Japan, of whom 57 were analysed (intervention group, n = 28, mean age 45.5 years; control group, n = 29, 46.0 years). The intervention group received a six-month programme consisting of nutrition education and the provision of healthy cafeteria meals along with nutritional information, which was thereafter repeated in the control group in a crossover design. At six months and one year after programme entry, primary outcome measures including body weight (BW), body mass index (BMI), waist circumference, blood pressure, and blood biochemistry were evaluated.
Results: At the one-year follow-up, the intervention group had significantly greater reductions in BW, BMI, and alanine aminotransferase than the control group (p = 0.017, p = 0.017, and p = 0.860, respectively).
Conclusion: The effects of the six-month weight-control programme incorporating nutrition education and nutrition environmental interventions were maintained to the one-year follow-up, resulting in significant differences in relevant parameters between intervention and control groups.
Objective: This study aimed to quantitatively and qualitatively examine breast cancer screening practices, including breast self-examination (BSE), and health literacy among patients with chronic disease.
Design: A prospective, multi-method study conducted with a targeted purposive sample of 297 patients with diabetes and/or hypertension from four ethnic groups (Latino, Vietnamese, African American, White-American) at an urban community health center.
Setting: A federally qualified health center in Western Massachusetts.
Methods: In our four-year study, 297 participants completed cancer knowledge, beliefs, attitudes and screening utilization scales and measures of health literacy. In addition to survey data collection, we conducted in-depth interviews, focus groups, home visits, and chronic disease diaries (n = 71).
Results: In focus groups, African American, Vietnamese and Latina participants offered interviewers an unprompted demonstration of BSE, reported regular BSE use at particular times of the month, and shared positive feelings about the screening method. In a sample where approximately 93% of women have had a mammogram, many also had performed BSE (85.2%). Women with adequate health literacy were more likely than those with inadequate health literacy to rely on it. Despite being positively inclined toward BSE, Vietnamese women, who had the lowest health literacy scores in our sample, were less likely to perform BSE regularly.
Conclusions: BSE seemed to be an appealing self-care practice for many women in our study, but we conclude that proper BSE practices may not be reinforced equally across ethnic groups and among patients with low health literacy.
Objective: This study, nested within a large cohort study, sought to explore how well Vietnamese mothers with pre-school children understood the dental health education material commonly available in New South Wales, Australia.
Design: Qualitative research.
Setting: Home-based interviews.
Method: Vietnamese-speaking mothers (n = 24) with young children were provided with two dental leaflets which gave advice on health behaviours in English and Vietnamese for comparison. Interviews were recorded, transcribed verbatim and analysed using a thematic coding.
Results: Mothers generally reported that the English leaflets were difficult to read due to their lower levels of English literacy skills. Although the mothers preferred leaflets in their native language, they noted that it did not completely reflect the Vietnamese culture. Mothers recommended pictorial presentations for immigrants to improve understanding.
Conclusions: The consistency of our findings suggest that health education leaflets should be provided to parents in their first language with use of illustrations to improve understanding and that producers of health education leaflets should consider cultural differences in translations.
Setting: The United Kingdom (UK) government has acknowledged that there is a problem with excess alcohol consumption, in particular amongst young people. Higher education is an important health-promotion setting in which to explore not only how sensible drinking patterns can be facilitated and embedded in students’ current lifestyles but also how students, as future citizens, can inform policies which, in turn, will impact on future populations.
Objective: This study aimed to explore and disseminate current practice relating to the promotion of sensible drinking amongst students attending higher education institutions (HEIs) in the south west of England. Along with the identification of examples of current practice, the study aimed to identify current issues and concerns relating to alcohol consumption amongst students.
Method: Survey data from HEIs across the south west of England were gathered using questionnaires to key respondents in each institution. To further investigate what information on sensible drinking is available for students, an electronic search was made of each of the HEI’s websites for relevant materials, initiatives and policies.
Results: The HEIs involved in this study used a wide range of approaches and initiatives related to sensible drinking amongst their students. All of these contribute towards encouraging a culture of safer and more sensible drinking-related behaviour amongst students, and towards an emerging body of good practice.
Conclusion: With the backdrop of the government’s alcohol strategy, and the evidence linking excessive alcohol consumption to less productive student learning, recommendations are made to enhance this work in a more coordinated and sustainable way.
Objective: Prior research on the efficacy of physical education has been conducted in a piecemeal fashion. More specifically, studies typically test a single benefit hypothesized to be associated with physical education (e.g. body mass index [BMI]) while excluding others (e.g. social skills) and not controlling for important confounds (e.g. diet). Such research designs have precluded a comprehensive evaluation of physical education, and may also help explain mixed findings reported in the literature. The purpose of this study, then, was to re-evaluate the efficacy of participation in physical education through a more robust model that considers BMI, academic achievement, self-concept, and social skills while controlling for poor diet and out-of-school activities (i.e. television viewing, sleep, and general activity levels).
Design, Setting, and Method: Structural equation modelling (SEM) was conducted on a sample of 10,210 fifth graders in the Early Childhood Longitudinal Study.
Results: Nationwide, 68% of fifth graders participated in physical education one or two days per week. Physical education was positively associated with academic achievement (effect size = .10), and negatively associated with both low self-concept (effect size = .06) and less healthy food choices (i.e. sugar-sweetened beverages, potatoes, and fast food; effect size = .11). However, participation in physical education was not associated with BMI or teacher-reported social skills.
Conclusion: Even at the low ‘dosages’ reported, physical education is associated with improved mental health, dietary choices, and academic achievement.
Background: Chronic disease accounts for the majority of healthcare costs. The Chronic Disease Self-Management Programme (CDSMP) has been shown to be effective in reducing the burden of chronic disease.
Objectives: The objective of this study was to measure the costs of delivering the Chronic Disease Self-Management Programme (CDSMP) in order to determine whether it has the potential to produce a net cost saving among elderly residents of South Florida.
Methods: Cost data were collected from four agencies participating in the delivery of CDSMP workshops in South Florida. Information on healthcare cost savings were obtained from the literature and updated to current dollars. Questionnaires were emailed to programme coordinators from agencies participating in the delivery of CDSMP workshops. Questionnaires were returned via email. Costs were computed from the perspective of the participating agencies.
Results: Costs for implementation per programme participant were US$204. These average costs are below the US$1,381 healthcare cost reductions documented in the literature during the first year following programme participation.
Conclusion: Results suggest the potential effectiveness of CDSMP in reducing healthcare costs among elderly residents of South Florida. This has implications for the further dissemination and sustainability of evidence-based programmes for seniors. An evaluation of outcomes among the South Florida population is needed.
Objective: To discuss how the effects of culture, economy, and geographical location intersect to form a gestalt triad determining health-related disparities in rural areas.
Methods: We critically profile each component of the deterministic triad in shaping current health-related disparities in rural areas; evaluate the uniquely composed intersections of these disparities in relation to Human Papillomavirus (HPV)-related cancer prevention in three isolated rural Georgia counties; and develop implications for future leadership in rural healthcare research, policy, and practice.
Results: The deterministic triad of culture, economy, and geographical location is unique to a rural community, and even if two rural communities experience the same health disparity, each community is likely to have a discretely different composition of cultural, economic, and geographic determinants.
Conclusion: The deterministic triad presents a challenge for health policymakers, researchers, and practitioners trying to develop health-related interventions that are equitable, efficacious, and practical in low-resource rural communities. The situation is worsened by the limited opportunities for employment, which leads to greater disparities and creates propagating cultural norms that further reduce access to healthcare and opportunities for sustainable health promotion.
Objective: This study examined the growth pattern in physical aggression over a five-year period among South Korean early adolescents and the effects of temperament (anger/frustration and emotion regulation) and parenting (harsh parenting and parental monitoring) on early adolescents’ physical aggression.
Design: A five-year longitudinal design was used to explore the growth pattern in physical aggression.
Method: Participants were 2844 early adolescents (1320 girls and 1524 boys; M age = 9.86 years, SD = 0.35 at wave 1) in the Korea Youth Panel Study (KYPS), a national representative of Korean children and adolescents. The latent growth curve model (LGM) was used for data analysis.
Results: There was a significant linear growth over time in physical aggression during early adolescence. However, there were significant individual differences of developmental trajectories of adolescent aggression. The initial level of aggression in early adolescence was positively associated with anger/frustration, and the rate of change in aggression was negatively related to emotion regulation. Parenting variables, which were harsh parenting and parental monitoring, were not related to the initial level and rate of change in physical aggression.
Conclusion: Temperament variables (anger/frustration, emotion regulation) cause the individual differences in initial level of aggression and rate of change in aggression.
Objective: College students embrace mobile cell phones (MCPs) as their primary communication and entertainment device. The aim of this study was to investigate college students’ perceptions toward using mHealth technology to deliver interventions to prevent high-risk drinking and associated consequences.
Design/setting: Four focus group interviews were conducted during the spring and fall of 2011 at a large public university in the southeastern United States (US) to collect data on the applicability of mHealth technology to alcohol-prevention programmes. The participants were students currently enrolled in a face-to-face alcohol-prevention programme.
Method: Thematic analysis of the content in the transcriptions was used to analyse the focus group responses using a codebook.
Results: Four major themes emerged which were: (1) education and usability; (2) Skype capabilities; (3) enhanced social networking; and (4) use for tracking and feedback. All of the participants said they would join an alcohol-intervention programme that incorporated mHealth mobile technology as a primary mode of communication.
Conclusions: The positive responses to the use of mobile applications indicate that use of interactive, real-time technology would be valuable to college students. Given the cost of face-to-face delivery of interventions, the findings are encouraging and support further exploration of the application of mHealth technology. Mobile technologies (mHealth) could provide a more effective delivery of alcohol-intervention programmes and increase the accessibility, relevance, and value of alcohol-intervention programmes.
Objective: This study examined the relationship between ethnic background and parental views of healthy body size, concerns surrounding overweight and attitudes to perceived causes of overweight in childhood.
Method: A self-report questionnaire was designed to explore parental attitudes towards childhood weight. Sampling deliberately over-represented the views of parents from minority ethnic groups. Eight-hundred-and-eight parents of school-aged children completed the questionnaire. Parental data from Asian British, Black African, Black Somali, Chinese, South Asian, White British and Yemeni groups were included in the analysis.
Results: Data showed that ethnic background was significantly associated with parental beliefs that overweight children will grow out of being overweight (X2[12, n = 773] = 59.25, p < 0.001) and that overweight children can still be healthy (X2[12, n = 780] = 25.17, p < 0.05). In both cases, agreement with the statements was highest among Black Somali parents. While the majority of parents believed that both dietary behaviours and physical activity played a role in the development of overweight in childhood, Yemeni parents were more likely to attribute overweight in childhood to dietary but not physical activity causes.
Conclusion: Ethnic differences in parental perceptions of weight in childhood must be considered in the design of, and recruitment to, childhood obesity interventions aimed at minority ethnic groups.
Objective: To examine the ability of medical students to identify hazardous drinkers using screening tools recommended in clinical practice.
Design: Observational cross-sectional study.
Setting: Faculty of Medicine of Castilla-La Mancha, Spain.
Method: The medical students learnt to use Alcohol Use Disorders Identification Test (AUDIT) and Systematic Interview of Alcohol Consumption (SIAC) questionnaires. After training with these instruments, the medical students anonymously assessed their own alcohol consumption.
Results: The medical students easily learnt to assess alcohol consumption using both instruments, as alcohol consumption was quantified correctly in 95.8% of cases. The questions asked by the students were referred to the questionnaires scoring procedure, quantification of the grams of alcohol consumed and conversion of grams of alcohol into standard drink units (SDUs). In total, 50.9% of men and 48.1% of women fulfilled criteria of excess alcohol consumption, and the global percentage of these drinkers corresponded to 49.5% (95% confidence interval [CI]: 42.4%–56.6%). Alcohol consumption of at least 28 SDUs/week in men and 17 SDUs/week in women was detected in 16.8% of participants.
Conclusion: Because of the simplicity of the instruments used to detect hazardous drinking, these can be learnt from the very first stages of medical training, thus encouraging students to initiate clinical prevention tasks, and increase their awareness of both their own and others’ hazardous behaviour.
Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits.
Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted by the ACA.
Methods: Community forum and focus group discussions were held with residents of a low-income community who are affected by health disparities, are heavily reliant on emergency care for their medical needs, and whose primary healthcare options should expand under the provisions of the ACA.
Results: Explored within a theory of planned behaviour framework, results suggest residents’ attitudes toward primary and emergency care are predicated on beliefs about costs, wait times, and the ability to access care locally.
Conclusion: In light of findings about the determinants that drive healthcare-seeking intentions and ultimately behaviours, we recommend educational strategies that health promoters can adopt to encourage populations that are newly insured and traditionally reliant on emergency services to pursue routine primary care.
Objective: Type 2 diabetes, prediabetes, and metabolic syndrome are increasingly relevant health problems for United States (US) college-aged students and their family members. This study’s aim was to determine the extent to which these chronic conditions were covered in leading college-level personal health textbooks and to what degree the books emphasized the preventive steps students can take to promote their health and minimize development or worsening of these conditions.
Design: A convenience sample of 10 leading college-level personal health textbooks was used in this cross-sectional study.
Setting: Textbooks selected for analysis are frequently used in introductory personal health courses on college campuses across the US.
Method: Textbooks were coded for level of coverage for select criteria that included risk factors, definitions, prevalence among college-aged youth, African Americans, and Hispanics, serious consequences associated with unmanaged type 2 diabetes, presence of self-assessment tool, prediabetes’ and metabolic syndrome’s association with type 2 diabetes, prevention strategies, student portrayals, and messages geared towards students living with these conditions.
Results: Exemplary coverage of information related to diabetes, prediabetes, and metabolic syndrome was uncommon for the following criteria: prevalence among African Americans and Hispanics, depiction of a student with diabetes or prediabetes, prevalence of messages geared toward readers with these conditions, and in-depth discussion of prevention strategies.
Conclusion: More thorough coverage in personal health textbooks is necessary given the rising prevalence of these health problems in young adults, the positive impact of healthy lifestyle choices, and the formal opportunity for learning presented through college personal health courses.
Objective: This article aims to review the previously published literature on the social and environmental factors which influence children (aged 3–5 years) to be obese/overweight and the accuracy of parental perceptions. Obesity levels are on the increase in today’s society and habits are being passed from parents to children, with family lifestyle choices often influencing this health condition. Childhood obesity has many consequences; therefore it is vital that action is taken to stop this epidemic spreading further.
Design: A variety of databases and websites were used to search for relevant and up-to-date research studies and information on the subject of childhood obesity.
Setting: There appears to be a dearth of research focusing on nursery and primary one-aged children, especially within the United Kingdom (UK). Therefore the literature focuses on this group within the population.
Method: Several studies on childhood obesity were identified and critically analysed in the following areas: childhood obesity and environment, childhood obesity and socioeconomic status.
Results: It became obvious from the identified studies that there is no clear solution to solving the issue of obesity in young children.
Conclusion: It appears that targeting several factors within their lives is the only way to begin to see a change in children’s lifestyles which will hopefully be passed onto future generations.
Objective: Innovative public health approaches are required to improve human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) education and prevention among adolescents, one of the most vulnerable groups to HIV/AIDS. Consequently, elearning and classroom instruction was assessed for HIV/AIDS knowledge uptake and internalizing among South African and Irish pupils between the ages of 11 and 16 years.
Method: An HIV/AIDS intervention was implemented based on a quasi-experimental design using experimental and control groups. Experimental group pupils underwent an elearning programme and the control group used the same material in workbooks in a classroom setting. The McNemar test assessed change in both groups’ knowledge levels from baseline to post-intervention. A theoretical framework guided by the conflict theory and health belief model strengthened the learning material. Discussions took place in the classroom and in an eforum; the latter was qualitatively analysed using thematic content analysis.
Results: A significant increase (P < 0.01) in HIV/AIDS knowledge uptake was experienced by the experimental group compared to a decline of 1.6% in the control group from baseline to post-intervention. Internalization of HIV/AIDS knowledge emerged in the eforum among experimental group pupils, while the classroom discussions faced structural barriers. Learning outcomes were demonstrated by higher marks achieved in the experimental than control group brochures, the outcome of the learning process.
Conclusion: Elearning proved a superior technique to classroom instruction for HIV/AIDS knowledge uptake and internalizing and should be considered for wider implementation.
Objective: To examine and discuss the evidence base behind the effectiveness of the ‘teach-back’ technique as an educational intervention for chronic obstructive pulmonary disease (COPD) patient self-management using respiratory inhalers.
Design: A systematic literature review
Method: A search was conducted through Medline, CINAHL Embase, Cochrane Library Databases and reference lists to obtain publications reporting on the ‘teach-back’ technique as an educational intervention for teaching COPD patients to use a respiratory inhaler.
Results: There were nine studies selected that met the criteria for this review. The articles provided strong and valid evidence in the conversion of incorrect to correct inhaler use after using the ‘teach-back’ technique among COPD patients. Most of the studies showed a statistically significant increase in the proportion of correct inhaler use.
Conclusion: The result of this review has research and routine clinical practice implications. Further research examining the long-term benefits of the ‘teach-back’ technique and correct use of inhalers is recommended. In clinical practice, it provides an alternative and effective patient education strategy for COPD patient self-management using respiratory inhalers.
Objective: The purpose of the study is to determine if an updated online evidence-based educational programme delivered through Facebook is effective in improving the knowledge, skills, and self-efficacy of patients with arthritis in relation to evidence-based self-management rehabilitation interventions for osteoarthritis (OA) and rheumatoid arthritis (RA).
Methods: Adult patients (>18 years old) with self-reported OA or RA were eligible for the study. One-hundred-and-ten participants were recruited from the general public and different arthritis patient organizations throughout Canada. Eleven participants were selected to participate in focus groups to select effective self-management strategies for OA and RA according to level of implementation burden. Ninety-nine participants were then selected to participate in the online Facebook intervention which included a ‘group’ web page providing case-based video clips on how to apply the selected self-management interventions. Over a three-month period participants were asked to complete three online questionnaires regarding their previous knowledge, intention to use/actual use of the self-management strategies, self-efficacy and confidence in managing their condition.
Results: Knowledge acquisition scores improved among OA and RA participants with a mean difference of 1.8 (p < 0.01) when compared from baseline to immediate post-intervention. At three months post-intervention, almost all self-management strategies were successful with participants following through on their intention to use the self-management strategies; however, statistically significant results were only demonstrated for ‘aquatic jogging’ (p < 0.05) and ‘yoga’ (p < 0.05) among OA participants, and ‘aquatic therapy’ (p < 0.01) among RA participants. Self-efficacy was maintained from immediate post-intervention to three months follow-up, and confidence improved as the study progressed.
Conclusions: This online programme can provide patient organization representatives with the opportunity to learn about and integrate evidence-based self-management strategies for OA and RA in their daily lives, to increase their awareness of useful community resources, and support their efforts to disseminate the information to others with arthritis.
Objective: To understand the views of men and service providers concerning the health information needs of men.
Design: A men’s health programme was implemented aimed at developing new health information resources designed for use by local organizations with men in socially disadvantaged groups. Research was carried out at the scoping stage to find out views of men and stakeholders.
Setting: The research was conducted within the north of England between Manchester, Bradford and Leeds. The region was selected as it is characterized by socio-economic and ethnic diversity.
Method: A structured evidence review was conducted on current provision of health information. Qualitative interviews were carried out with men (n = 46) across four groups, young men (aged 16–21), new fathers (25–45), middle-aged men (40–55), and older men (60+). Telephone interviews were carried out with stakeholders with expertise in men’s health, including health professionals, service providers and commissioners (n = 20). All interviews were fully transcribed and analysed thematically.
Results: Key themes emerging concerned: routines men follow for engaging with health information; support required for making effective use of information; preferred settings and media approaches; and what men would like to see in the future. The importance of personalization and settings-based approaches was explored, and factors engendering trust were outlined.
Conclusion: The research outlined common themes and differences among men according to age and life stage. There is a need for targeting materials to more fine-grained ‘segments’ of men. The project contributes to producing actionable insights, while it remains important to explore complexities of men’s health information needs.
Objective: A physical activity passport (PAP) was developed to increase student’s physical activity through the collaboration of student life and academics. The purpose was to measure the effectiveness of the PAP.
Design: The research design used was a quantitative, descriptive, quasi-experimental design with experimental and control groups.
Setting: This study investigated a mid-sized southeastern university.
Method: Two hundred and seventy-eight undergraduates (159 females, 116 males) sampled from 12 physical activity courses participated (109 freshmen, 71 sophomores, 53 juniors and 42 seniors). There were 144 in the PAP group and 134 in the non-PAP group. Participants filled out the Godin Leisure-Time Exercise Questionnaire (GLTEQ) as well as a demographic questionnaire.
Results: The results showed that those who participated in the PAP attended more than four times as many group fitness classes than did those who did not participate in the PAP. Furthermore, distinctive differences were found among students that might aid in future programming.
Conclusion: Although results refuted the hypotheses, there were several future implications that could be drawn, most significantly the connection to future research involving self-determination theory.
Objective: To explore low socioeconomic parents’ beliefs in relation to children’s nutrition.
Design: A qualitative, longitudinal study over 12 months involving 37 low socioeconomic parents.
Setting: Perth, Western Australia.
Method: Parents’ nutrition-related beliefs were explored via interviews, focus groups and self-introspections. All parents participating in the study had at least one overweight or obese child aged five to nine years.
Results: Seven beliefs that are inconsistent with the recommendations in the nutrition literature were common among the study participants: (1) treats are appropriate for daily consumption; (2) food rewards are appropriate for encouraging good behaviour; (3) overweight children will outgrow their weight problems; (4) it is appropriate for children to regularly eat in front of the television; (5) if children do not get the food they want they will refuse to eat so it is appropriate to give them any food they will eat; (6) it can be difficult to get children to eat breakfast so it is appropriate to give them any food they will eat; and (7) serving cordial is an appropriate way to encourage children to drink more fluids.
Conclusion: The suboptimal beliefs that were identified among these low SES parents are likely to be contributing to their children’s overweight status and thus are in need of attention in child obesity interventions in general and parent education programmes in particular.
Aspirin has public health potential to reduce the risk of ischaemic vascular events and sporadic cancer. One objection to the wider use of aspirin for primary prevention, however, is the undesirable effects of the medicine, which include increasing risk of bleeding and haemorrhagic stroke. Marathons also carry risks of serious events such as cardiac arrests and sudden death. Based on epidemiological estimates, a person running a marathon might be 20 to 100 times more likely to end up in hospital than a person who is taking an aspirin tablet. Yet the cumulative risk of daily aspirin use for primary prophylaxis may be important. One option open to middle-aged individuals who want to take aspirin is to start with an infrequent regime, such as once per week, in order to then build to daily use. It is important to get all concerns into perspective and comparisons can offer a challenge to any excessive risk aversion regarding the public health potential of aspirin.
Objective: To analyse the interrelated processes of identity, participation and knowledge in the context of the health educational Lifecalculator computer game. The analysis focuses on if and how this school-based health promotion initiative communicated relevant health knowledge to adolescents. Further development of the concept of health identity was a secondary objective of the study.
Setting: Danish public schools.
Methods: A qualitative study based on 21 focus group interviews with a total of 103 adolescents and 10 individual interviews with their teachers.
Results: The simplified description of health and health choices in Lifecalculator makes it hard for the adolescents to relate the game to their everyday lives. They know that everyday health choices are more complex and they consequently dismiss the information altogether and do not gain much knowledge. The adolescents’ identities and the way they interpret themselves and their health in relation to others decide if and how they acquire knowledge. Healthy adolescents, who consider themselves as healthy, find it easier to relate to the health knowledge than the unhealthy adolescents who are aware of their unhealthiness. Lifecalculator seems to confirm that healthy adolescents (who view themselves as healthy) are healthy and unhealthy adolescents (who view themselves as unhealthy) are unhealthy and, as such, this approach does very little in terms of motivating participation and presenting the adolescents with new health knowledge.
Conclusions: The study of Lifecalculator and the theoretical advances disclose the multi-layered interrelatedness of health identity, knowledge and participation. This interrelatedness creates multiple perspectives for both practice and research.
Objective: The aim of this study was to identify promoting and inhibiting correlates associated with the physical activity (PA) of children and adolescents (aged 3–18). The intention was to demonstrate the complexity of correlates of PA and to determine possible influencing factors.
Design: A systematic review of reviews.
Methods: Systematic database research was carried out in Medline, Cochrane Library, EMBASE, PsycInfo, Springer Link and Thieme Connect. Inclusion criteria were that the study: (a) was classified as a systematic review with or without meta-analysis; (b) was published between 2000 and 2009; (c) dealt with children and adolescents aged 3–18; (d) had as its dependent variable any measure of overall PA; and (e) reviewed associations between quantitatively measured variables and PA. The internal validity of the systematic reviews thus identified was evaluated using a validated quality instrument.
Results: Nine systematic reviews without meta-analysis and one systematic review with meta-analysis were selected. Altogether 16 correlates were identified which were consistently associated with PA of children and/or adolescents: sex, age, ethnicity, parental education, family income, socioeconomic status, perceived competence, self-efficacy, goal orientation/motivation, perceived barriers, participation in community sports, parental support, support from significant others, access to sport/recreational facilities und time outdoors.
Conclusions: Although the findings of the reviews covered are to some extent heterogeneous, it is possible to identify consistent correlates of PA in children and adolescents. The results show that PA is a complex and multi-dimensional behaviour determined by numerous biological, psychological, sociocultural and environmental factors.
Objective: This study examined the temporal stability (i.e. test–retest reliability) of the Salutogenic Wellness Promotion Scale (SWPS) using intraclass correlation coefficients (ICC). Current intraclass results were also compared to previously published interclass correlations to support the use of the intraclass method for test–retest analyses.
Method: One thousand, one hundred and thirty-one participants completed the SWPS twice, two weeks apart. ICC and descriptive statistics were calculated.
Results: Test–retest reliability was moderate to high for 23 of 25 SWPS items in males and 25 of 25 SWPS items in females. Differences in reliability across the seven SWPS dimensions were observed.
Conclusions: The reliability of the SWPS suits it well for further refinement. Intraclass correlation procedures likely detect more error, when compared to interclass correlation analyses, in the examination of temporal stability of measures.
Objective: Little research has investigated children’s physical activity levels during school recess and the contribution of recess to school day physical activity levels by weight status. The aims of this study were to examine non-overweight and overweight children’s physical activity levels during school recess, and examine the contribution of recess to school day physical activity.
Design: Cross-sectional.
Setting: Four elementary schools located in Nebraska, United States of America (USA).
Methods: Two hundred and seventeen children (99 boys, 118 girls; 47.9% overweight) wore a uni-axial accelerometer for five consecutive school days during autumn 2009. The proportion of time spent engaged in sedentary (SED), light (LPA), moderate (MPA) and vigorous (VPA) intensity physical activity during recess was determined using age-specific accelerometer thresholds.
Results: Overweight children engaged in more %MPA and less %VPA than non-overweight children, respectively. No differences were found between overweight and healthy weight children’s moderate-to-vigorous physical activity (MVPA). Recess contributed 16.9% and 16.3% towards non-overweight and overweight children’s school day %MVPA, respectively.
Conclusion: Examining %MVPA as an outcome variable may mask differences in recess physical activity levels between non-overweight and overweight children. Future research is needed to establish why healthy weight and overweight children engage in differing levels of %MPA and %VPA during recess.
Objective: To establish family-centred health education for patients in a neurosurgery unit and to evaluate its impact on patients’ and families’ satisfaction.
Design: A cooperative inquiry as a participatory research through which a group of clinical nurses and an academic researcher engaged in cycles of action and reflection.
Setting: The study was conducted in a 26-bed neurosurgery unit in a university hospital located in a central province of Iran.
Method: A parallel mixed method was used to gather and analyse the data. Qualitative data regarding existing health education practice among nurses were collected using focus group discussions. Qualitative content analysis was used to identify problems in context. Quantitative analysis using t test (two tailed) was also done to compare the scores of patients and their families’ satisfaction with the nurses’ educational activities before and after implementing the agreed action plans.
Results: Three main hindering factors including intra-professional, inter-professional, and institutional factors were recognized as barriers to establishing family-centred health education. The satisfaction scores of patients and families with the nurses’ health education practices was significantly (P < 0.001) improved after performing the action phases.
Conclusion: It seems that improvement in patients and their families’ satisfaction indicated the success of the nurses in meeting health informational needs. Practical knowledge of health education practice was also enhanced through collaborative working.
Objectives: This study aims to investigate tobacco use behaviours and its correlates among secondary school students in Nepal and Sri Lanka together with cross-country comparisons.
Design: Cross-sectional survey.
Methods and Settings: The data were from the Global Youth Tobacco Survey (GYTS), 2007. Current tobacco use was considered as a response variable. Predictors were selected based on existing literature and theories on adolescent tobacco use. The data of 1,444 Nepalese and 1,377 Sri Lankan students aged 13–15 years was used for analysis.
Results: Prevalence of tobacco use varies with 9.4% and 9.1% among Nepalese and Sri Lankan students respectively. Boys (13.2 vs. 5.3 for Nepal, 12.4 vs. 5.8 for Sri Lanka), older and senior students was more likely to be tobacco users in both countries. The average age of tobacco initiation was 10.2 years in Nepal and 8.6 years in Sri Lanka. Factors, namely, individual characteristics, tobacco use among friends, smoking at home and public places, free tobacco products, and lessons about negative effects of tobacco in class were significantly associated with tobacco use in Nepal and Sri Lanka. For instance, friends’ tobacco use was a good predictor for adolescents’ usage (odds ratio [OR] = 4.0, confidence interval [CI] = 2.61–6.23 in Nepal; OR = 2.5, CI = 1.50–4.23 in Sri-Lanka). Similarly, course curriculum significantly reduced smoking among students.
Conclusion: Prevention of tobacco use among school students should be top priority of a country as they are long-term customers and replacement smokers who quit or die. Therefore comprehensive strategies as we proposed along with existing prevention programmes should be tightened to stop them from hazardous behaviours.
Objective: To determine the prevalence of home safety practices and use of safety equipment by disadvantaged families participating in a national home safety equipment scheme in England.
Design: Cross-sectional postal survey sent to a random sample of 1,000 families.
Setting: England, United Kingdom.
Results: Half the families (51%) returned a completed questionnaire. The majority of families (82.3%) reported never drinking hot drinks whilst holding a child and 90.7% reported almost always keeping medicines locked away. High numbers of families reported that they never leave their children in the bath alone (85.7%). Of families with children under one year, 82.1% would never leave the baby on a high surface but only just over half (53.3%) said they never use a baby walker. One-third of families stored cleaning products unsafely in the kitchen or bathroom. Minority ethnic families were significantly less likely to adopt a number of safety practices than white families. Ten per cent of respondents reported that their children had had one or more injuries requiring medical attention in the six months preceding completion of the questionnaire.
Conclusions: While the prevalence of many safety practices was high in families, findings regarding the use of baby walkers, storage of cleaning products and the practices of minority ethnic families highlight issues requiring further health education intervention. National surveys such as this one provide key information necessary for planning future strategies.
Objective: This study investigated how young urban students conceptualize health and fitness and tried to identify the sources of their information about health-related issues. The findings are intended to help make suggestions for policy makers to design and develop effective health-education strategies.
Methods: Focus group discussions (FGDs) of 20 groups, each comprised of eight 10th-grade students, were carried out. In total 160 students participated in the FGDs.
Results: Young students’ knowledge and perceptions about health and fitness had certain limitations, although most of the students emphasized the importance of good health and felt that they knew the meaning of health and fitness. They were most concerned with physical health and failed to consider other aspects of health such as mental/psychological, behavioural and social aspects. This represents a lack of awareness of contemporary conceptions of health and illness.
Conclusion: These findings are important when considering the design of effective high school health education strategies that meet state content standards and for influencing students to continue participating in health-promoting activities.
Objectives: The study explores the relationships among teachers’ health representations, their ideas about health promotion, their working conditions and their involvement in health-promotion activities at school.
Methods: A questionnaire was administered to 107 teachers in 86 schools in Milan (Italy). The questionnaire was structured in four parts: teachers’ involvement in health-promotion programmes, teachers’ representations of health and their ideas regarding methods for promoting health; some dimensions of teacher’s job characteristics (job overload, work group, collaboration with relatives); burn-out and job satisfaction; socio-demographics data of teachers and characteristics of the schools.
Results: The results show that teachers have ambiguous health representations; however, the traditional idea of health as absence of illness was prevalent among the teachers surveyed. Regarding health-promotion activities, the teachers seemed to prefer health education programmes based on informative techniques. Some representations of health were connected to the importance that teachers attributed to health promotion and to teachers’ participation in health-promotion activities. Teachers’ working conditions appear not to be related to their involvement in health promotion.
Conclusions: The majority of teachers involved in this study remained substantially linked to health education models and have not switched to the health-promotion approach. This could be related to teachers’ health representations. To encourage the adoption of the health promotion approach at school, changing teachers’ health representations could be a first step.
Objective: To assess the effectiveness of physical education (PE) interventions designed to foster health features among school-aged children, and to present a qualitative perspective of the different approaches that are most effective in promoting health among youth.
Design: Systematic review.
Method: An extensive electronic literature search was carried out of published trials on interventions targeted to alter health features using school PE. The systematic searches across PE programmes and different health features were conducted using Medline and Web of Science databases. Following screening for scope and relevance, the studies included were compared based on the type of PE programme: augmented PE programme, non-augmented PE programme and multi-component programme.
Results: A number of positive outcomes have been reached. Improvements were reported in both self-reported and objectively measured physical activity (PA), student activity levels during PE, physical fitness, blood profile, fundamental movement skills, cardiovascular disease risk, health-knowledge and dietary profiles. A considerable number of PE-interventions failed to decrease body mass index (BMI), adiposity measures and percent body fat (%BF). Modest effects were also observed for bone mass acquisition.
Conclusion: Evidence revealed positive and consistent results across different health features. Nevertheless, the findings regarding body composition were inconsistent and sparse. Few considerations and recommendations were raised toward the PE role in the promotion of healthy lifestyles, and a number of implications for health promotion practice have been stressed.
Objectives: This is an exploratory study to examine the relations among self-esteem, oral health behaviours and clinical oral health status in Chinese adults. In addition, gender differences in clinical oral health status and oral health behaviours were explored.
Methods: Participants were 192 patients from a private dental clinic in Hong Kong aged between 18 and 67 years. Prior to oral health examination, participants completed a questionnaire about their oral health behaviours and the Rosenberg’s Self-Esteem Scale. A dentist and a registered dental hygienist examined their tooth condition and clinical oral health status.
Results: Participants with high self-esteem had better clinical oral health status than participants with low self-esteem despite no difference in their oral health behaviours. Male participants flossed less frequently than female participants but there was no difference in their clinical oral health status. Linear regression analyses showed that only self-esteem was, but gender, age, and tooth conditions were not, a significant predictor of clinical oral health status.
Conclusions: In general, Chinese adults in Hong Kong had satisfactory oral health behaviours. Chinese adults with high self-esteem had better clinical oral health status than those with low self-esteem. However, oral health behaviours did not differ by level of self-esteem. Implications for implementing psychosocial elements in oral health education were discussed.
Objective: This research identifies effective and ineffective interventions for reducing barriers to the uptake of eye care services in developing countries.
Design: Systematic literature review.
Setting: Only research studies done in developing countries were included.
Method: The review is restricted to English-language articles published between 1997 and 2007. It includes studies that reported randomized trials (controlled and uncontrolled) and surveys with some form of outcome measure, with or without process evaluation. The literature search was conducted on six electronic databases. Data were extracted and synthesized using a standard data extraction form. A narrative synthesis was carried out for the purpose of this review. The quality of the included trials was assessed by CRD guidelines and Crombie’s checklist. The applicability of research findings was evaluated by the RE-AIM model.
Results: One randomized cluster trial and nine surveys were critically appraised. Three multi-faceted interventions were judged effective while another three were found ineffective. Two out of the three effective interventions used service provision and educational input. Two out of the three ineffective interventions also used service provision alongside other methods including screening and counselling. Findings of effective interventions were generalizable.
Conclusion: The review suggests that eye health education and service provision lessen the barriers to service uptake and increase the uptake of eye care services. The role of counselling and screening services needs further review by large and good-quality studies.
Background: Nutrition education is used as a way of promoting lifelong healthy eating practices among school adolescents. There is limited published information on the impact of nutrition education programmes in India.
Objectives: To assess the knowledge and practices of high school students with respect to healthy diets before and after a nutrition education programme.
Design: Pre- and post-intervention questionnaire survey.
Setting: Two private schools in Chennai city.
Method: This study was conducted among adolescents studying in standard VIII and IX in two private schools in Chennai city. Nutrition education as lectures and interactive discussions were given to students one hour every week for a period of 10 weeks. Information on knowledge and attitude on healthy eating and dietary practices was collected before and after the nutrition education intervention using a questionnaire. Differences in knowledge, attitude and practice of students on healthy diet were measured using the X² test with the level of significance p<0.05.
Results: A total of 181 students were involved in the study (response rate 92%). Following the nutrition education programme, satisfactory dietary knowledge significantly improved from 37% to 67% (p<0.001). Similarly, students showing a positive attitude towards healthy diet increased from 18% to 40% (p<0.001). The proportion of students taking soft drinks reduced from 20% to 10% (p<0.01) and ingestion of fast food items through fast food restaurants reduced significantly.
Conclusions: This short-term nutrition education programme brought significant improvements in dietary knowledge and reductions in soft drinks and fast foods consumption.
Objective: Insufficient and poor quality sleep is prevalent in children, and is a significant public health concern due to the negative consequences for health. Certain sleep-related behaviours are associated with improved sleep, and sleep behaviours are amenable to efforts targeted towards behaviour change. Parental educational interventions have been successful at improving parents’ knowledge and children’s health outcomes in some areas of health, but no population-based educational interventions have been designed to improve parents’ knowledge of healthy children’s sleep. This study aimed to design and test an educational tool to increase caregivers’ knowledge of healthy children’s sleep in a primary care setting.
Setting: A hospital-based pediatric primary care clinic where children attend for well-child and sick visits.
Method: Parents of 95 children aged three months to 12 years completed two surveys, one prior to and one after receiving the intervention. The surveys assessed children’s sleep habits (pre-intervention) and parental sleep beliefs and sleep knowledge (pre- and post-intervention). The intervention was a short, informational brochure.
Results: Following the intervention there was a significant increase in parents’ knowledge regarding children’s healthy sleep, and in the number of parents who planned to make positive behaviour changes regarding their child’s sleep practices.
Conclusion: Simple written educational interventions may be effective tools with which to increase parents’ knowledge and promote healthy sleep behaviours in children.
Objective: To explore the experiences of young men aged 16–19, living in an area of high deprivation, when accessing local sexual health services.
Design: A qualitative design drawing on ethnographic methods.
Setting: A local college.
Methods: A multi-method approach was adopted using: one-to-one semi-structured interviews with young men and stakeholders; focus groups with young men; and participant observation in the areas surrounding the college clinics.
Results: While a number of the young men constructed their masculinity as dominant, promiscuous and deliberately unfeminine, this was not widespread and was often a conscious performance. This was possibly a response to boredom that the young men frequently mentioned but also because they felt it was expected of them. The young men in this study demonstrated the need to take responsibility for their actions, recognized the importance of making good judgements, and to have respect for their partner in relationships. They understood that taking alcohol and drugs could affect their ability to act in a sexually responsible manner. It was also clear that, while targeted sexual health messages remain a beneficial public health strategy, there remained a perception that existing sexual health services were still aimed at women and not suited to the young men.
Conclusion: The young men in this study demonstrated adherence to aspects of hegemonic masculinity but this was extremely complex and suggests a nuanced approach is needed to understand young men’s attitudes to sexual health services. By taking this approach strategies for enabling men to access services will be more appropriate and potentially more successful.
Objective: The aim of the study is to explore school nurses’ experience of health education.
Design: A qualitative approach, phenomenology was used to answer the question.
Method: Sixteen participants were recruited through purposeful and snowball sampling. Participants undertook an audio-recorded interview which was transcribed and analysed.
Results: Five themes represent school nurses’ experience of health education. Within these five themes, three issues were identified by the participants as having a negative impact on their experience of health education. These were: (1) feeling unwanted by the school; (2) not supported by the school hierarchy; and (3) a lack of role definition.
Conclusion: These three issues provide important insight into school nurses’ experience of health education and have implications for other school nurses and professionals in the school environment.
Objective: This study aimed to investigate how patients with chronic conditions evaluate telephone health coaching provided by their health insurance company.
Methods: A retrospective survey was conducted among coaching participants (n=834). Outcomes included the general evaluation of the coaching, the evaluation of process and effects and the impact on patient-physician communication.
Results: Participants’ average age was 66.2 years and the majority were women (58.3%). The majority (78.3%) of the insured persons were satisfied with the coaching and 82.3% would recommend it to others. More than half of the participants (53.3%) had learned about new options to influence their health condition. Sub-group differences in the evaluation of the health coaching were found for age, gender and medical condition.
Conclusion: Health coaching might be useful in supporting patients with chronic conditions. While the results indicate a general positive appraisal, a possibility for improvement could be a stronger focus on the individual situation and the imparting of specific skills. Target groups might be selected in a specified manner for the coaching, as older participants in need of specific care seem to benefit less from the approach. Longitudinal and controlled studies are needed to investigate clinical effects of health coaching.
Objective: The present study reports on the results of a 2.5-year college-wide, coordinated intervention that was implemented from June 2007 to December 2009 to reduce the amount and frequency of students’ alcohol consumption.
Design: Quasi-experimental design that used a one-group (freshmen living on campus) pretest/posttest design (N = 6,815 in 2007–2008 and N = 7,550 in 2008–2009) with a pseudo comparison group (non-freshmen living off campus).
Setting: Indiana University-Bloomington, USA.
Method: The social-ecological framework, a multi-tiered strategy that considers the individual, the social milieu, and the environment, was used to guide the selection and implementation of interventions in a university setting to target individuals, the student population, the college, and the surrounding community to reduce high-risk drinking. Freshmen, who were mandated to live on campus, comprised the intervention group while non-freshmen living off campus comprised the pseudo comparison group that received only the environmental-level intervention.
Results: A larger decrease was observed in the amount and frequency of alcohol consumption in freshmen than in non-freshmen for the intervention period (mean drinks consumed per week: –15.9% versus –7.5%; percentage of students who drank at least once a week: –17.5% versus –6.7%; and binge drinking: –12.2% versus –1.0%).
Conclusion: An ecologically guided campus-wide intervention that is multi-tiered appears to be effective in reducing drinking behaviour.
Objective: We aimed to improve the education of medical students involved in a longitudinal perinatal health improvement project in Gowa, Malawi.
Design: We conducted qualitative interviews with students who participated in the project, reviewed their quantitative reports, and assessed the application of methodologies consonant with the learning objectives of a novel community health improvement course within their experience.
Setting: The Gowa Health Promotions Project, designed to improve perinatal care for women and their families within the Gowa Health Clinic, used community participatory research strategies.
Method: Medical students partnered with clinic workers and the local residents evaluated and revised an existing perinatal educational programme. Qualitative and quantitative health and programme data were collected, and programme revisions were implemented. The value of the student experiences as a public health educational tool was evaluated by the authors.
Results: Project sustainability was enhanced by a fellowship and planning for sequential students. The community health course structure and goals enhanced learning in the project. Engagement of investigators as early as possible in an international public health enhancement project improves student learning and ongoing commitment.
Conclusion: Service learning objectives aimed at providing valuable medical learning to student learners immersed in other cultures are consistent with evidence-based learning objectives in the field of public health. Proactively structuring this experience to explicate these goals can enhance student learning. This dual strategy may improve the sustainability of international health programmes by educating medical students while leading them into careers where these skills will be leveraged.
Objective: Previous studies have shown that academic achievement has a significant effect on juvenile delinquency, with the reverse reported as well. This study, therefore, examined the reciprocal causal relationships between academic achievement and juvenile delinquency.
Methods: The participants were 3449 Korean adolescents (mean age 13.2 years, standard deviation (SD)=0.4 at Time 1) from the Korea Youth Panel Survey. They were followed from the 8th to the 11th grade. A cross-lagged autoregressive model with four-year longitudinal data was used for the analysis.
Results: For all grades (Time 1 through Time 4), juvenile delinquency was negatively affected by low academic achievement, while no effects of delinquency on academic achievement were indicated.
Conclusion: There was a significant prediction from academic achievement for juvenile delinquency, rather than reciprocal influences between academic achievement and juvenile delinquency among Korean adolescents, which is different from Western counterparts. This study contributes to theoretical understanding of relations between academic achievement and delinquency in diverse cultural settings and interventions to promote optimal social health.
Objective: To analyse teachers’ health views in order to obtain general trends of factors influencing health and health education and to fit them into the negative–positive model of health proposed by Downie and collaborators.
Method: This large international study involved 15 countries from Western and Eastern Europe, North and Sub-Saharan Africa, the Middle East and South America, with high socioeconomic and cultural diversity. The questionnaire constructed and validated by the European FP6 project BIOHEAD-CITIZEN was applied in each country to a balanced sample of pre-service teachers (Pre) and in-service teachers (In) of primary schools (P) and secondary schools, teaching biology (B) or national language (L).
Results: Women, older persons, those having longer higher university education, primary school teachers (compared to secondary teachers) and language teachers (compared to biology teachers) have a more positive view of health. The major difference was found between countries, rather than religion, where five groups emerged from cluster analysis.
Conclusion: The study does not lead to a comprehensive view of the factors influencing teachers’ perceptions of health but results showed that there is a variety of variables associated with health and health education views. These findings can contribute to facilitate developing appropriate specific health education teachers’ training courses.
Objective: To develop and implement an intervention for problem alcohol and substance use among student athletes at a large Midwestern department of intercollegiate athletics in the USA, by use of screening, a brief intervention, referral to treatment (SBIRT) and motivational interviewing (MI). This paper outlines the development of the protocol, the way in which athletic staff members were trained to conduct SBIRT/MI interventions with student athletes who screened positive on the ASSIST screening tool, and the initial fidelity assessment used to demonstrate levels of athletic-staff learning and retention of the process.
Design: The developmental phase of the project used focus groups. Athletic staff members were trained by a clinical psychologist, during two face-to-face sessions. The recorded practice sessions with student actors were assessed for adherence to project protocols and MI principles.
Setting: This study was conducted at a large Midwestern university in the USA.
Method: Four focus groups were held with a total of 29 individuals from distinct segments of the athletics department. Five athletic staff members were trained in SBIRT/MI. Each staff member completed between 4–8 practice sessions with student actors, which were later assessed for implementation fidelity.
Results: In pilot testing with student actors, staff achieved "good" (µ ≥ 1.5 on a scale of 0–2) performance ratings on the majority of protocols and displayed mixed, but generally positive abilities to utilize MI techniques while avoiding MI-inconsistent behaviors.
Conclusion: A relatively short training sequence can adequately prepare non-clinical staff members in an athletics department to be ready to deliver a SBIRT/MI-driven protocol to any future at-risk student-athletes identified by drug and alcohol screening.
Objective: To examine how norm appeals and guilt influence smokers’ behavioural intention.
Design: A quasi-experiment.
Setting: South Korea.
Method: Two hundred and fifty-five male smokers were randomly assigned to descriptive, injunctive, or subjective anti-smoking norm messages. After they viewed the norm messages, their norm perceptions, guilt and behavioural intention were measured.
Results: The study revealed several findings: (1) injunctive norm perceptions significantly affected behavioural intention; (2) descriptive norm perceptions had a non-significant impact; (3) subjective norm perceptions had an unexpected impact on behavioural intention; (4) guilt arousal strongly and directly affected behavioural intention in all three conditions; and (5) guilt arousal did not mediate the relationship between norm perceptions and guilt.
Conclusion: Injunctive norms messages that smoking in the presence of others is an unacceptable behaviour in the society could persuade smokers to alter their behaviours. In addition, our study suggests substantial potentials of guilt in smokers’ behaviour change.
Context and Objective: Australian rural general practitioners (GPs) require public health knowledge. This study explored the suitability of teaching complex public health issues related to Aboriginal health by way of a hybrid problem-based learning (PBL) model within an intensive training retreat for GP registrars, when numerous trainees have no PBL experience.
Methods: A mixed method evaluation. Pre-training surveys on PBL experience and post-training semi-structured telephone interviews exploring the impact of the model and its desirability. Thematic and discourse analysis of interview statements, coded independently by two researchers.
Results: Seventeen GP trainees and four tutors participated. Six main themes emerged: experience; PBL impact; learning modalities; educational needs; educational expectations; and educational planning.
Discussion: No discernable differences were identified between Australian and international graduates, the knowledge impact of the hybrid model or desirability of the problem. While scabies was a suitable scenario to explore rural public health complexities, a tension regarding the desire for intensive learning and PBL format needs to be addressed to increase trainees’ satisfaction. A reduction in the number of PBL sessions, PBL instruction and highly structured PBL groups will assist. Trainee’s value mixed modality education, including PBL, so a tailored hybrid PBL is worth consideration.
Objective: Insufficient and poor quality sleep is prevalent in children, and is a significant public health concern due to the negative consequences for health. Certain sleep-related behaviours are associated with improved sleep, and sleep behaviours are amenable to efforts targeted towards behaviour change. Parental educational interventions have been successful at improving parents’ knowledge and children’s health outcomes in some areas of health, but no population-based educational interventions have been designed to improve parents’ knowledge of healthy children’s sleep. This study aimed to design and test an educational tool to increase caregivers’ knowledge of healthy children’s sleep in a primary care setting.
Setting: A hospital-based pediatric primary care clinic where children attend for well-child and sick visits.
Method: Parents of 95 children aged three months to 12 years completed two surveys, one prior to and one after receiving the intervention. The surveys assessed children’s sleep habits (pre-intervention) and parental sleep beliefs and sleep knowledge (pre- and post-intervention). The intervention was a short, informational brochure.
Results: Following the intervention there was a significant increase in parents’ knowledge regarding children’s healthy sleep, and in the number of parents who planned to make positive behaviour changes regarding their child’s sleep practices.
Conclusion: Simple written educational interventions may be effective tools with which to increase parents’ knowledge and promote healthy sleep behaviours in children.
Objective: This qualitative study aimed to describe how educators and parents engage with students on health issues within the context of the Healthy School Approach in a disadvantaged Quebec school.
Method: Individual interviews were conducted at the school setting with both educators (n = 5) and parents (n = 5) during the school year of 2010–2011. The interview protocol was based on Hoover-Dempsey, Walker and Ice’s (2010) revised theoretical model of the involvement process and more precisely on the mechanisms of influence, modelling, reinforcement, teaching and encouragements.
Results: Findings indicate that educators’ and parents’ actions tend to involve modelling and encouragements in particular, with the main emphasis on physical activity and nutrition. Educators stress the importance of grounding their health actions in school activities related to the school project, whereas parents believe that their participation as volunteers in the various health-related activities organized at school significantly helps their efforts to support their child. Results highlight the parents’ undeniable contribution to children’s health within current educational systems.
Conclusion: In their conclusion, the authors put into light the importance of two challenging denominators: (1) a shared vision of health; and (2) coherent health education actions in a disadvantaged environment.
Objective: The purpose of the study was to discover whether tomato consumption in elementary- and middle-school students could be increased through a school lunch programme developed by agricultural high-school students acting as peer educators.
Design: The high-school lunch programme included the process of growing tomatoes and providing a newsletter on school lunches to elementary- and middle-school children. Agricultural high-school students were trained as peer educators.
Setting: Six hundred and thirty-one students at 16 schools in Hokkaido, Japan, participated in this programme.
Method: The evaluation survey items comprised questions about taste preference, eating motivation, and behaviours related to the high-school lunch programme and the usual school lunch. The analysis provided a comparison between a group of students who ate more tomatoes after the programme and a group who showed no change in eating preferences, and revealed the factors that affected the increase in tomato consumption.
Results: In all, 17% of the students started to eat more tomatoes after the programme than they had eaten previously. Among the students who ate more tomatoes, the ratio of answers on the choices ‘Tomatoes were delicious’, ‘I request high-school lunch again’, and ‘I want to eat high-school tomatoes at home’ was significantly higher than that among other students whose tomato intake did not increase. The most important factors affecting increased tomato consumption were ‘students’ tomatoes were delicious’.
Conclusion: A school lunch programme developed by agricultural high-school students may be effective for increasing vegetable consumption in elementary- and middle-school students.
Objective: To develop a totally online reality-based course that engages students and enables the development of enhanced teamwork and report-writing skills.
Setting: Outbreaks of infectious diseases impacts upon commerce, trade and tourism as well as placing strains on healthcare systems. A general course introducing university students to epidemiology and public health would help public education into the consequences of worldwide outbreaks.
Methods: Scaffolding of course activities was used to enable students to build upon skill acquisition and development. Student feedback was used to continuously improve the course.
Results: The course enables around 80 students per year to engage efficiently and effectively with the courseware. Student satisfaction was high and has improved with fine-tuning of the course.
Conclusions: We have developed an effective team-based course that has high student engagement and satisfaction. The model could be used to effectively deliver other science-based courses online.
Objective: To perform a systematic review of the literature concerning behavioural mobile health (mHealth) and summarize points related to heath topic, use of theory, audience, purpose, design, intervention components, and principal results that can inform future health education applications.
Design: A systematic review of the literature.
Method: Thirty-four interventions published in peer-reviewed journals before July 2010, employing short message service (SMS) and/or multimedia message service to address health-related behavioural change, were reviewed.
Results: Five interventions utilized SMS alone, 18 employed SMS/Internet, and 11 utilized SMS, Internet, and other strategies. Intervention length ranged from four weeks to one year. Twenty interventions (59%) were evaluated using experimental designs, and most resulted in statistically significant health behavioural changes.
Conclusion: Surveillance of mHealth interventions’ role in facilitating behavioural change is a judicious parallel activity for health education and health behaviour authorities.
Objective: The purpose of this study was to determine the geographic distribution of all new dentists who graduated over a period of six years. Perth, the capital city of Western Australia, is one of the world’s most isolated cities, with a population of approximately 1.6 million people, situated over 2000km from its nearest next major capital city. It has a single dental school graduating between 25 and 50 graduates per year.
Design: Retrospective analysis.
Setting: Western Australia.
Method: Using data from open access sources, the practice locations of dental graduates from 2004–2009 were located. All practice locations were mapped against variables such as entry type (standard and non-standard) and year of graduation using ArcGIS, and the distribution was analyzed based on a concentric boundary approach, using the dental school as the centre point.
Results: Over the period of six years there were 228 graduates with an almost equal proportion of males (49%) and females. In total, 83% of all local graduates continue to practice in the state of Western Australia. Around 15% of the recent graduates (last two years) and 35% of the experienced graduates (five and six years post-graduation) work within the 10km radius of their dental school. Over a period of six years, approximately 20% of the non-standard graduates and 30% of the standard graduates practice dentistry in more urbanized areas associated with the place of graduation.
Conclusion: An apparent association exists between graduation year, type of enrollment and practice location, with a larger proportion of standard graduates working in urbanized areas than their non-standard counterparts.
Objective: Schools are likely to be better able to achieve compliance with smoke-free regulations if principals and teachers perceive the importance of the smoke-free policy. The purpose of this study is to measure teacher and administrator attitudes towards the smoke-free policy in Turkish schools, which is a total smoking ban.
Method: The target population of the study was from primary and high schools on the Anatolian side of Istanbul. Data were collected from 373 teachers and administrators from 134 schools. Variance and discriminant analyses were used to examine the data for associations of attitude with gender, occupation, smoking status, and other characteristics.
Results: It was found that overall teacher and administrator attitudes towards the ban on smoking in schools fell in the ‘undecided’ range. Smokers and those with a high level of nicotine addiction had less positive attitudes towards the smoke-free regulation compared to nonsmokers and those with a lower level of nicotine addiction. It was determined that the most discriminative items in the questionnaire for teacher and administrator attitudes had to do with strict implementation of the regulation and enforcement with fines. Regardless of smoking status and nicotine addiction, teachers and administrators affirmed that ‘it is needed to allow an open area for smokers’.
Conclusions: In light of these results, it appears the smoke-free policy is viewed not only in terms of teachers’ behaviour as role models but also in terms of their personal rights.