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Online platforms can support health and educational professionals in their daily work; however, it is challenging to keep online platforms sustainable. This paper aims to indicate the most important factors of platform sustainability from the perspective of professionals involved in online platforms. Further, it aims to understand how these factors operate. A mixed methods study was carried out among professionals from Europe, Australia, the USA and Canada. In the first phase, the importance of 54 factors from the literature was assessed with a questionnaire among 17 professionals. The relative importance of the factors and the consensus regarding this importance were calculated using median scores and interquartile deviations. In total, 19 factors were selected representing general characteristics, characteristics related to the platform, communication, visitor and context. In the second phase, insight was gained regarding the experiences with those factors through 12 individual Skype interviews. The most frequently mentioned important factors of platform sustainability were (i) having sufficient time, resources and expertise, (ii) user friendliness and (iii) creating a sense of belonging. Platforms should use a planned approach to address a combination of factors directly from platform development. Gaining long-term resources is challenging and should be considered from the start of a project by building partnerships. To promote user friendliness, platforms should be simple, have a clear set-up and provide high-quality tools. Finally, establishing a sense of belonging could be supported by branding and face-to-face networking activities. For all aspects, involving visitors and stakeholders is essential. [ABSTRACT FROM AUTHOR]

This paper reports on a study undertaken to determine what progress has been made in the uptake and impact of the CompHP Core Competencies on Health Promotion practice, education and training in Europe since their publication in 2011. The study used a purposive sample comprising health promoters who had contributed to the development of the CompHP Competencies was augmented by snowball sampling across European Health Promotion practitioners. An online survey tool was employed to elicit information on respondents' attitudes to the Competencies, levels of current and intended use, and opinions on their impact. A total of 81 responses were received from 25 European countries. Findings on factors considered likely to influence the use of the Competencies were generally positive, as were respondents' attitudes to them. However, only 53% of respondents reported that the CompHP Competencies were used in their country and 54% that they used them in their practice. The Competencies were most frequently used in Health Promotion education, where their impact was also most apparent. A lack of support and recognition of the Competencies by key organizations and stakeholders at country level emerges as a potentially critical factor influencing their uptake and use. The survey findings provide an insight into the uptake and impact of the CompHP Core Competencies to date and begin to address the gap in empirical evidence on the use and impact of Health Promotion competencies. However, further research is required to explore the factors influencing implementation of the CompHP Core Competencies at a country level. [ABSTRACT FROM AUTHOR]

The European Urban Health Indicators System Project Part 2 (EURO-URHIS 2) is a cross-national study that was implemented in Europe. It consists of four data collection tools that were specifically developed to collect health data at an urban level. This paper reviews some of the methodological constraints in adapting the EURO-URHIS 2 study in Ho Chi Minh City, Vietnam. No attempt to extend the original study beyond Europe has been reported before. Cultural, political, economic and social differences create specific obstacles as well as challenges. This paper sets out how these challenges were addressed, examining key aspects of the methodology, including study design, translation of the questionnaire and data collection. It was found that the EURO-URHIS 2 adult data collection tool methodology could not be replicated in Vietnam. A lack of basic infrastructure and population registers led to significant changes being made to the sampling and survey administration. It was recommended that the Expanded Programme on Immunization (EPI) was used as the replacement method. Despite the limitations in using the EPI method, the overall strengths and benefits were found to address methodological issues and the resource poor setting. [ABSTRACT FROM AUTHOR]

Health literacy has gained momentum in the Western world, yet in Europe the concept of health literacy is only marginally integrated in research, policy and practice. The present paper presents how translation may act as an influential factor with regard to integration of the health literacy notion in Europe. This study has compared five data sources that provide translations of health literacy: The European Union's Health Strategy; the translations applied in the European Health Literacy Project; national health expert opinions and Google Translate. The comparison integrated Peter Fawcett's translation techniques as a framework for analysis. The results showed a total of 28 translations: 22 from the European Union Health Strategy; 6 from the HLS-EU project; 17 from experts; 25 from Google Translate. Some countries are consistent in translations of health literacy, other countries diverge, the reasons being that health literacy is not yet mainstreamed and the translations are primarily driven by a latent polarized discourse of the concept of literacy. The study showed that translations in general reveals enriched insights in the cohesion of health literacy as one notion and provides the European Health Literacy Glossary that can inform health professionals, academia and decision-makers to further advance health literacy across Europe. [ABSTRACT FROM AUTHOR]

Urban–rural disparities in resources, services and facilities not only impact daily living conditions but also contribute to inequalities in physical activity, which may be associated with variations in basic public resources between urban and rural areas. This study aims to examine the evolution of perceived opportunities for physical activity in European urban and rural environments from 2002 to 2017 and their association with an active lifestyle. Data from four waves (2002, 2005, 2013 and 2017) of cross-sectional Eurobarometer surveys were collected (n = 101 373), and multilevel binomial logistic regressions were conducted. Firstly, the time trend of perceived opportunities for physical activity between urban and rural environments was explored, and secondly, the effect of urban–rural perceived opportunities on achieving an active lifestyle over the years was estimated. The findings revealed that individuals residing in rural settings encountered less opportunities to be physically active. Conversely, urban settings experienced an increase in perceived opportunities. The significance of health promotion through perceived physical activity opportunities lies in the increased likelihood of being physically active, regardless of place of residence or individual socioeconomic factors [in the area: odds ratio (OR) = 1.40, 95% confidence interval (CI) = 1.34–1.47; provided by local sport clubs: OR = 1.29, 95% CI = 1.23–1.35]. Modifying environmental aspects, such as enhancing the quantity, quality and accessibility of physical activity opportunities in both rural and urban areas, may lead to improved physical activity and health promotion, particularly among individuals who are more physically inactive. [ABSTRACT FROM AUTHOR]

Innovative actions are local initiatives which leverage the interactions between the ocean and human health to reduce the risks and enhance the benefits for the stakeholders and the natural environment. These initiatives can have strong positive effects on human health and wellbeing as well as on the marine environment. We analysed 150 such innovative actions in Europe. Using a combined case study and survey approach, innovative actions were identified using interviews and content analysis of websites and compiled into a database. Quantitative data were analysed according to the Drivers, Pressures, State, Impact and Response (DPSIR) framework, guided by selected in-depth interviews. Overall, the innovative actions provided a positive impact on the health of both the ocean and humans through increasing food provision, water quality and tourism opportunities; and addressing environmental issues such as commercial fish stock depletion, pollution and climate change. Innovative actions contributed to meeting various targets of the Sustainable Development Goals (SDGs) 3, 13 and 14. These actions played a potential role ahead of and alongside policy. Some of the innovative actions may have potential to be put in place elsewhere. Such up-scaling would need to be adapted to local circumstances and could be facilitated by an innovative action exchange platform. [ABSTRACT FROM AUTHOR]

Obesity is a global challenge for healthy populations. It has given rise to a wide range of public health interventions, focusing on supportive environments and lifestyle change, including diet, physical activity and behavioural change initiatives. Impact is variable. However, more evidence is slowly becoming available and is being used to develop new interventions. In a period of austerity, momentum is building to review these initiatives and understand what they do, how they do it and how they fit together. Our project seeks to develop a relatively straightforward systematic framework using readily accessible data to map the complex web of initiatives at a policy, population, group and individual level aiming to promote healthy lifestyles, diet and physical activity levels or to reduce obesity through medical treatments in a city or municipality population. It produces a system for classifying different types of interventions into groupings which will enable commissioners to assess the scope and distribution of interventions and make a judgement about gaps in provision and the likely impact on mean body mass index (BMI) as a proxy measure for health. Estimated impact in each level or type of intervention is based upon a summary of the scientific evidence of clinical and/or cost effectiveness. Finally it seeks, where possible, to quantify the potential effects of different types of interventions on BMI and produce a cost per unit of BMI reduced. This approach is less sophisticated but identifies the areas where more sophisticated evaluation would add value. [ABSTRACT FROM AUTHOR]

These reflections from a Child Public Health perspective underline the dramatic changes in children's conditions in Europe over this last century, including a considerable improvement in health. However, we still face problems, disturbing facts and alarming signs. There are important gaps in our knowledge about essential areas of children's health panorama and about particularly vulnerable sub-groups of children, which are less healthy, less well cared for and not enjoying the good conditions of life. We also see an evident lack of the child's perspective, implying acknowledgement and action on the views of the children themselves. Moreover, in spite of the generally improving standard, societal inequity in economy, education and health is increasing and the recent economic crises have struck hard on families with children. There are many good signs implying continuing progress for children and their conditions and also an improved respect for their rights. But with the increasing segregation in our societies, the risk is imminent that the health problems will increase, and that some groups get left far behind. Although actions on this field are primarily a political responsibility, people working with children can make a difference. There are also many examples of projects, particularly on local levels, where professionals act to promote children's health, prevent their ill-health and facilitate their health behaviour, rather than to repair their diseases. Children's particular needs and protection is now generally accepted, and the growing concern for their rights opens a window to the future for a more powerful child health advocacy. [ABSTRACT FROM AUTHOR]

MyHealth European project (2017–2020) was committed to elaborate on models to engage vulnerable migrants and refugees (VMR) in their health through community involvement. Low healthcare access and poor quality of healthcare services for VMR is a common reality in many European countries. The purpose of the present study, as part of MyHealth project, was the development of an agenda for actions and consequent recommendations to tackle the issue. A qualitative research design was applied at four study sites in Barcelona, Spain; Berlin, Germany; Brno, Czech Republic and Athens, Greece. The Metaplan® group discussions allowed the collection, organization and process of ideas and opinions elaborated in the collaborative groups. In total, 14 sessions took place: 4 with health and social professionals (n  = 41) and 10 with VMR (n  = 77). A participatory thematic analysis was performed at every session and overall for all sessions a thematic analysis synthesized the findings. The suggested actions were divided into two levels of recommendations: (i) local authorities at destination country-related, such as the investment in health professionals' cultural competences, and (ii) VMR-related, such as adaptation of help-seeking behavior patterns. Special attention was proposed to women survivors of violence and homeless minors. The study concluded to an agenda for action in Europe. We advocate for a public health paradigm shift where, while holding a bottom-up approach, VMR as well as professionals working with them are actively and meaningfully engaged in the decision-making process of access-enhancing and health promotion strategies in a given socio-cultural context. [ABSTRACT FROM AUTHOR]

Disparities in health between social groups have been documented all over Europe. We summarize the methods and results of the Addressing Inequalities in Regions (AIR) project, which identified illustrative interventions and policies developed in European regions to reduce inequalities at the primary health care level. The first phase was a systematic review of the published literature. The second phase was a survey of European regions, collecting information on policies aiming at reducing health inequalities through primary health care and identifying regional, innovative and evaluated interventions. The third phase assessed interventions through methods defined by a formal consensus, and selected illustrative practices considered good practices for several of nine evaluation criteria. The review included 98 evaluations of interventions and 10 reviews; 80% of interventions were from North-America. Three main pathways to reduce health inequalities were identified: providing health promotion, improving financial access to care and modifying care provision. The first survey identified 90 interventions. Most national strategies included health inequalities issues. Education was the most frequently identified targeted determinant. Most interventions were health promotion general or targeted at specific health determinants, conditions or groups. The second survey assessed 46 interventions. Many involved the population in planning, implementation and evaluation. We also identified the multidisciplinary of interventions, and some who had an impact on empowerment of the targeted population. The AIR project documented that policies and actions can be implemented at the regional level through primary care providers. Policies and interventions are seldom evaluated. [ABSTRACT FROM AUTHOR]

In the UK and Japan, there is concern regarding rising rates of annual new HIV infections among Men who have Sex with Men (MSM).Whilst in the UK and Europe, gay businesses are increasingly recognized as being important settings through which to deliver HIV prevention and health promotion interventions to target vulnerable populations; in Japan such settings-based approaches are relatively underdeveloped. This article draws on qualitative data from a recently completed study conducted to explore whether it is feasible, acceptable and desirable to build on the recent European Everywhere project for adaptation and implementation in Japan. A series of expert workshops were conducted in Tokyo, Nagoya and Osaka with intersectoral representatives from Japanese and UK non-governmental organizations (NGOs), gay businesses, universities and gay communities (n = 46). Further discussion groups and meetings were held with NGO members and researchers from the Japanese Ministry of Health, Labour and Welfare's Research Group on HIV Prevention Policy, Programme Implementation and Evaluation among MSM (n = 34). The results showed that it is desirable, feasible and acceptable to adapt and implement a Japanese version of Everywhere. Such a practical, policy-relevant, settings-based HIV prevention framework for gay businesses may help to facilitate the necessary scale up of prevention responses among MSM in Japan. Given the high degree of sexual mobility between countries in Asia, there is considerable potential for the Everywhere Project (or its Japanese variant) to be expanded and adapted to other countries within the Asia-Pacific region. [ABSTRACT FROM AUTHOR]

Healthy Stadia (HS) is a European public health pilot-program started in 2007 to support sports stadia in promoting the health of people who work and visit sports stadia, as well as inhabitants of the surrounding communities. The aim of this study is to describe the process evaluation of the program, from its beginning in July 2007 to December 2009, in order to assess the feasibility and sustainability of an HS network across Europe. The program involved nine associate partners involved in the coordination of activities at a local level, in the recruitment of stadia, in the development of specific program tasks and in the dissemination of the program at a national level. The activities of associate partners were evaluated through structured questionnaires administered every 6 months. The questionnaire response rate from associate partners was 77.8% for the first and third evaluations and 88.9% for the second and fourth evaluations. According to the evaluation's results, several good practices such as alcohol prevention policies and those supporting people with disabilities were implemented in stadia over the course of the program. Conversely, practices supporting mental health and green transport were generally not achieved. The implemented activities mainly involved staff and visitors. Lack of human and economic resources, especially toward the end of the program, was considered the principal challenge for program development. In conclusion, the process evaluation presented the feasibility of the HS program and the development of health promoting practices in sport stadia over time. [ABSTRACT FROM AUTHOR]

‘Caring and Supportive Environments' are fundamental to a social model of health and were a core theme of Phase V (2009-13) of the WHO European Healthy Cities Network. Deploying the methodology of realist evaluation, this article synthesizes qualitative evidence from 112 highly structured case studies from 68 Network cities and 71 responses to a General Evaluation Questionnaire, which asked cities to analyze city attributes and trends. A schematic model was developed to describe the interaction between action targeted toward children, migrants, older people and action on social and health services, health literacy and active citizenship—the six subtopics clustered within the theme Caring and Supportive Environments. Four hypotheses were tested: (i) there are prerequisites and processes of local governance that increase city capacity for creating supportive environments; (ii) investing in health and social services, active citizenship and health literacy enhance the social inclusion of vulnerable population groups; (iii) there are synergies between social investment and healthy urban planning; and (iv) these investments promote greater equity in health. The evaluation revealed many innovative practices. Providers of health and social services have developed partnerships with agencies influencing wider determinants of health. Health literacy campaigns address the wider context of people’s lives. In a period of economic austerity, cities have utilized the social assets of their citizens. Realist evaluation can help illuminate the pathways from case study interventions to health outcomes, and the prerequisites and processes required to initiate and sustain such investments. [ABSTRACT FROM AUTHOR]