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Background: The combination of four protective lifestyle behaviours (being physically active, a non-smoker, a moderate alcohol consumer and having adequate fruit and vegetable intake) has been estimated to increase life expectancy by 14 years. However, the effect of adopting these lifestyle behaviours on general health, obesity and mental health is less defined. We examined the combined effect of these behaviours on self-rated health, overweight/obesity and depression. Methods: Using data from the Survey of Lifestyle Attitudes and Nutrition (SLÁN) 2007 (), a protective lifestyle behaviour (PLB) score was constructed for 10 364 men and women (>18 years), and representative of the Republic of Ireland adult population (response rate 62%). Respondents scored a maximum of four points, one point each for being physically active, consuming five or more fruit and vegetable servings daily, a non-smoker and a moderate drinker. Results: One-fifth of respondents (20%) adopted four PLBs, 35% adopted three, 29% two, 13% one and 2% adopted none. Compared to those with zero PLBs, those with four were seven times more likely to rate their general health as excellent/very good [OR 6.8 95% CI (3.64–12.82)] and four times more likely to have better mental health [OR 4.4 95% CI (2.34–8.22)]. Conclusions: Adoption of core protective lifestyle factors known to increase life expectancy is associated with positive self-rated health, healthier weight and better mental health. These lifestyles have the potential to add quality and quantity to life. [ABSTRACT FROM PUBLISHER]

Introduction: Despite the evidence supporting the value of digital supports for enhancing youth mental health services, there is a lack of guidance on how best to engage with young people in coproduction processes during the design and evaluation of these technologies. User input is crucial in digital mental health, especially for disadvantaged, vulnerable and marginalised young people as they are often excluded from coproduction. A scoping review of international literature written in English will explore the coproduction processes with marginalised young people in digital mental health supports, from mental health promotion to targeted interventions. The review is guided by the research question: what are the most appropriate coproduction processes for engaging young people, especially marginalised young people, in the different stages of designing and evaluating digital mental health supports? The review aims to map and summarise the evidence, inform the overall research project and address the knowledge gaps., Methods and Analysis: The scoping review uses Arksey and O'Malley's framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews. From 22-24 October 2023, PubMed, Scopus, EBSCO, ASSIA, Web of Science, Ovid MEDLINE, Cochrane database, Embase, Google Scholar, ProQuest, OAIster and BASE will be systematically searched. Papers from 2021 onwards with a range of study designs and evidence that illustrate engagement with marginalised young people (aged 16-25) in the design, implementation and evaluation of digital technologies for young people's mental health will be considered for inclusion. At least two reviewers will screen full texts and chart data. The results of this review will be summarised quantitatively through numerical counts of included literature and qualitatively through a narrative synthesis., Ethics and Dissemination: Ethical approval is not required. Results will be disseminated through publications in peer-reviewed journals., Trial Registration Number: This scoping review protocol has been registered with the Open Science Framework (https://osf.io/9xhgv)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Effective school-based mental health promotion and prevention interventions in low-and middle-income countries (LMICs) can positively impact the mental health and well-being of large numbers of young people. This scoping review aimed to investigate the implementation of effective mental health promotion and prevention interventions in LMIC schools. A scoping review of the international literature was conducted and followed the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews guidelines. Medline, PsycInfo, Scopus, Embase, CINAHL and Cochrane were searched for peer-reviewed literature published from 2014 to 2022. PsycExtra, Google Scholar and the websites of key organisations were searched for relevant grey literature. Study selection focussed on mental health promotion interventions, including the development of social and emotional skills and mental health literacy, and prevention interventions, including anti-bullying and skill-based interventions for "at-risk" students. Twenty-seven studies evaluating 25 school-based interventions in 17 LMICs were included in the review. Fifteen interventions were developed in the implementing country and 10 were adapted from high-income countries (HICs) or other settings. Findings from the studies reviewed were generally positive, especially when interventions were implemented to a high quality. Universal life-skills interventions were found to increase social and emotional skills, decrease problem behaviours and positively impact students' mental health and well-being. Mental health literacy interventions increased mental health knowledge and decreased stigma among students and school staff. Outcomes for externally facilitated anti-bullying interventions were less positive. All 19 effective studies reported on some aspects of programme implementation, and 15 monitored implementation fidelity. Eleven studies outlined the programme's underpinning theoretical model. Only four studies reported on the cultural adaptation of programmes in detail. Including young people in the adaptation process was reported to facilitate natural cultural adaptation of programmes, while input from programme developers was considered key to ensuring that the core components of interventions were retained. The review findings indicate increasing evidence of effective mental health interventions in LMIC schools. To facilitate the sustainability, replication and scaling-up of these interventions, greater attention is needed to reporting on intervention core components, and the processes of implementation and cultural adaptation in the local setting., Competing Interests: The authors declare none., (© The Author(s) 2024.)

The Political Declaration from the United Nations High-Level Meeting on Universal Health Coverage: Moving Together to Build a Healthier World (2019) provided important reaffirmation of health as a precondition for sustainable development and equity, as well as of the role for primary care as a cornerstone of universal health coverage. Health promotion, prevention and sustainable healthcare go hand in glove. Health promotion can enable more effective use of health resources by reducing demand for expensive health services and reducing hospital admissions. Promoting mental and physical health, and addressing health literacy and the social determinants of health, enables governments and departments of health to (i) empower citizens and communities to take control of their health, and (ii) better support innovative and financially sustainable healthcare. Without the bedrock underpinning of effective health promotion, treasuries and health systems will struggle to meet the rising costs and burden of ill health.

The importance of intersectoral collaboration and partnership working in mental health promotion, together with the requisite competencies for effective collaboration, is widely acknowledged. This Delphi-based qualitative study examined how intersectoral collaboration and partnership work are constructed and adopted in mental health promotion practice. Descriptive data from a Delphi panel of mental health promotion practitioners working in the health sector (n = 32) were used as a data source. Thematic analysis was used to analyze the data. Applying the theory of collaborative advantage, eight themes of collaboration advantage and the related competencies were identified: management structure, leadership, communication and language, common aims, working processes, resources, trust, and commitment and determination. The themes capture the competencies required to influence and work with others to improve the mental health and wellbeing of individuals and communities. The identified theme areas can be used to inform education and training and capacity building for professional practice in mental health promotion. Future research is needed to explore other possible collaborative advantage themes in mental health promotion practice and the competencies required to facilitate effective partnerships across sectors. Further investigations are also needed on the identified theme areas in order to develop and guide capacity building and training in mental health promotion., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Community engagement is crucial for controlling disease outbreak and mitigating natural and industrial disasters. The COVID-19 pandemic has reconfirmed the need to elevate community engagement to build equity, trust and sustained action in future health promotion preparedness strategies. Using the health promotion strategy of strengthening community action enhances the opportunity for better outcomes. There is, therefore, a need to improve our understanding of community engagement practices during crises, scale-up good community engagement initiatives, and improve and sustain people-centered approaches to emergency responses. This paper presents five case studies from the United States, Singapore, Sierra Leone, Kenya and South Africa that demonstrate the potential strengths that can be nurtured to build resilience in local communities to help mitigate the impact of disasters and emergencies. The case studies highlight the importance of co-developing relevant education and communication strategies, amplifying the role of community leaders, empowering community members to achieve shared goals, assessing and adapting to changing contexts, pre-planning and readiness for future emergencies and acknowledgement of historic context., (© The Author(s) 2021. Published by Oxford University Press.)

Transformative health promotion actions are needed to achieve health equity and the Sustainable Development Goals (SDGs), advance human and planetary wellbeing, and ensure that we build back better post-COVID-19. Health policies and systems need to be aligned with the values, principles and strategies of health promotion and investment made in strengthening essential health promotion functions. This paper considers how transformative health promotion can be advanced, by reflecting critically on what progress needs to be made and the structures and processes that are required to strengthen health promotion at a systems level. Progress in implementing health promotion is variable, and there is a general lack of investment in developing the necessary health promotion systems for substantive progress to be made. Key enablers and system requirements for comprehensive health promotion are examined, including the following critical elements: (i) effective advocacy for the concept and practice of health promotion; (ii) enabling policy structures for universal health promotion actions on a cross-sectoral basis; (iii) effective implementation systems, support mechanisms and workforce capacity for multisectoral health promotion action; (iv) investment in innovative research methods and knowledge translation to inform transformative health promotion approaches. In strengthening capacity to implement transformative health promotion actions, political will needs to be mobilized to ensure that dedicated and sustainable funding is made available, and the organizational and workforce capacity to deliver effective health promotion interventions is in place. The International Union for Health Promotion and Education (IUHPE) plays a central role in advancing transformative health promotion through mobilising and supporting its global members and partners in strengthening health promotion systems.

This commentary reports on the development and implementation of the competency-based IUHPE Health Promotion Accreditation System in the context of workforce capacity as a key activity of the International Union for Health Promotion and Education (IUHPE). The process of developing the System is described, including how it built on, and added to, international research and experience in competency-based approaches to health promotion. An overview of how the System works, its current status and future plans, is presented. Evidence of the positive impact of the System to date, in particular in the context of health promotion education, is considered.

Irish Travellers are a minority ethnic group who experience a high prevalence of mental health problems and a rate of suicide six times higher compared to the general Irish population. This study explores Travellers' perceptions of mental health and its determinants. It also identifies the most relevant factors for promoting positive mental health and wellbeing among this socially excluded group. A descriptive qualitative approach was employed to explore participants' perceptions of mental health and mental health needs. Four focus groups were conducted with a total of 25 adult members of the Travelling community. Inductive thematic analysis was undertaken to identify and interpret the main themes emerging from the participants' responses. Travellers conceptualize mental health mostly in negative terms and showed a lack of awareness of the concept of positive mental health. Travellers showed a strong awareness of the social determinants of mental health identifying employment, better education, suitable accommodation, a reduction of discrimination and improved trust and social cohesion as important determinants that need to be addressed to improve their mental health status. The centrality of cultural identity and social-emotional skills emerged as key factors in promoting positive mental health among Travellers. The findings suggest that Travellers' mental health is multidimensional and requires a socio-ecological approach that addresses the wider determinants of health. Community mental health promotion initiatives should focus on reducing discrimination, enhancing social and emotional wellbeing and self-esteem, improvement of living conditions, reduced mental health stigma, and the promotion of Traveller culture and positive self-identity., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

As a setting where children and adolescents live and learn, linked to the family and embedded within the wider community, schools have an important influence on every student's health. Many health interventions have used schools as a platform, often for standalone programmatic initiatives to reduce health risks, and sometimes for more comprehensive approaches, but the interventions, uptake, and sustainability are generally disappointing. Evidence shows that, to improve health and to reduce inequality, all students must attend school from a young age and for as long as possible, and their educational success therein must be maximised. Thus, beyond educational benefits, schools are also important for health. Coherence between each school's policies, structures and systems, human resources, and practices is required to advance both academic and health outcomes. Beyond simply implementing ready-made programmes into schools, health professionals can position themselves as catalysts for structural change as they have many opportunities to advocate for, and participate in, the intersectoral implementation of reforms and innovations in school systems to promote the health of all students., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Globally, health systems are faced with the difficult challenge of how to get the best results with the often limited number of health workers available to them. Exacerbating this challenge is the task of meeting ever-changing needs of service users and managing unprecedented technological advances. The process of matching skills to changing needs and opportunities is termed task shifting. It involves questioning health service goals, what health workers do, asking if it can be done in a better way, and implementing change. Task shifting in healthcare is often conceptualised as a process of transferring responsibility for 'simple' tasks from high-skilled but scarce health workers to those with less expertise and lower pay, and predominantly viewed as a means to reduce costs and promote efficiency. Here we present a position paper based on the work and expertise of the European Commission Expert Panel on Effective ways of Investing in Health. It contends that this is over simplistic, and aims to provide a new task shifting framework, informed by relevant evidence, and a series of recommendations. While far from comprehensive, there is a growing body of evidence that certain tasks traditionally undertaken by one type of health worker can be undertaken by others (or machines), in some cases to a higher standard, thus challenging the persistence of rigid professional boundaries. Task shifting has the potential to contribute to health systems strengthening when accompanied by adequate planning, resources, education, training and transparency., Competing Interests: Declaration of Competing Interest None declared, (Copyright © 2020 Elsevier B.V. All rights reserved.)

School-based social and emotional learning (SEL) programs can be effective in producing positive outcomes for students. However, when the implementation quality is poor, these programs often lose their effectiveness and fail to produce the expected positive outcomes. The current study evaluates a school-based SEL program for 15-18-year-olds in Ireland by determining the impact of implementation quality on program outcomes. The study also examines the effects on outcomes of different implementation dimensions including Dosage, Adherence, Quality of Delivery, and Participant Responsiveness. Employing a cluster randomized controlled trial design, this study collected student outcome data ( n = 675) from 32 disadvantaged schools across three time points (pre-, post-, 12-month follow-up) and compared these data across three treatment groups (high-implementation, low-implementation, and control). Linear mixed models (LMM) were used to determine the relationships between the implementation data and student outcome data longitudinally. The findings revealed that the positive effects of the program were only observed with the high-, but not the low-implementation group (reduced suppression of emotions ( p = 0.049); reduced avoidance coping ( p = 0.006); increased social support coping ( p = 0.009); reduced levels of stress ( p = 0.035) and depressive symptoms ( p = 0.025). The comparison of implementation dimensions revealed that only Quality of Delivery had a significant effect on all of the tested outcomes. This study highlights the importance of high-quality implementation in producing positive outcomes and supports the need to evaluate implementation using multiple dimensions.

School-based social and emotional learning (SEL) programs have been shown to be effective in producing positive outcomes for adolescents. However, variability in implementation quality can have a negative impact on these program effects. The aim of this current study is to examine the variability in implementation quality for schools implementing the MindOut program and to identify factors that were likely to contribute to this variability. Employing a mixed methods approach, quantitative and qualitative implementation data were collected from teachers (n = 16) and students (n = 280) who participated in the MindOut program. Quantitative indicators were used to score schools' implementation quality across four dimensions (dosage, adherence/fidelity, quality of delivery and participant responsiveness), and these were averaged to determine overall level of implementation (high/low). Qualitative data identified factors that contributed to implementation quality, and factors were then analyzed in accordance with the schools' implementation level grouping. Findings indicated that variability in implementation quality existed both between and within schools. A total of eight schools were assigned as high implementers and another eight as low implementers. Influencing factors were categorized into five themes: (i) program factors, (ii) participant factors, (iii) teacher factors, (iv) school contextual factors, and (v) organizational capacity factors. Several differences between high and low implementers were found in relation to these influencing factors. The findings contribute to the evidence on implementation quality in schools by advancing knowledge on measuring implementation quality across multiple dimensions and informants successfully. These findings can also inform practitioners of the main influencing factors in schools so that strategies can be developed to optimize implementation quality in the future.

Vaccination is one of the most cost-effective public health interventions. However, the EU is facing increasing outbreaks of vaccine preventable diseases, with some fatal cases of measles. This paper reviews the main factors influencing vaccination uptake, and assesses measures expected to improve vaccination coverage. Obstacles to vaccination include concerns about vaccine safety and side effects, lack of trust, social norms, exposure to rumours and myths, and access barriers. Responses fall into three broad categories. Regulation, including the introduction of mandatory vaccination, can be justified but it is important to be sure that it is an appropriate solution to the existing problem and does not risk unintended consequences. Facilitation involves ensuring that there is an effective vaccination programme, comprehensive in nature, and reducing the many barriers, in terms of cost, distance, and time, to achieving high levels of uptake, especially for marginalised or vulnerable populations. Information is crucial, but whether in the form of public information campaigns or interactions between health workers and target populations, must be designed very carefully to avoid the risk of backfire. There is no universal solution to achieving high levels of vaccine uptake but rather a range or combinations of options. The choice of which to adopt in each country will depend on a detailed understanding of the problem, including which groups are most affected., Competing Interests: Declaration of Competing Interest Luigi Siciliani: I have no declarations of interest. Claudia Wild: I have no declarations of interest. Martin McKee: I have no declarations of interest. Dionne Kringos: I have no declarations of interest. Margaret M. Barry: I have no declarations of interest. Pedro Pita Barros: I have no declarations of interest. Jan De Maeseneer: I have no declarations of interest. Liubove Murauskiene: I have no declarations of interest Walter Ricciardi: I have no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This paper reports on a case study that explored the broader contextual factors influencing the implementation of the CompHP Core Competencies at a country level in Ireland and Italy between 2011 and 2018. The sample comprised key informants who were Health Promotion experts and were knowledgeable about how the competencies had been used in their country. These experts formed National Reference Groups that guided the research process in each country and helped identify additional key informants. Qualitative methods were utilized consisting of a desk review and semi-structured interviews. The data from each country were analyzed separately using a thematic analysis approach, with the findings then compared and reviewed by the National Reference Groups. A total of 26 interviews were completed (13 in each country). The findings show that both the focus and rate of progress of implementing the competencies differed across the two countries and that this reflected their levels of Health Promotion infrastructure and capacity development. A lack of awareness of the competencies was identified as a major limiting factor in implementation in both countries, of particular concern in relation to employers and decision-makers. While the case study focused on implementing the competencies in two European countries, there are insights from their experience that can inform implementation in other countries. The study also begins to address the gap in empirical evidence on the use and impact of Health Promotion competencies and the factors that influence their implementation.

Organisational Health Literacy (OHL)-interventions are needed to overcome health inequality. OHL-interventions have successfully identified communication barriers at the organisational level, but evidence is limited on the extent to which this leads to sustainable organisational change. This study aims to assess the implementation fidelity, moderators (barriers and facilitators), and long-term impact of OHL-interventions in hospitals in Ireland and The Netherlands. We used a longitudinal mixed-methods approach to assess two similar OHL-interventions in one Irish and three Dutch hospitals. The OHL-interventions concerned the improvement of navigation and implementation of health literacy-friendly communication throughout organisations. Participants were 24 hospital employees and 40 older adults who use hospital services. At six, eight, and eighteen months, we assessed the level of implementation, barriers and facilitators, and impact through questionnaires and in-depth semi-structured interviews. After older adults and professionals had identified a number of communication problems, we found that professionals had successfully implemented OHL-interventions to promote navigation and comprehensible communication. Limited resources and variation in organisational structures and procedures were perceived as barriers to implementation. The participation of service users, leadership support, and a stepwise implementation of interventions were perceived to facilitate implementation. In the long term, the OHL-interventions led to system-wide improvements, as shown by better embedding of health literacy policies, enhanced patient engagement, provision of plain language training and comprehensible information. Findings were similar for the two countries. Embedded OHL-interventions resulted in sustainable and system-wide health literacy changes in all four hospitals. Following implementation, OHL-interventions have the potential to promote health equity and empowerment among health service users.

Introduction . Competency-based approaches have been developed in health promotion over the past four decades but, to date, there has been limited focus on the evaluation of their use and impact. In 2016, 5 years after publication of the CompHP Core Competencies Framework for Health Promotion, an evaluation of their use and impact across the health promotion community in Europe was initiated. As a first step in this process, a scoping review of the literature was undertaken which aimed to explore the current status of health promotion competencies, with a particular focus on developments in Europe and ascertain what evidence exists about the use and impact of health promotion competencies on practice, education, and training. Method . Searches of the electronic databases and gray literature were conducted between February 2016 and December 2017. The searches were limited to sources published in English between 2009 and 2017, which focused on health promotion competencies. Results . A total of 39 sources were identified for in-depth analysis, of which 26 were theoretical papers and 13 were papers reporting on empirical studies. Many of the sources presented health promotion competency frameworks or described their development. Some examples of the use of health promotion competencies were found but only two instances of their evaluation were identified. Conclusions . The review found few empirical studies on the implementation and use of health promotion competencies and highlights a lack of evaluation studies on their impact on practice, education, and training.

Despite the importance of subjective well-being (SWB) for students' mental and physical health, there is a lack of longitudinal studies investigating the development of SWB in adolescents and what factors are associated with it over time. The present study seeks to shed further light on this question by investigating adolescents longitudinally. A sample of German academic tracks students ( N = 476) from five schools were followed longitudinally over a time period of 30 months with four measurement points from Grade 11 to Grade 13. Alongside the longitudinal assessment of SWB (mood and life satisfaction), a range of other factors were also assessed at t1 including; demographic factors (sex, age, socio-economic status (HISEI)), intelligence, grades (report cards provided by the schools), personality (neuroticism, extraversion) and perceived parental expectations and support. Latent growth curve models were conducted to investigate the development of SWB and its correlates. On average, mood and life satisfaction improved at the end of mandatory schooling. However, students significantly differed in this pattern of change. Students' life satisfaction developed more positively if students had good grades at t1. Furthermore, even though introverted students started with lower life satisfaction at t1, extraverts' life showed greater increases over time. Changes in mood were associated with socio-economic background; the higher the HISEI the more positive the change. As social comparisons in school performance are almost inevitable, schools should intervene to buffer the influence of school grades on students' SWB.

School-based social and emotional learning programs aim to provide students with the skills they need to deal with life challenges, thereby enhancing their social and emotional wellbeing, academic outcomes, and reducing their risk of mental health difficulties. While there is a robust evidence base on the effectiveness of these programs originating from the US, there is a relative paucity of research on how these programs impact young people in other county contexts, especially for older adolescents and those at higher risk. This study sets out to address this research gap by evaluating the effectiveness of a social emotional learning program designed for older adolescents in Ireland, the MindOut program. MindOut is a universal school-based social and emotional learning program designed for older adolescents in Ireland which was developed based on a common elements approach underpinned by CASEL's framework. Employing a cluster randomized-controlled trial, data on social and emotional skills, academic performance and mental health outcomes were collected from students (n = 497; 51.1% female) ages 15-18 years in 32 disadvantaged schools. There were significant improvements in intervention students' social and emotional skills including, reduced suppression of emotions (p = 0.035), use of more positive coping strategies [reduced avoidance coping p = < 0.001) and increased social support coping p = 0.044)]. Improvements in mental health and wellbeing were also found with significantly reduced levels of stress (p = 0.017) and depressive symptoms (p = 0.030) as well as reduced anxiety scores for females students (p = 0.044). These short-term evaluation findings support the positive impact of school-based social and emotional learning programs, such as MindOut, when designed to be both age and culturally appropriate and delivered to older adolescents in disadvantaged schools.

A Health in All Policies approach requires creating and sustaining intersectoral partnerships for promoting population health. This scoping review of the international literature on partnership functioning provides a narrative synthesis of findings related to processes that support and inhibit health promotion partnership functioning. Searching a range of databases, the review includes 26 studies employing quantitative (n = 8), qualitative (n = 10) and mixed method (n = 8) designs examining partnership processes published from January 2007 to June 2015. Using the Bergen Model of Collaborative Functioning as a theoretical framework for analyzing the findings, nine core elements were identified that constitute positive partnership processes that can inform best practices: (i) develop a shared mission aligned to the partners' individual or institutional goals; (ii) include a broad range of participation from diverse partners and a balance of human and financial resources; (iii) incorporate leadership that inspires trust, confidence and inclusiveness; (iv) monitor how communication is perceived by partners and adjust accordingly; (v) balance formal and informal roles/structures depending upon mission; (vi) build trust between partners from the beginning and for the duration of the partnership; (vii) ensure balance between maintenance and production activities; (viii) consider the impact of political, economic, cultural, social and organizational contexts; and (ix) evaluate partnerships for continuous improvement. Future research is needed to examine the relationship between these processes and how they impact the longer-term outcomes of intersectoral partnerships., (© The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The rapid growth in the use of online technologies among youth provides an opportunity to increase access to evidence-based mental health resources. The aim of this systematic review is to provide a narrative synthesis of the evidence on the effectiveness of online mental health promotion and prevention interventions for youth aged 12-25 years. Searching a range of electronic databases, 28 studies conducted since 2000 were identified. Eight studies evaluating six mental health promotion interventions and 20 studies evaluating 15 prevention interventions were reviewed. The results from the mental health promotion interventions indicate that there is some evidence that skills-based interventions presented in a module-based format can have a significant impact on adolescent mental health, however, an insufficient number of studies limits this finding. The results from the online prevention interventions indicate the significant positive effect of computerized cognitive behavioral therapy on adolescents' and emerging adults' anxiety and depression symptoms. The rates of non-completion were moderate to high across a number of studies. Implementation findings provide some evidence that participant face-to-face and/or web-based support was an important feature in terms of program completion and outcomes. Additional research examining factors affecting exposure, adherence and outcomes is required. The quality of evidence across the studies varied significantly, thus highlighting the need for more rigorous, higher quality evaluations conducted with more diverse samples of youth. Although future research is warranted, this study highlights the potential of online mental health promotion and prevention interventions in promoting youth wellbeing and reducing mental health problems.

Schools are recognized as one of the most important settings for promoting social and emotional well-being among children and adolescents. This clustered randomized controlled trial evaluated Zippy's Friends, an international school-based emotional well-being programme, with 766 children from designated disadvantaged schools. The purpose of this study was to evaluate the immediate and long term impact of the programme and to determine the impact of implementation fidelity on programme outcomes. Teachers reported emotional literacy outcomes using the Emotional Literacy Checklist, and emotional and behavioural outcomes using the Strengths and Difficulties Questionnaire. Controlling for the hierarchical structure of the data, path analysis using structural equation modelling revealed that the programme had a significant positive impact on the children's emotional literacy scores including significant improvements in the subscale scores of self-awareness (P < 0.001), self-regulation (P < 0.01), motivation (P < 0.001) and social skills (P < 0.001) at post-intervention. These results were maintained at 12-month follow-up (P < 0.01). The programme, however, did not have a significant impact on children's emotional and behavioural problems. Analysis of programme fidelity indicated that high fidelity was directly related to improved emotional literacy scores at post-intervention., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The CompHP Project on Developing Competencies and Professional Standards for Health Promotion in Europe was developed in response to the need for new and changing health promotion competencies to address health challenges. This article presents the process of developing the CompHP Core Competencies Framework for Health Promotion across the European Union Member States and Candidate Countries., Method: A phased, multiple-method approach was employed to facilitate a consensus-building process on the development of the core competencies. Key stakeholders in European health promotion were engaged in a layered consultation process using the Delphi technique, online consultations, workshops, and focus groups., Findings: Based on an extensive literature review, a mapping process was used to identify the core domains, which informed the first draft of the Framework. A consultation process involving two rounds of a Delphi survey with national experts in health promotion from 30 countries was carried out. In addition, feedback was received from 25 health promotion leaders who participated in two focus groups at a pan-European level and 116 health promotion practitioners who engaged in four country-specific consultations. A further 54 respondents replied to online consultations, and there were a number of followers on various social media platforms. Based on four rounds of redrafting, the final Framework document was produced, consisting of 11 core domains and 68 core competency statements., Conclusions: The CompHP Core Competencies Framework for Health Promotion provides a resource for workforce development in Europe, by articulating the necessary knowledge, skills, and abilities that are required for effective practice. The core domains are based on the multidisciplinary concepts, theories, and research that make health promotion distinctive. It is the combined application of all the domains, the knowledge base, and the ethical values that constitute the CompHP Core Competencies Framework for Health Promotion.

Background: The CompHP Pan-European Accreditation Framework for Health Promotion was developed as part of the CompHP Project that aimed to develop competency-based standards and an accreditation system for health promotion practice, education, and training in Europe., Method: A phased, multiple-method approach was employed to facilitate consensus building with key stakeholders in health promotion across Europe. Consultation processes included focus and discussion groups at European and country levels, an online survey, a web-based consultation, and testing in academic and practice settings. Successive drafts of the Framework (a total of five) were revised based on the feedback from each consultation stage., Findings: A total of 405 participants from 29 of the 34 target countries contributed to the consultation process. The overall response to the Framework was positive, with negative feedback focusing mainly on the barriers that may impact on its implementation., Conclusions: The CompHP Pan-European Accreditation Framework for Health Promotion provides an agreed system to promote quality assurance and competence for health promotion practice and education in Europe. The Framework, which builds on the CompHP Core Competencies and Professionals Standards, outlines the systems and processes for the accreditation of health promotion practitioners and health promotion education and training by accrediting organizations at national and European levels.

Background: Mental health problems are disproportionately higher amongst homeless people. Many barriers exist for homeless people with mental health problems in accessing treatment yet little research has been done on service provision and quality of care for this group. The aim of this paper is to assess current service provision and identify barriers to care for homeless people with mental health problems in 14 European capital cities., Method: Two methods of data collection were employed; (i) In two highly deprived areas in each of the 14 European capital cities, homeless-specific services providing mental health, social care or general health services were assessed. Data were obtained on service characteristics, staff and programmes provided. (ii) Semi-structured interviews were conducted in each area with experts in mental health care provision for homeless people in order to determine the barriers to care and ways to overcome them., Results: Across the 14 capital cities, 111 homeless-specific services were assessed. Input from professionally qualified mental health staff was reported as low, as were levels of active outreach and case finding. Out-of-hours service provision appears inadequate and high levels of service exclusion criteria were evident. Prejudice in the services towards homeless people, a lack of co-ordination amongst services, and the difficulties homeless people face in obtaining health insurance were identified as major barriers to service provision., Conclusions: While there is variability in service provision across European capital cities, the reported barriers to service accessibility are common. Homeless-specific services are more responsive to the initial needs of homeless people with mental health problems, while generic services tend to be more conducive to long term care. Further research is needed to determine the effectiveness of different service delivery models, including the most effective coordination of homeless specific and generic services.

Objectives: This paper examines the relationships between indicators of positive and negative dimensions of mental health, social well-being and physical health., Methods: The paper reports on data collected in the third National Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007), a cross-sectional survey conducted with a representative sample of 10,364 Irish adults. The survey included measures of positive mental health and non-specific psychological distress from the SF-36 questionnaire, together with measures of social well-being, subjective health, and selected health behaviours., Results: Positive mental health is predicted by lower levels of loneliness and higher levels of social support. Better self-rated health, positive health behaviours and lower GP consultation rates are associated with higher levels of positive mental health. Lower levels of social well-being, were found to be the strongest predictors of negative mental health., Conclusions: Social well-being and health behaviours correlate with both positive and negative mental health. These findings highlight the need to endorse comprehensive approaches to population mental health promotion. The inclusion of both positive and negative mental health indicators in future population health surveys is supported by the findings.

Intersectoral partnerships have been identified as a useful mechanism for addressing the health challenges that face society. In theory, partnerships achieve synergistic outcomes that amount to more than can be achieved by individual partners working on their own. This study aimed to identify key factors that influence health promotion partnership synergy. Data were collected from 337 partners in 40 health promotion partnerships using a postal survey. The questionnaire incorporated a number of multidimensional scales designed to assess the contribution of factors that influence partnership synergy. New validated scales were developed for synergy, trust, mistrust and power. Pearson's correlations and multiple regression analysis were used to identify the significance of each factor to partnership synergy. Trust, leadership and efficiency were shown to be the most important predictors of partnership synergy. Synergy is predicated on trust and leadership. Trust-building mechanisms need to be built into the partnership forming stage and this trust needs to be sustained throughout the collaborative process. We need to develop systems where the best leaders are put forward for intersectoral partnerships. This should be consistent across all sectors and organizations.

The interest in competencies, standards, and quality assurance in the professional preparation of public health professionals whose work involves health promotion and health education dates back several decades. In Australia, Europe, and North America, where the interest in credentialing has gained momentum, there have been rapidly evolving efforts to codify competencies and standards of practice as well as the processes by which quality and accountability can be ensured in academic professional preparation programs. The Galway Consensus Conference was conceived as a first step in an effort to explore the development of an international consensus regarding the core competencies of health education specialists and professionals in health promotion and the commonalities and differences in establishing uniform standards for the accreditation of academic professional preparation programs around the world. This article describes the purposes, objectives, and process of the Galway Consensus Conference and the background to the meeting that was convened.

This paper reports the outcome of the Galway Consensus Conference, an effort undertaken as a first step toward international collaboration on credentialing in health promotion and health education. Twenty-nine leading authorities in health promotion, health education, and public health convened a 2-day meeting in Galway, Ireland, during which the available evidence on credentialing in health promotion was reviewed and discussed. Conference participants reached agreement on core values and principles, a common definition, and eight domains of core competency required to engage in effective health promotion practice. The domains of competency are catalyzing change, leadership, assessment, planning, implementation, evaluation, advocacy, and partnerships. The long-term aim of this work is to stimulate a global dialogue that will lead to the development and widespread adoption of standards and quality assurance systems in all countries to strengthen capacity in health promotion, a critical element in achieving goals for the improvement of global population health.

This article was prepared to inform the deliberations of the Galway Consensus Conference by providing a common and global reference point for the discussion of terminology and key conceptual and professional issues in the credentialing of health education and health promotion specialists. The article provides a review of the terminology that is currently employed across different countries in defining health education and health promotion as well as health educator and health promotion specialist. The terminology used to describe concepts in professional credentialing of health education and health promotion specialists and the scope of professional responsibilities of such specialists, including the terms professional competencies, professional standards, and accreditation, are also reviewed. Finally, key unresolved issues are identified and discussed from a global perspective. The article concludes that despite differences in terminology in the definitions of roles and responsibilities, health education and health promotion are conceptually more similar than different across countries.

This paper explores the perceptions of illness causation and health inequalities of Travellers, an ethnic minority group who experience considerable social and health disadvantages in Ireland. In order to allow for subjective meanings to emerge, a qualitative methodology with purposive sampling was employed. Participants in the study were invited to respond to a vignette in a focus group setting. Forty-one Traveller women were recruited to the focus groups through community projects or adult education initiatives. The study not only illustrates the complexity of lay perceptions of ill-health and health inequalities, but raises important questions about the prevalence of depression and of domestic violence in the Travelling community. These Traveller women were very willing to discuss the structural factors that contributed to their health status, attributing ill-health to social and environmental factors, such as accommodation, hardship and discrimination. Further, they broadly rejected behavioural explanations of the heart disease described in the vignette. Traveller women's understandings of health and the factors that determine it are deeply embedded in the social context of their lives and their ethnic identity. These findings are discussed in the context of social identity and ethnicity, and contribute to theoretical debates about the role of that identity in recognising inequality. The study revealed that Traveller women see many shortcomings in health service provision. They need service provision to be culturally sensitive and responsive to their needs.