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Background: Physical activity (PA) promotion in healthcare systems is one of the priority areas highlighted by the World Health Organization, which recognizes that progress has been slow largely due to a lack of awareness and investment while requiring a system-based approach. Community pharmacies are one of the health structures that are more easily accessible to populations, thus constituting an ideal venue for developing health promotion activities. This research aimed to describe PA-enabling interventions developed in community pharmacies by pharmacists. Methods: An electronic search was performed in PubMed, Scopus, Web of Science, Cochrane and reference lists of the different papers until June 2023. Studies were eligible if performed in community pharmacies by pharmacists, focused on interventions aimed at increasing PA levels and if at least one PA-specific outcome was measured at two different time points. Results: We identified 7076 publications in the initial search, plus 31 records identified through backward citation tracking from relevant studies. After an initial screening, 236 were selected for full-text analysis. Of the 29 selected papers, 10 presented a low risk of bias for the measurement of PA levels. PA outcomes were generally self-reported outcomes where the change in terms of the percentage of individuals considered active or who increased PA because of the intervention. Conclusion: Several interventions to improve PA through community pharmacies were found although with a high level of heterogeneity and with only few with a low risk of bias. More targeted research that aims to capture PA levels and support the training of healthcare professionals is needed. [ABSTRACT FROM AUTHOR]

Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF–LPF frameworks and suggestions to increase the transformative power of future studies. [ABSTRACT FROM AUTHOR]

Organizations offer activities and programmes to improve their employees' health. These workplace health promotion (WHP) activities usually have an individualized and top-down focus, a low uptake among employees, and are perceived to be out of line with employees' experiences and definitions of health. This paper follows up on studies that have broadened the focus of WHP by including social relations and delves deeper into how daily practices and experiences of (un)belonging at work relate to workplace health. Based on ethnographic research in two companies in the Netherlands, this paper analyses how (un)belonging is expressed and experienced by employees. The paper shows that employees define health at work as a social practice. It also demonstrates how dynamics at work shape different dimensions of (un)belonging that, in turn, affect employees' perceived health at work. These findings indicate the importance of including (un)belonging in the workplace as an ingredient of WHP. [ABSTRACT FROM AUTHOR]

Summary: Despite progression in the ethical and methodological conduct of Aboriginal and Torres Strait Islander health research, disparities still pervade, indicating limitations in knowledge translation. One identified gap is a lack of documented experiences detailing how ethical guidelines may be practically applied. This paper aims to (i) describe the research processes involved in co-designing a physical activity and psychosocial health program for Aboriginal and Torres Strait Islander girls and (ii) highlight learnings of the collaborative research journey. The Criteria for Strengthening Reporting of Health Research involving Indigenous Peoples (CONSIDER) statement was used to document participatory research activities undertaken with an Aboriginal community partner. Building upon the CONSIDER statement, Aboriginal (N = 3), Torres Strait Islander (N = 1) and non-Indigenous (N = 4) research team members engaged in critical reflection to identify lessons learnt. Researchers identified a tension between participatory research principles and the expectations of funding agencies and research institutions. Consequently, timelines must be flexible to foster meaningful community engagement and participatory processes. Additionally, researchers and community stakeholders are encouraged to embrace tensions that may associated with participatory research or the pressures Aboriginal and Torres Strait Islander researchers face from their community and organization. Furthermore, differences in professional (i.e. occupational) and cultural knowledge systems need to be acknowledged and accounted for within the early stages of a project to ensure informed decision-making. Identified lessons will assist relevant stakeholders in the development of future Aboriginal and Torres Strait Islander health programming, ensuring the most appropriate health solutions are devised with community. Lay Summary: The ethical and methodological quality of Aboriginal and Torres Strait Islander health research and associated community engagement has progressed significantly in the last thirty years. Despite this progress, improvements in Aboriginal and Torres Strait Islander health disparities have been slow and inconsistent, indicating there are limitations in the available information for health promotion stakeholders. One identified gap is a lack of documented experiences detailing how guidelines may be practically applied. This paper, therefore, details how an intercultural, intersectoral team engaged in a participatory Aboriginal and Torres Strait Islander health research project (i.e. Tidda Talk). In addition to documenting research processes, the paper also offers lessons learnt: (i) Prioritize a flexible response within the project plan, (ii) Embrace Aboriginal and Torres Strait Islander community empowerment whilst working at the cultural interface (i.e. a place of knowledge exchange between Aboriginal and Torres Strait Islander and Western culture, resulting in two-way learning) (iii) Plan to navigate different knowledge systems, (iv) Acknowledge the pressures and demands placed on Aboriginal and Torres Strait Islander researchers. These documented experiences and lessons learnt have the potential to benefit researchers and practitioners in future health service design and evaluation, allowing for culturally appropriate practices to be identified and replicated. [ABSTRACT FROM AUTHOR]

There are various research designs and approaches to investigate how health-promoting activities are implemented in complex, real-world systems, and to identify potential health effects that might occur following implementation. Although literature describes guidelines to perform and report about implementation research and effect evaluations, no specific guidelines exist on analysing and reporting about the combination of effectiveness data and implementation data collected as part of intervention evaluation in complex and diverse settings. This paper describes the evaluation of primary school-based health-promoting activities in complex systems. Furthermore, an approach for data categorization inspired by Rogers' Diffusion of Innovations theory is presented that can facilitate structuring the study's results and relating the degree of implementation to any impact on effectiveness outcomes that might be observed. Researchers interested in using this approach for data categorization have to ensure that the following three conditions are met: (i) data on an intervention's efficacy in a controlled setting with optimal implementation is available; (ii) key points that define an intervention's optimal implementation are available and (iii) an evaluation study is performed, collecting both effectiveness data and implementation data in a real-world context. This data categorization approach can be useful to generate more insight into an intervention's effectiveness under varying circumstances, and optimal support and advice can be provided to stakeholders to achieve maximum impact of population-based health-promoting interventions in complex, real-world systems. However, the proposed approach is a first suggestion and further testing and adaptation is necessary to increase its usefulness. Knowledge and experience sharing among researchers performing comparable research can increase the knowledge base regarding this subject. [ABSTRACT FROM AUTHOR]

Although health education programmes have been implemented in higher music education (HME) and their evaluations published in peer-reviewed journals, guidelines as to what ought to be included in these programmes are still missing. This study aimed to document expert discussions on the content of an ideal health education curriculum for HME students in the UK, integrating critical thinking. Four interdisciplinary workshops were conducted, where 67 experts in relevant fields took part, and were asked to discuss four lists of topics and concepts created based on literature reviews (cognitive biases, logical fallacies, critical appraisal tools and health topics). Only the list on health topics is relevant here. Notes taken by the participants and ourselves were thematically analysed. Four themes were identified, two of which are reported in this paper: (i) The health education curriculum and (ii) A settings-based approach to health. Part I of this project (published elsewhere) is focussed on the critical thinking content of health education for conservatoire students. The present paper focusses on the ideal health education curriculum and its implications for the wider context of health promotion. [ABSTRACT FROM AUTHOR]

Background: Primary care is an ideal setting for physical activity interventions to prevent and manage common long-term conditions. To identify those who can benefit from such interventions and to deliver tailored support, primary care professionals (e.g. GPs, practice nurses, physiotherapists, health care assistants) need reliable and valid tools to assess physical activity. However, there is uncertainty about the best-performing tool.Objective: To identify the tools used in the literature to assess the physical activity in primary care and describe their psychometric properties.Method: A systematic review of published and unpublished literature was undertaken up to 1 December 2016). Papers detailing physical activity measures, tools or approaches used in primary care consultations were included. A synthesis of the frequency and context of their use, and their psychometric properties, was undertaken. Studies were appraised using the Downs and Black critical appraisal tool and the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) initiative checklist.Results: Fourteen papers reported 10 physical activity assessment tools. The General Practice Physical Activity Questionnaire (GPPAQ) was most frequently reported. None of the assessment tools identified showed high reliability and validity. Intra-rater reliability ranged from kappa: 0.53 [Brief Physical Activity Assessment Tool (BPAAT)] to 0.67 (GPPAQ). Criterion validity ranged from Pearson's rho: 0.26 (GPPAQ) to 0.52 (Physical Activity Vital Sign). Concurrent validity ranged from kappa: 0.24 (GPPAQ) to 0.64 (BPAAT).Conclusion: The evidence base about physical activity assessment in primary care is insufficient to inform current practice. [ABSTRACT FROM AUTHOR]

Little is known about unintentional drowning deaths in Indonesia, the world's fourth most populous and largest archipelagic country. This study aimed to describe the epidemiology and risk factors of unintentional drowning in Indonesia and explore existing health promotion and drowning prevention approaches in Indonesia within a socio-ecological health promotion framework. A scoping review, guided by PRISMA-ScR, was conducted to locate peer-reviewed studies and government reports/policy documents published until May 2023, in English or Indonesian language, using MEDLINE (Ovid), CINAHL, Informit, PsycINFO (ProQuest), Scopus, SafetyLit, BioMed Central and Google Scholar, Indonesian journal databases (Sinta, Garuda) and government agencies websites around the terms: drown, swim, flood, hurricane, cyclone, disaster, water rescue and maritime/boat safety. This review identified 32 papers. However, a paucity of information on unintentional drowning rates, risk factors and prevention in Indonesia was noted. The unavailability of a coordinated national drowning data collection system in Indonesia, from which national and subnational subcategory data can be collected, underlines the possibility of under-representation of drowning mortality. The association between various exposures and drowning incidents has not been fully investigated. An over-reliance on individual-focused, behaviour-based, preventive measures was observed. These findings highlight the need for improving drowning surveillance to ensure the availability and reliability of drowning data; and strengthening research to understand the risk factors for drowning and delivery of drowning prevention programs. Further policy development and research focusing on health promotion approaches that reflect a socio-ecological approach to drowning prevention in Indonesia is imperative. [ABSTRACT FROM AUTHOR]

Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes—the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts' proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities. [ABSTRACT FROM AUTHOR]

Dental caries, a non-communicable disease, is one of the most prevalent diseases globally and share common modifiable risk factors with obesity such as excess sugar intake. However, prioritization by governments to improve population oral health has been limited and is typically excluded from the discourse of public health policy development. Therefore, interventions that target dental caries can have other co-benefits including obesity prevention. In Victoria, Australia, local government authorities have a regulatory requirement to develop their Municipal Health and Wellbeing Plans. The aim of this paper is to identify whether prioritization for oral health by local government authorities in Victoria has changed through the subsequent renewal of the Victorian Public Health and Wellbeing Plans 2011–2015 and 2019–2023. Three desktop audits for all publicly available Municipal Health and Wellbeing Plans by local government authorities in Victoria were conducted between 2014 and 2022. Key terms related to oral health was searched within these policy documents and categorized into six indicators: (i) included oral health as a priority, (ii) linked healthy eating and oral health, (iii) supported the Achievement Program, (iv) included the Smiles 4 Miles program, (v) advocated for fluoridated drinking water, and (vi) included other strategies related to oral health. Overall, there was statistically significant reduction in five of the six indicators, with the exception for prioritization of other strategies related to oral health such as targeting excess sugar intake and smoking. A multi-sectoral approach, that includes oral health would be advantageous to address the growing burden of non-communicable diseases. [ABSTRACT FROM AUTHOR]

Transnational corporations (TNCs) shape population health both positively and negatively through their national and international social, political and economic power and influence; and are a vital commercial determinant of health. Individual and group advocacy and activism in response to corporate products, practices or policy influences can mediate negative health impacts. This paper discusses the unequal power relations existing between TNCs that promote their own financial interests, and activists and advocates who support population and environmental health by challenging corporate power. It draws on interview data from 19 respondents who informed 2 health impact assessments conducted on TNCs; 1 from the fast food industry, and 1 from the extractive industries sector. It reveals the types of strategies that civil society organizations (CSOs) have used to encourage TNCs to act in more health promoting ways. It discusses the extent to which these strategies have been effective, and how TNCs have used their power to respond to civil society action. The paper highlights the rewards, and the very real challenges faced by CSOs trying to change TNC practices related to health, within a neoliberal policy environment. It aims to provide evidence for socially oriented actors to inform their advocacy for changes in public policy or corporate practices that can contribute to improving population health and equity and tackling commercial determinants of health. [ABSTRACT FROM AUTHOR]

Cancer is a primary societal challenge worldwide, with over 23 million new cases/year, and 10 million deaths/year. Estimates of preventable cancer deaths rise as high as 70%, but such estimates rely heavily on individual behaviors, which in turn are correlated with knowledge and attitudes towards health and cancer. This paper describes the iterative evidence-based development of the first entertainment-education series on cancer prevention to be televised, and reports its effectiveness evaluation. A nominal group defined the guiding principles that were translated into key characteristics for a series named ' 2' Life-changing minutes '. Pilot episodes were produced and evaluated in two complementary studies—a focus group study with medical doctors and a survey study with prospective viewers. Results from these studies guided the optimization and production of the full series, which was broadcast on national public TV, in prime time. An evaluation study was performed afterwards with naturally-occurring viewers and results show audience reach on par with purely entertainment series, that health messages can be clearly conveyed through fictional narratives, and that the series has high levels of appreciation and health promotion potential. ' 2' Life-changing minutes ' constitutes a novel and effective proposal for health promotion, that challenges the primacy of information and statistics still common in health communication, with a new format based on stories, characters and social contexts to successfully promote health. [ABSTRACT FROM AUTHOR]

Few case studies exist in the public health or design literatures showing how to create national scale messaging campaigns in low-income countries using design processes. In this paper, we describe how we used Behaviour Centred Design to develop Nyumba ni choo , the Tanzanian National Sanitation Campaign. The process involved multiple iterations of ideation and filtration by professional creatives, government staff, academics and sanitation specialists to create a branded mass communication campaign, which was refreshed annually. The campaign was based on the insight that Tanzania is modernizing rapidly, with people upgrading their homes, but leaving their outside toilets in a 'traditional' state. Built around the 'big idea' that a household is not fully modern without a good-quality, modern toilet, the campaign employed reality TV shows, live engagements and mass and digital media postings, all targeted at motivating both the government and general population to improve toilets. The campaign has made toilets a topic of national conversation and has led to a major uptick in the rate of toilet building. Efforts to improve public health-related behaviour can be enhanced by using systematic approaches that build on available evidence, understand behaviour in its common settings, employ psychological theory and engage creative expertise. [ABSTRACT FROM AUTHOR]

A growing number of employers implement worksite health promotion programs (WHPPs). In particular, blue-collar workers may benefit from these WHPPs. However, they are less likely than other workers to participate and little is known about which factors affect their participation. The aim of this scoping literature review is to produce an overview of studies on factors associated with blue-collar workers' participation in WHPPs. Five databases were searched: BSU, PsycINFO, Medline, Web of Science and CINAHL. The review included peer-reviewed empirical studies on determinants associated with blue-collar workers' participation in WHPPs. Factors were extracted and categorized. Similar determinants were clustered and the direction of the associations was further examined. Nineteen papers describing 11 qualitative and 4 quantitative studies met the eligibility criteria. Seventy-seven determinants were analyzed (in quantitative studies) or reported (in qualitative studies). In most studies, only participant characteristics were investigated. Participation may be enhanced by addressing needs, tailoring from a broad range of activities, offering group activities, requiring little effort and commitment at the start, using incentives, leading by example and combining WHPPs with occupational safety interventions. WHPPs seem to be able to reach blue-collar workers, but it remains particularly challenging to reach shift workers and those who do not yet experience health complaints. [ABSTRACT FROM AUTHOR]

Background Chronic disease is a significant burden on the global population. The Helping Everyone Achieve Long Term Health (HEALTH) Passport is a paper-based approach previously utilized to help adults modify clinical risk factors through lifestyle, which may be effective in improving the long-term health of school-age children. This study investigates the feasibility of in-school use by engaging trainee teachers in primary and secondary education. Methods Two hundred and fifty six unique responses were collated to evaluate current teaching of the main health risk factors and HEALTH Passports specifically adapted for schools. Trainees attended workshops with pre- and post-questionnaires used to measure training efficacy and evaluate the Passports' suitability for in-school use. Narrative analysis of feedback was performed. Results Feedback received for both Passports was positive overall. Trainees highlighted the need for the Passports to be further age differentiated. Significantly increased confidence (P  < 0.01) in knowledge of exercise, type 2 diabetes, weight and blood pressure was shown. Confidence in smoking, drugs and alcohol knowledge was reduced highlighting the requirement for further teacher training. Conclusions The HEALTH Passport has potential as an intervention to improve health literacy in school-age children. Age adaptation is needed with references to weight measures removed. Emotional well-being should be focused on, and data management stringently assessed for child protection. [ABSTRACT FROM AUTHOR]

Community participation is a central concept for health promotion, covering a breadth of approaches, purposes and activities. This paper reports on a national knowledge translation project in England, UK, which resulted in a conceptual framework and typology of community-based approaches, published as national guidance. A key objective was to develop a conceptual framework linked to sources of evidence that could be used to support increased uptake of participatory methods across the health system. It was recognized that legitimacy of community participation was being undermined by a scattered evidence base, absence of a common terminology and low visibility of community practice. A scoping review, combined with stakeholder consultation, was undertaken and 168 review and conceptual publications were identified and a map produced. A 'family of community-centred approaches for health and wellbeing' was then produced as way of organizing the evidence and visually representing the range of intervention types. There are four main groups, with sub-categories: (i) strengthening communities, (ii) volunteer and peer roles, (iii) collaborations and partnerships and (iv) access to community resources. Each group is differentiated using key concepts and theoretical justifications around increasing equity, control and social connectedness. An open access bibliography is available to accompany the framework. The paper discusses the application of the family of community-centred approaches as a flexible planning tool for health promotion practice and its potential to be used as a framework for organizing and synthesizing evidence from a range of participatory methods. [ABSTRACT FROM AUTHOR]

Effective interventions are needed to stop homophobic behaviours in sport settings as these behaviours are associated with negative health and social outcomes for individuals who identify as Lesbian, Gay, Bisexual, Transgender, Queer or other diverse genders and sexualities. This paper reports the results of a quasi-experimental study commissioned by a public health agency to explore the benefits of a novel intervention that has been widely adopted by Australian community sport clubs. The 'Pride Cup' intervention includes education for club leaders, sport participants and the hosting of a rainbow-themed 'pride game'. Survey responses of male participants from six randomly selected sport clubs which had received the intervention (n = 148) were compared to responses (n = 137) from six randomly selected comparison clubs (Australian Football, cricket, field hockey, roller derby). Employing a post-test-only design, the study explored differences in homophobic attitudes, behaviours and individual efficacy to react negatively to homophobic behaviours. The study found significant differences (p < 0.001) in self-reported use of homophobic slurs (e.g. fag) in the last 2 weeks by participants in the treatment (11%) versus comparison (31.8%) clubs, and significant differences in the perceived use of these slurs by teammates (25.9% vs. 56.6%) or coaches (7.8% vs. 23.3%). There were also significant differences in efficacy scores, but no differences in homophobic attitudes. These results, combined with evidence of community-driven adoption, support the allocation of public health resources to conduct larger scale trials using pre/post designs to confirm these findings. [ABSTRACT FROM AUTHOR]

Context The presence of retail food establishments around schools can be a potentiating or protective factor for overweight in students, depending on access to these places as well as types of foods available therein. The hypothesis for this study was that a greater density and proximity of retail food establishments around schools influence the weight of students. Objective To systematically review the available observational literature on the association between retail food establishments around schools and the occurrence of overweight and obesity in schoolchildren and adolescents. Data Sources Observational studies were searched in the MEDLINE, EMBASE, and SCOPUS databases published until May 2019. Data Extraction Two independent reviewers extracted relevant data. Data Analysis Data on the 31 included studies were summarized with narrative synthesis according to meta-analyses of observational studies in epidemiology, exploring the type of food establishments around schools and analyzing qualitatively the impact of proximity or density on overweight and obesity rates. Conclusion Of the 31 articles, a direct association between proximity or density of establishments (mainly fast food restaurants, convenience stores, grocery stores) around schools and overweight and obesity in children and adolescents were found in 14 studies. However, authors of 13 papers found no association and inverse association was presented in 4 papers. The studies presented different methods of classification, location, and analysis of retail food establishments, making it difficult to conclude the real influence that the presence of these establishments near schools have on the nutritional status of children and adolescents. Therefore, future studies should consider the use of longitudinal designs and standardized analysis of the food environment around schools to better understand this food environment and its influence on health-related behaviors. [ABSTRACT FROM AUTHOR]

This paper explores the well-being ['well-being' and 'wellbeing' are used interchangeably in the literature. Well-being is used in this paper (except in the reference list where exact wording is maintained)] benefits of participation in a workplace choir for health service staff. A mixed method study, this project combines quantitative measures of work engagement, perceived stress, resilience levels and work absences with qualitative interviews with choir participants. It is the first study of workplace choirs in Ireland and one of very few studies internationally that research health service staff choirs. There is some preliminary evidence of benefits that choir attendance may increase positive perception of workers' mental health as well as effect depression rates. However, evidence is limited quantitatively and difficulties in measuring the health benefits of arts interventions are noted. Qualitative data, however, confirms previous study findings, namely that a workplace choir can promote social connectedness, enjoyment at work and staff engagement. Work place choir was also noted to appeal mainly to a limited demographic of work place staff and people with relatively positive health and well-being. Efforts must be made to engage staff from lower socio-economic backgrounds, diverse cultural backgrounds and male staff in work place health promotion activities, as these groups were found less likely to join a work place choir. Given the low cost and low risk of this activity, and the qualitative benefits reported, it is recommended to continue to develop and evaluate health service workplace choirs. [ABSTRACT FROM AUTHOR]

School-based employee interventions can benefit the health of staff and have the potential to influence the health of school students through role-modelling. However, interventions within schools typically focus on students, with very few studies addressing obesity and related health behaviours among school staff. A systematic review of the peer-reviewed literature published between January 2000 and May 2020 was undertaken to synthesize the evidence on the impact that school-based obesity prevention programmes have on the staff they employ. Search terms were derived from four major topics: (i) school; (ii) staff; (iii) health promotion and (iv) obesity. Terms were adapted for six databases and three independent researchers screened results. Studies were included if they reported on the outcomes of body weight, dietary behaviours and/or physical activity. Of 3483 papers identified in the search, 13 studies met the inclusion criteria. All 13 studies included an intervention that focussed on improving nutrition, physical activity or both. All included studies demonstrated a positive outcome for either dietary intake, weight or body mass index or physical activity outcomes, however not all results were statistically significant. The included studies showed promising, although limited, impacts on employee health outcomes. This review demonstrated a lack of global focus and investment in interventions targeting school staff, particularly in contrast to the large amount of research on school-based health promotion initiatives focussed on students. There is a need for further research to understand effective interventions to promote health and prevent obesity in this large, diverse and influential workforce. [ABSTRACT FROM AUTHOR]

This paper describes children's perceptions and visions for a healthier social and physical environment in the setting of a primary school on the Danish island of Bornholm. Guided by an everyday-life perspective and applying participatory action research methods including social imagination and visual techniques within the framework of future creating workshops, the study engaged 50 children aged 6–9 years in creative processes of identifying health-related problem areas and solutions in their school setting. The study observed that the children were very capable of articulating their thoughts, ideas and visions for a better and healthier school environment. Identified problem areas and solutions differed widely and represented a broad perspective of health including social, physical, environmental and emotional aspects. The paper discusses advantages and challenges of involving children in decision-making processes and concludes that children are visionary and creative agents of change in health promotion projects provided that applied participatory methods are appealing to the children. [ABSTRACT FROM AUTHOR]

Globally, prisoners tend to come from marginalized and socially disadvantaged sections of the society and exhibit a high incidence of ill health, linked to social exclusion and multiple complex needs. Prisons therefore offer an important opportunity to tackle inequality and injustice, through promoting health, reducing reoffending and facilitating community reintegration.This paper reports on and critically discusses findings from an evaluative research study, which aimed to identify and explore impacts of prisoners' participation in an innovative social and therapeutic horticultural programme, 'Greener on the Outside for Prisons' (GOOP), delivered in prisons in North West England. Focus groups with 16 prisoners and semi-structured interviews with six prison staff were conducted at five sites. Presented under three overarching themes (health and well-being; skills development, employability, and work preparedness; and relationships), findings suggest that engagement with and participation in GOOP were important in improving positive mental well-being, increasing physical activity and knowledge about healthier eating; developing skills and work readiness; and building relationships and catalysing and strengthening prosocial behaviours, important for good citizenship and effective resettlement. The paper concludes that – in the context of the current UK prison reform agenda and concern about the high incidence of violence, substance misuse, self-harm and suicide – prison-based horticulture can offer multiple benefits and make a significant contribution to the creation of safe, secure, supportive and health-enhancing environments. Furthermore, it contends that by joining up health and justice agendas, programmes such as GOOP have the potential to serve as powerful catalysts for wider systemic change, thereby helping tackle inequalities and social exclusion within societies across the globe. [ABSTRACT FROM AUTHOR]

Despite international recognition of health promotion (HP) as a cost-effective way to improve population health, it is not highly regarded nor is it sufficiently institutionalized in many health systems. This diminishes its ability to deliver on its public health promises. This paper examined the role of organizational structure and human agency within the South African health system (drawing on Giddens's structuration theory) in determining the extent of, and barriers to, the institutionalization of HP. We conducted a qualitative case study using a combination of in-depth interviews (n = 37), key informant interviews (n = 8) and one-day workshops (n = 5) with Department of Health (DoH) staff (HP and non-HP personnel) from national, provincial and district levels as well as external HP stakeholders. Within the South African health system, there are dedicated HP staffs, with no specified professional competencies or a coherent hierarchy of job titles. Allocated HP resources were frequently shifted to other programmes. This resulted in a disconnect between national and provincial levels, which impeded communication and opportunity to develop a shared vision and coherent programme. We found some examples of successful HP organization and implementation practices, such as the tobacco control legislation. Overall, HP staff had limited agency and were often unable to articulate the vision for HP. Uncertainty about the role of HP has led to powerlessness, and feelings of resentment have generated demotivation and moral distress. HP voices were seldom heard and were repressed by dominant curative-focused structures. If leaders of HP continue to be embedded in such an institution, there is little chance of driving an effective HP agenda. Therefore, there is a need to engage policy-makers to integrate HP into the health system fabric. Establishment of an independent HP foundation could be one mechanism to drive multi-sectoral collaboration, contribute to evidence-based HP research and further develop health in all policies through advocacy. [ABSTRACT FROM AUTHOR]

Despite long-standing public and scientific interest in the phenomenon of sleep, the current decade has shown tremendous growth in our understanding of the sleep of children who have medical or developmental conditions. To accommodate, promote, and guide that growth, Journal of Pediatric Psychology, Clinical Practice in Pediatric Psychology, and Journal of Developmental and Behavioral Pediatrics have published coordinated special issues, encompassing >30 relevant articles. This article introduces the special issue in Journal of Pediatric Psychology, highlighting papers that illustrate how sleep problems are not only commonly comorbid with childhood medical and developmental conditions; they are also likely caused by and contribute to these conditions. In doing so, these coordinated special issues guide clinical care and reveal opportunities for future research. [ABSTRACT FROM AUTHOR]

Although rising rates of obesity are recognized as a major concern for Australian public health, debate on what (if any) responsive action should be undertaken is conceptually and normatively complex. It is shaped by diverse values and interests; different representations of the problem; and many options for action by government, the private sector or individuals. This paper presents research documenting arguments for and against implementing a sugar tax in Australia. It is based on semi-structured interviews with representatives from industry (n  = 4), public health (n  = 4), policy think tanks (n  = 2); and document and media analyses. The research design was informed by framing and agenda setting theory with results reported under four main themes: framing economic impacts, framing equity, framing obesity and framing the 'nanny state' versus individual liberty argument. We found that proposals for a sugar tax as part of policy responses to the issue of overweight and obesity in Australia are framed very differently by actors who either support or oppose it. A conclusion is that policy makers and public health advocates involved in policy debates on a sugar tax need to understand the role of problem and 'solution' framing, and develop positions based on protecting the public interest as a basic ethical responsibility of governments and public agencies. [ABSTRACT FROM AUTHOR]

Background Children's second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The 'First Steps 2 Smoke-free' (FS2SF) intervention is the first to trial this approach delivered as part of health professionals' routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women's capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others' smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage. [ABSTRACT FROM AUTHOR]

Summary Meal kits are popular for consumers seeking greater convenience in preparing meals at home. The market share for meal kit subscription services (MKSSs) is growing in developed nations including Australia, however, literature about their health promoting qualities, e.g. nutritional composition, is scarce. This study aimed to assess the characteristics and nutritional composition of meals offered from an MKSS over 12 months. Nutritional data were extracted from recipes available to order from HelloFresh in Australia from 1 July 2017 to 30 June 2018. In total, 346 (251 unique) recipes were retrieved. Per serve (median size 580 g), meals contained a median of 2840 kJ (678 kcal) of energy, 58 g carbohydrate (14 g sugar), 44 g protein, 28 g total fat (8 g saturated fat) and 839 mg sodium. Median energy from macronutrients was total fat (38%), carbohydrates (34%), protein (25%) and saturated fat (11%). This paper is the first to describe characteristics of recipes available from an MKSS over a 12-month period of time. With their growing popularity, meal kit delivery services have the capacity to influence consumer food behaviours, diets and subsequently population health. MKSSs may function to promote health though education, training, and enabling home cooking behaviours, and may be a powerful commitment device for home cooking behaviour change. However, it is important for health professionals, including dietitians and nutritionists, to understand the nutritional risks, benefits and suitability of this contemporary mealtime option before recommending them to clients and members of the public as part of health promotion. Lay summary Meal kit delivery services are growing in popularity in developed countries, complementing busy lifestyles with pre-measured ingredients and recipe instructions delivered to the home. These meal kits have the ability to influence consumer diets and population health, and may support health promoting diet behaviours, e.g. eating vegetables, and enable home cooking. In this study, we reviewed a years' worth of recipes from a popular meal kit service. We report that a typical recipe contained approximately nine different ingredients, comprising three vegetables and required three ingredients from the home pantry. Meals took ∼35 min to prepare and were found to be relatively high in energy from fat and protein, and relatively low in energy from carbohydrates. The level of sodium varied widely and some meals exceeded the Australian Suggested Dietary Target for sodium (<2000 mg). Meal kit recipes were found to have health promoting qualities, frequently including vegetable ingredients, however, improvements to recipes would make these meal kits more health promoting. Current diet intakes and the nutritional composition of meal kits recipes should be reviewed before being recommended by health professionals. [ABSTRACT FROM AUTHOR]

In recent years, health promotion has come under critique for being framed according to the contexts and priorities of Western communities, with the notion of 'control' underpinning much of its theoretical and practical development. Ceding space to Indigenous voices and knowledge is one way forward to overcoming this limitation and decolonizing the field. This paper reports on insights gained from a participatory digital storytelling project focused on Indigenous health promotion that took place at M'Wikwedong Indigenous Friendship Centre in the city of Owen Sound, Canada. The research team was formed by M'Wikwedong's Executive Director, five Indigenous youth and two university researchers. We co-created data through an 8-month digital storytelling process that involved 13 weekly research meetings, the creation of 4 digital stories and video screenings. We analysed data from seven group interview transcriptions, field notes and video transcripts through qualitative coding and theme building. The four themes we identified speak to the ways M'Wikwedong reinforced connections to youth, their sense of self, place in the city and Indigenous cultures. From our findings, we theorize that egalitarianism of knowledge, restoring balance in relationships and Indigenous leadership are core components of an 'ethos of connection' that underlies Indigenous health promotion. The 'ethos of connection' challenges Western notions of 'control' and brings attention to the unique expertise and practices of urban Indigenous communities and organizations as a primary basis for health promotion. [ABSTRACT FROM AUTHOR]

This paper examines the value of participatory approaches within interventions aimed at promoting mental health and wellbeing in the workplace. Specifically the paper explores data from the thematic evaluation of the Mental Health and Employment project strand within the Altogether Better programme being implemented in England in the Yorkshire and Humber region, which was funded through the BIG Lottery and aimed to empower people across the region to lead better lives. The evaluation combined a systematic evidence review with semi-structured interviews across mental health and employment projects. Drawing on both evaluation elements, the paper examines the potential of workplace-based ‘business champions’ to facilitate organizational culture change within enterprises within a deprived regional socio-economic environment. First, the paper identifies key policy drivers for interventions around mental health and employment, summarizes evidence review findings and describes the range of activities within three projects. The role of the ‘business champion’ emerged as crucial to these interventions and therefore, secondly, the paper examines how champions' potential to make a difference depends on the work settings and their existing roles, skills and motivation. In particular, champions can proactively coordinate project strands, embed the project, encourage participation, raise awareness, encourage changes to work procedures and strengthen networks and partnerships. The paper explores how these processes can facilitate changes in organizational culture. Challenges of implementation are identified, including achieving leverage with senior management, handover of ownership to fellow employees, assessing impact and sustainability. Finally, implications for policy and practice are discussed, and conclusions drawn concerning the roles of champions within different workplace environments. [ABSTRACT FROM AUTHOR]

Objective.: To demonstrate proof of concept for a smart phone‐empowered community health worker (CHW) model of care for breast health promotion, clinical breast examination (CBE), and patient navigation in rural Bangladesh. Methods.: This study was a randomized controlled trial; July 1 to October 31, 2012, 30 CHWs conducted door‐to‐door interviews of women aged 25 and older in Khulna Division. Only women who disclosed a breast symptom were offered CBE. Arm A: smart phone with applications to guide interview, report data, show motivational video, and offer appointment for women with an abnormal CBE. Arm B: smart phone/applications identical to Arm A plus CHW had training in “patient navigation” to address potential barriers to seeking care. Arm C: control arm (no smart phone; same interview recorded on paper). Outcomes are presented as the “adherence” (to advice regarding a clinic appointment) for women with an abnormal CBE. This study was approved by Women's College Hospital Research Ethics Board (Toronto, Ontario, Canada) and district government officials (Khulna, Bangladesh). Funded by Grand Challenges Canada. Results.: In 4 months, 22,337 women were interviewed; <1% declined participation, and 556 women had an abnormal CBE. Control group CHWs completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams compared with CHWs in arms A and B. Arm B had the highest adherence. Conclusion.: CHWs guided by our smart phone applications were more efficient and effective in breast health promotion compared with the control group. CHW “navigators” were most effective in encouraging women with an abnormal breast examination to adhere to advice regarding clinic attendance. Community health workers (CHWs) used smart phones with and without patient navigation to promote breast health in rural Bangladesh and were compared with CHWs using paper‐and‐pencil methods only. Findings showed that CHWs who did not use the smart phone applications completed fewer interviews, had inferior data quality, and identified significantly fewer women with abnormal breast exams, indicating that smart phones can be used to promote breast health in rural areas. CHWs with smart phones and 1‐day training in patient navigation were more effective in encouraging women with abnormal breast exams to attend for proper care. [ABSTRACT FROM AUTHOR]

Nurses play an important role in promoting public health. Traditionally, the focus of health promotion by nurses has been on disease prevention and changing the behaviour of individuals with respect to their health. However, their role as promoters of health is more complex, since they have multi-disciplinary knowledge and experience of health promotion in their nursing practice. This paper presents an integrative review aimed at examining the findings of existing research studies (1998–2011) of health promotion practice by nurses. Systematic computer searches were conducted of the Cochrane databases, Cinahl, PubMed, Web of Science, PsycINFO and Scopus databases, covering the period January 1998 to December 2011. Data were analysed and the results are presented using the concept map method of Novak and Gowin. The review found information on the theoretical basis of health promotion practice by nurses, the range of their expertise, health promotion competencies and the organizational culture associated with health promotion practice. Nurses consider health promotion important but a number of obstacles associated with organizational culture prevent effective delivery. [ABSTRACT FROM PUBLISHER]

Developing meaningful indicators to track youth mental health (MH) is important to support the development and evaluation of responsive mental health promotion (MHP) initiatives that address the socio-economic determinants of youth MH. Development of relevant indicators is challenged, however, by the lack of knowledge regarding the relations among socio-economic factors and youth MH. Thirty diverse young people from a Canadian metropolitan area were engaged within a process of social praxis to explore their experiences of the inter-relationship between their socio-economic environments and their MH and their processes of seeking to realize their MH. Participants emphasized 'needs' as foundational to MH, whereas 'wants', driven by materialistic and wealth-oriented values and social norms, constrained their MH. Their reflections on the inter-relations among their MH and socio-economic processes highlight eight inter-related MH needs within the Canadian socio-economic context. In this paper, we present these needs and show how these needs, young people's affective states, and their access to resources within co-evolving socio-economic processes (to enable their needs) illustrate the fundamental inter-relation between young people's MH and socio-economic processes. We identify implications for measuring youth MH within MHP practice, including the importance of iterative indicator frameworks that include measures of young people's access to resources to enable their MH needs and their degree of distress. [ABSTRACT FROM AUTHOR]

Despite decades of concern about reducing health inequity, the Commission on the Social Determinants of Health (CSDH) painted a picture of persistent and, in some cases, increasing health inequity. It also made a call for increased evaluation of interventions that might reduce inequities. This paper describes such an intervention—the Social Inclusion Initiative (SII) of the South Australian Government—that was documented for the Social Exclusion Knowledge Network of the CSDH. This initiative is designed to increase social inclusion by addressing key determinants of health inequity—in the study period these were education, homelessness and drug use. Our paper examines evidence from a rapid appraisal to determine whether a social inclusion initiative is a useful aspect of government action to reduce health inequity. It describes achievements in each specific area and the ways they can be expected to affect health equity. Our study highlighted four factors central to the successes achieved by the SII. These were the independent authority and influence of the leadership of the SII, the whole of government approach supported by an overarching strategic plan which sets clear goals for government and the clear and unambiguous support from the highest level of government. We conclude that a social inclusion approach can be valuable in the quest to reduce inequities and that further research on innovative social policy approaches is required to examine their likely impact on health equity. [ABSTRACT FROM AUTHOR]

The implementation of effective community-based health interventions within Spanish football clubs has the potential to positively influence the public health agenda and enable the healthcare system in Spain to be more successful and sustainable. This paper aims to explore the involvement of Spanish football clubs in health promotion activities, their potential for future involvement and what that would require. A mixed methods explanatory sequential design, with a purposive sample of La Liga clubs. Data collection included online questionnaires and phone interviews. Quantitative methods enabled us to describe the number and types of programmes the clubs are currently involved in. Qualitative data was useful to further unpick the processes followed by the clubs in planning and developing health promotion programmes, while identifying any determinants to change. Seventeen clubs completed questionnaires and 11 participated in interviews. Clubs generally support inclusive programmes that target disadvantaged groups. Health-related programmes focus on healthy eating, physical activity and blood donation. Thematic analysis of interviews with 11 representatives of La Liga clubs resulted in three-key themes. These related to: (i) Diversity of programmes; (ii) (Lack of) evidence-based approaches to intervention design and evaluation and (iii) Contrasting views about a club's role in health promotion interventions. Spanish football clubs have potential to reach into communities that are currently underserved. However, there is limited infrastructure and understanding within the clubs to do this. Nevertheless, there is huge opportunity for organizations with public health responsibility in Spain to implement translational approaches within football-based settings. [ABSTRACT FROM AUTHOR]

Background Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations. Methods Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness. Results Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines' supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program. Conclusions Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more 'local testing' of modified interventions within such contexts. This can then inform 'thinking globally' on guidelines for the delivery of NCD care in crisis settings. [ABSTRACT FROM AUTHOR]

Focusing on the conceptualization of a whole university approach, this paper reports on an international qualitative study that explored vice-chancellors' and network members' understanding of and commitment to Health Promoting Universities, examined perspectives on leadership and investigated the Okanagan Charter's potential to catalyse whole university leadership and change. A multi-method qualitative approach was used: semi-structured interviews and focus groups were conducted face-to-face with vice-chancellors (n = 12) and Health Promoting University co-ordinators who were members of the UK Healthy Universities Network (n = 8); telephone interviews were conducted with a mix of UK and non-UK Health Promoting University co-ordinators (n = 5) and two online questionnaires were distributed to non-UK network co-ordinators (n = 6) and non-UK Health Promoting University co-ordinators (n = 10). Through thematic analysis, a number of key themes emerged that build a new conceptualization of the whole university approach (see Figure 1): building a broad understanding and framing of health; developing a supportive ethos and culture; embedding health into the university and joining up areas of work; focusing on the whole population and facing challenges and seizing opportunities. The study elicited rich and wide-ranging views from multiple stakeholders from universities and networks across four continents, confirming Health Promoting Universities as a truly global movement. Looking ahead, there are clear opportunities and challenges. First, the media narrative of a student mental health 'crisis' has focused universities' attention on 'health', but from a single issue 'illness' perspective. This risks detracting from the whole system Health Promoting Universities approach. Second, even with the Okanagan Charter inspiring individuals and universities, there are still major challenges in translating the rhetoric of whole system approaches into meaningful action within large, complex and culturally diverse organizations. [ABSTRACT FROM AUTHOR]

To better address the mental health and substance use crises facing youth globally, a comprehensive approach, inclusive of mental health promotion is needed. A key component of mental health promotion is policy intervention to address the social and structural determinants of health. Importantly, youth should be engaged in these efforts to maximize relevancy and impact. Yet, while there is growing interest in the inclusion of youth in the policymaking process, there is a paucity of guidance on how to do this well. This environmental scan reports findings from a comprehensive search of academic and grey literature that was conducted using the electronic databases: CINAHL, ERIC, MEDLINE, PsycINFO, Google Scholar, and Google. Search terms included variations of 'youth*', 'educat*', 'engage*', 'policy' and 'policy training'. Thirteen English language training programmes met inclusion criteria. Analysis identified marked differences in programme philosophy and focus by geographic region and highlights the need for enhanced evaluation and impact measurement moving forward. This paper makes a needed contribution to the evidence-base guiding this key mental health promotion strategy, which holds the potential to address critical gaps in approaches to youth mental health and substance use. [ABSTRACT FROM AUTHOR]

A holistic well-being approach, understood as an approach that pays attention to the promotion of individual, relational and collective well-being in a particular context, is proposed as a way to address the fragmented nature in which mental health and well-being programmes are implemented in school communities in South Africa. The goal of this paper is to indicate key aspects for sustainable coordination of a process to facilitate holistic well-being in South African schools. Research was conducted in six South African schools with the aim of developing an integrated, multilevel process to facilitate holistic well-being in these contexts. A participatory action learning and action research approach was applied. As part of this research, key aspects that could contribute to the sustainable coordination of holistic well-being were identified. The research comprised a cross-case analysis of the data gathered, as well as a focus group that was held with the coordinators who facilitated the development of the process in each school. In addition, the school principals completed a semi-structured questionnaire, and Skype interviews were conducted with four international experts. The five aspects identified as key to the sustainable coordination of well-being are: that ownership and responsibility should reside in the school context; that there should be a clear vision for the promotion of holistic well-being; that the connections between all involved should be deepened; that all efforts to promote holistic well-being should be integrated, and that the complexity of the process should be acknowledged. [ABSTRACT FROM AUTHOR]

In this paper, we describe and critically reflect on the possibilities and challenges of developing and implementing an empowerment-based school intervention regarding healthy food and physical activity (PA), involving participants from a Swedish multicultural area characterized by low socioeconomic status. The 2-year intervention was continually developed and implemented, as a result of cooperation and shared decision making among researchers and the participants. All 54 participants were seventh graders, and the intervention comprised health coaching, health promotion sessions and a Facebook group. We experienced that participants valued collaborating with peers, and that they took responsibility in codeveloping and implementing the intervention. Participants expressed feeling listened to, being treated with respect and taken seriously. However, we also experienced a number of barriers that challenged our initial intentions of aiding participation and ambition to support empowerment. Moreover, it was challenging to use structured group health coaching and to work with goal-setting in groups of participants with shared, and sometimes competing, goals, wishes and needs related to food and PA. Successful experiences from this intervention was the importance of acquiring a broad and deep understanding of the context and participants, being open to negotiating, as well as adjusting the intervention. [ABSTRACT FROM AUTHOR]

Every year, the majority of Hong Kong young adults who graduate from secondary school progress onto tertiary education. Poor eating patterns among young adults could lead to long-term health implications associated with overweight and obesity. Using the socio-ecological model as a theoretical framework, this paper reviews the current food-related policies in Hong Kong and proposes a comprehensive policy approach relevant to a variety of organizational contexts that has the potential to support positive eating patterns among young adults by enhancing the local food environment. Hong Kong has an unusual food supply in that more than 95% of food is imported, making it vulnerable to food insecurity. Education interventions commonly conducted in Hong Kong are unlikely to be helpful because young adults acquire nutrition-related knowledge when they attend secondary school. There is a need to change the food environment in Hong Kong so that young adults can easily translate their nutrition knowledge into making healthy food choices. Policy approaches might be among the most effective strategies for bringing positive changes in eating patterns because they have the potential to directly influence the food environment and context where an individual lives. A comprehensive suite of approaches that fill the policy gaps, remove barriers of healthy food consumption and create more healthy food choices is required to improve diet and health. [ABSTRACT FROM AUTHOR]

There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion. [ABSTRACT FROM AUTHOR]

From a public health perspective, gambling shares many of the same characteristics as alcohol. Notably, excessive gambling is associated with many physical and emotional health harms, including depression, suicidal ideation, substance use and addiction and greater utilization of health care resources. Gambling also demonstrates a similar 'dose-response' relationship as alcohol—the more one gambles, the greater the likelihood of harm. Using the same collaborative, evidence-informed approach that produced Canada's Low-Risk Alcohol Drinking and Lower Risk Cannabis Use Guidelines, a research team is leading the development of the first national Low-Risk Gambling Guidelines (LRGGs) that will include quantitative thresholds for safe gambling. This paper describes the research methodology and the decision-making process for the project. The guidelines will be derived through secondary analyses of several large population datasets from Canada and other countries, including both cross-sectional and longitudinal data on over 50 000 adults. A scientific committee will pool the results and put forward recommendations for LRGGs to a nationally representative, multi-agency advisory committee for endorsement. To our knowledge, this is the first systematic attempt to generate a workable set of LRGGs from population data. Once validated, the guidelines inform public health policy and prevention initiatives and will be disseminated to addiction professionals, policy makers, regulators, communication experts and the gambling industry. The availability of the LRGGs will help the general public make well-informed decisions about their gambling activities and reduce the harms associated with gambling. [ABSTRACT FROM AUTHOR]

Around 2.3 billion people in developing countries still lack access to improved sanitation facilities and almost one billion practice open defecation (OD). The Community-Led Total Sanitation (CLTS) has recently become a particularly popular approach used in more than 60 countries. CLTS is a behavior-change approach that aims to ignite community action and make OD socially unacceptable without providing any external financial or material support to individual households. CLTS is sometimes perceived as a revolutionary approach that has proven to be highly cost-effective in abolishing OD. However, it has been criticized for its use of unethical practices and questioned with respect to the sustainability of its outcomes and the limited health benefits it can generate. Based on semi-structured interviews with development workers experienced in the implementation of CLTS in 14 different countries, this paper seeks to examine practical views on the issues surrounding this approach. We found that despite acknowledging some of the controversies and the possibly limited sustainability of results, CLTS is generally considered an effective and satisfactory tool for improving sanitation conditions. Practitioners first of all accentuate the normative importance of the elimination of OD attained through CLTS without weighting on (the absence of) evidence on the longer term effects or impacts on health. However, a need for various modifications of CLTS according to local social and natural environments was strongly expressed, including changes that go against the core principles of CLTS like no subsidies and no technical assistance principles. [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]

The aim of this study was to describe the goals, activities, and methods of EUMOVE project in developing a set of resources targeting both primary and secondary schools that allow the entire educational community to promote healthy lifestyles (HL). The EUMOVE project is an Erasmus+ program based in the Creating Active Schools (CAS) framework. The project lasted 3 years and was developed by 14 academic and non-governmental institutions from Spain, Portugal, France, Italy, and the UK. EUMOVE was divided into three phases. In the first phase, several work packages were carried out aimed to ensure the coordination/management of the project activities. In the second phase, seven educational resources strengthened by rigorous scientific research were developed to promote HL from schools. During the last phase, all the resources were disseminated through scientific seminars, workshops with families and teachers, and the online promotion by the non-governmental institutions of each country. The EUMOVE project developed and promoted a smartphone APP, video/activity repository of physically active lessons, active break virtual platform, learning units, and parent/teachers/school-leaders' guidelines to promote physical activity, active commuting, active school playgrounds, healthy diet, and sleep habits. To our knowledge, EUMOVE is the first European project to provide a set of practical tools based on scientific evidence to help schools or future school-wide interventions implement a paradigm shift based on the CAS framework for the promotion of HL. Future research will need to investigate the implementation, effectiveness, and scalability of this proposal. [ABSTRACT FROM AUTHOR]

Background National action plans (NAPs) are key instruments for governing antimicrobial resistance (AMR). In Europe, we can now observe many countries updating their NAPs which raise two key research questions; what substantial modifications are states opting for, and how do they wish to address challenges related to AMR governance in a comparative perspective? Methods Building on a previous analytical classification, we address these two questions by examining data of updated versions of NAPs in 13 European Union member states covering seventeen elements related to AMR governance. Results Our results substantiate the large variation with regard to both substantive issues and governance-related matters. Most tellingly, they highlight the growing importance of the One Health approach in updated versions of NAPs. Our analysis also shows that while substantive issues remain important, One Health and the coordination and collaboration issues it entails are becoming more salient in the second or third generation of NAPs. Conclusions Updated NAPs suggest that EU member states are becoming increasingly knowledgeable on the causes and consequences of AMR and how it needs to be addressed. The enhanced level of knowledge also leads these countries to address the next set of issues and challenges; to improve domestic and international coordination and collaboration. Thus, the revised NAPs present a noticeable development from substantive issues towards governance issues. [ABSTRACT FROM AUTHOR]

This scoping review aims to give a narrative account of existing realist evaluation practices in health promotion. Realist evaluations of health promotion interventions published between 2010 and 2021 were identified by searching five academic databases: Embase, Pubmed, PsycINFO, ScienceDirect and Scopus. A data-charting form was created based on the characteristics of realist evaluation and four core features of an approach appropriate for evaluating health promotion interventions. Seventeen articles met the inclusion criteria. These were classified into two types of studies: those aiming to build an initial program theory and those aiming to test an initial program theory. Our results revealed a great variety of realist evaluation practices and uncovered a growing interest in realist evaluation over the years. Our searches identified a lack of participative practice and capacity-building intention. Our examination of the data collection and analysis methods points to some common practices in using multi-methods. Perspectives on realist evaluation practices and on assessing the effectiveness of health promotion have been identified. [ABSTRACT FROM AUTHOR]

Although it has been show that early detection through mammograms is the most effective way to reduce breast cancer mortality, breast cancer is the leading cause of cancer deaths among women worldwide with survival rates being even lower in low- and middle-income countries as compared to high-income countries. Despite the availability of breast cancer screening programs in Brazil through the public health system, some women do not participate in these programs due to structural and/or inter/intrapersonal barriers. The Community Health Worker (CHW) model is a promising approach to reach these women who have not been reached through other efforts. This paper describes a participatory approach for capacity building of CHWs to promote breast cancer screening among low-income women 50 years of age and older in a southern city in Brazil as a combined effort between two academic institutions, the municipal health care system, and a local non-profit organization. The capacity building program consisted of an 8-hour training focusing on knowledge (e.g. breast cancer and screening) and skills (e.g. communication skills, basic principles of behavior change) to promote breast cancer screening among community members. Pre- and post-test questionnaires assessed changes in breast cancer knowledge and self-perceived knowledge and confidence (N =44). There was a significant increase in objective knowledge regarding breast cancer overall, risk factors, and behavior change strategies between pre- and post-test. There was also a significant increase in self-perceived knowledge and confidence, items related to knowledge about breast cancer, breast cancer early detection methods, and the ability to solve problems between pre- and post-test as well as a significant increase in their confidence to motivate women to get a mammogram. Overall, this study demonstrates the importance of welldeveloped capacity building programs to promote breast cancer screening among health care professionals, especially those with limited educational attainment, such as CHWs. [ABSTRACT FROM AUTHOR]

This paper reports on the health promotion and disease prevention conducted at Australian multi-disciplinary primary health care (PHC) services and considers the ways in which the organizational environment affects the extent and type of health promotion and disease prevention activity. The study involves five PHC services in Adelaide and one in Alice Springs. Four are managed by a state health department and two by boards of governance. The study is based on an audit of activities and on 68 interviews conducted with staff. All the sites undertake health promotion and recognize its importance but all report that this activity is under constant pressure resulting from the need to provide services to people who have health problems. We also found an increased focus on chronic disease management and prevention which prioritized individuals and behavioural change strategies rather than addressing social determinants affecting whole communities. There was little health promotion work that reflected a salutogenic approach to the creation of health. Most activity falls under three types: parenting and child development, chronic disease prevention and mental health. Only the non-government organizations reported advocacy on broader policy issues. Health reform and consequent reorganizations were seen to reduce the ability of some services to undertake health promotion. The paper concludes that PHC in Australia plays an important role in disease prevention, but that there is considerable scope to increase the amount of community-based health promotion which focuses on a salutogenic view of health and which engages in community partnerships. [ABSTRACT FROM AUTHOR]

The Raising Sexually Healthy Children (RSHC) program is a peer-to-peer leadership training program for immigrant parents in Toronto, Canada. It was established in 1998 with the goal of promoting family sex education and parent–child communication. This evaluative study examined the developmental processes and outcomes of the RSHC program to identify the strengths, challenges and insights that can be used to improve the program. It employed a multi-case study approach to compare the RSHC programs delivered in the Chinese, Portuguese and Tamil communities. Data collection methods included focus groups, individual interviews and document analysis. The cross-case analysis identified both common and unique capacity building processes and outcomes in the three communities. In this paper, we report factors that have enhanced and hindered sustainable capacity building at the individual, group/organizational and community levels, and the strategies used by these communities to address challenges common to immigrant families. We will discuss the ecological and synergetic, but time-consuming processes of capacity building, which contributed to the sustainability of RSHC as an empowering health promotion program for immigrant communities. We conclude the paper by noting the implications of using a capacity building approach to promote family health in ethno-racial-linguistic minority communities. [ABSTRACT FROM AUTHOR]