Health Promotion Practice最新文献

Eastern North Carolina (ENC) residents have higher rates of type 2 diabetes, lower life expectancy, less physical activity (PA), and higher food insecurity than the rest of North Carolina. Black individuals in ENC may face health disparities due to systemic and societal barriers to PA and a nutritious diet; modifiable behaviors that may improve overall health. The purpose of this study was to explore the lived experiences of rural Black women who live in ENC and who meet the criteria for overweight and obesity in the context of PA and healthful diet promotion. Photo-elicitation was used to explore this population's specific experiences with PA and nutrition, including barriers and facilitators, through photos and focus groups. Participants (N = 14; 43.5 ± 8.7 years old; body mass index (BMI) = 34.6 ± 5.9 kg/m²) were Black women in the rural Southeastern United States. Recruitment strategies included community outreach, listservs, social media, and word of mouth. Using photos submitted, our team conducted focus groups and completed content analyses to identify themes to tailor the development of a future health promotion program for Black women. Overarching themes were (a) Reframing the Mindset, (b) Accountability, and (c) Cultural Relativity. Findings demonstrate that Black women living in rural areas desire culturally relevant PA and nutrition programming focusing on healthy lifestyles versus weight loss. Future practice and research should utilize these findings to develop and examine the health impact of a health promotion program designed for Black women by Black women on PA levels, diet quality, and quality of life.

Efforts to effect racial health disparity (RHD) policy change are urgent, necessary, and subject to a key barrier: defensiveness among White privileged audiences. Within the literature to date, such defensiveness is under-investigated, and when examined, is typically conceived of as an individual cognitive outcome-a message effect-rather than a communication interaction. Yet policy change advocacy efforts, ranging from community organizing to change campaigns, necessitate communication interactions between advocates and privileged policy change audiences, such as neighborhood groups or policymakers themselves. This defensiveness conceptualization, focused on individual cognitions, therefore limits our understanding of interactive communication barriers in RHD policy advocacy processes. To address this limitation, our research conceives of defensiveness using the privileged identity exploration (PIE) model, developed by Watt in 2007, which posits that defensiveness strategies are used as part of an interactive communication process when people are asked to reflect on their own privilege. Defensiveness strategies, as described by Watt and colleagues in 2021 and 2023, are normal communicative reactions to protect one's self-identity from threatening information; the PIE models eight such strategies. RHD information invokes racial privilege, therefore eliciting defensiveness. Using a thematic analysis of semi-structured qualitative interviews with White young adults from the Chicago (U.S.) area (N = 27), we identify defensiveness strategies relative to COVID-19 RHDs. Using the PIE as a lens to understand the data, we find some strategies lacking, some similar but differently nuanced, and identify a novel strategy among our participants, suggesting message tailoring opportunities. We describe implications for future research and practice.

During the past decade, public libraries have been framed as key health promotion partners for everything from telemedicine to the opioid crisis. This study's goal was to evaluate the impacts of health promotion initiatives involving public libraries as collaborators. Using preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a search of three databases (PubMed, CINAHL Complete, and Library and information science abstracts (LISA)) for articles written in English referencing "health" and "public libraries" returned 985 unique citations, of which 67 papers were selected for review, based on the criteria of being peer-reviewed articles on health initiatives involving public libraries. All studies were published between 1957 and 2023, with 88% published in the 2000's, and 76% conducted in the United States. Most studies consisted of descriptive accounts of health promotion initiatives, with minimal reporting of outcome measures for the populations targeted. Better understanding the impacts of health promotion initiatives involving public libraries requires more rigorous assessment mechanisms, and the long-term success of these partnerships depends on stronger and sustained linkages between those working in health and those working in libraries, particularly public libraries.

Shifts in colorectal cancer (CRC) screening, including guidance from the United States Preventive Services Task Force lowering the recommended screening age from 50 to 45 years in 2021, may leave gaps in clinicians' understanding of related barriers and beliefs held by patients. This study uses the National Institute on Minority Health and Health Disparities Research Framework to analyze factors influencing CRC screening uptake among individuals aged 44-54 years and identifies how gaps in knowledge intersect with screening barriers, particularly as they relate to the health care system and sociocultural environment. In 2022, the Centers for Disease Control and Prevention's Division of Cancer Prevention and Control's Screen for Life campaign conducted 12 online focus groups to gather audience insights and test materials. Researchers conducted the focus groups in English and Spanish with individuals aged 44-54 years who had never had CRC and had never received a CRC screening. Focus groups gauged participants' knowledge, awareness, and behavior pertaining to CRC and CRC screening. Results show that participants often lacked knowledge about risk factors and screening modalities and appreciated emotionally resonant communication approaches that addressed gaps in knowledge using demystifying, destigmatizing language and representative imagery. Findings also indicate a need to help patients overcome barriers related to insurance coverage, treatment options, and discrimination. Results may guide the development of future health promotion efforts and empower health care providers to approach conversations with their patients with additional context regarding patients' needs.

BackgroundDiabetes affects millions of people in the United States and poses significant health and economic challenges, but it can be prevented or managed through health behavior changes. Such changes might be aided by voice-activated personal assistants (VAPAs), which offer interactive and real-time assistance through features such as reminders, or obtaining health information. However, there are little data on interest and acceptability of integrating VAPAs into programs such as the National Diabetes Prevention Program (National DPP) or diabetes, self-management, education, and support (DSMES) services.MethodsWe conducted individual and small-group semi-structured interviews of National DPP and DSMES staff and program participants. We used rapid-turnaround qualitative thematic analysis to identify emerging themes using an adapted version of the Consolidated Framework for Implementation Research (CFIR).ResultsNearly all program participants and staff had prior experience with VAPAs, but not in the context of these programs. Most program participants felt confident in their ability to use VAPAs but were concerned about their privacy and security. Program staff were optimistic about the feasibility of integrating VAPAs into existing programs given their ability to support healthy habit formation, but staff were less optimistic about using VAPAs to share health information. Program staff also felt that additional resources to support VAPA use would help ensure that VAPAs would not create an extra burden on staff and program participants.ImplicationsIntegrating VAPAs as a resource to enhance mobile applications already in use shows potential to support health behavior change. Future research should include how this technology could be further optimized to enhance utility.

Cervical cancer is the leading cause of cancer-related death among Latin American women, including Guatemalans. This is troubling, given we have a vaccine, screening tool, and treatment for this preventable disease. Human papillomavirus (HPV) causes most cervical cancer. HPV self-testing is a viable option for women in low-resource areas, such as Guatemala. More information is needed about barriers to HPV self-testing. We conducted four focus groups (N = 43) in three locations in San Raymundo with female community leaders to assess the lived experience of their attitudes, practices, and knowledge about cervical cancer. Participants shared barriers they face receiving Pap tests, the HPV vaccine, and self-testing for HPV. We concluded culturally targeted information is needed about cervical cancer prevention, screening, and treatment. Policies should include outreach to marginalized populations in remote areas with low-literacy indigenous Mayans. Practices should include partnerships with lay midwives and health promoters to help Guatemalan women self-test for HPV.

Use of community health workers (CHWs) has increased in recent years, with many being tasked with providing motivational interviewing (MI). However, little research exists regarding ideal means of training CHWs in MI. Therefore, the objective of this study was to explore the feasibility and perceptions of a CHW-focused MI training. This feasibility study employed a single-arm pre-post design, with a convenience sample of n = 24 Oklahoma-based CHWs. For MI training, four online asynchronous modules and one in-person session were developed and delivered by a graduate student competent in MI in collaboration with a member of the Motivational Interviewing Network of Trainers and per corresponding recommendations. The following indicators of feasibility were assessed via both pre-post surveys and semi-structured interviews: acceptability, demand, implementation, limited efficacy, and Practicality. Among responding CHWs, both the training and delivery of MI by CHWs as a whole were deemed feasible, including acceptability (e.g., 93% of respondents reported as "Excellent" or "Very Good"), demand (e.g., increase in actual MI use), implementation (e.g., exceeded recruitment goal), limited efficacy (e.g., some increases in knowledge), and practicality (e.g., delivery of MI training in existing systems, yet consistent with existing literature). Primary challenges included completion of data collection procedures and perceptions of overwhelm. These data indicate training CHWs in MI is feasible and in high demand, but there are important considerations, including minimizing data collection burden, delivering training in smaller intervals over longer periods of time, providing more opportunities for practice, and evaluating context-specific opportunities for feedback and coaching to achieve proficiency.

Low rates of blood lead level screening among young children persist as a public health issue in the United States, including in Texas where levels remain below the national average. This article describes a multiyear, multipartner initiative aimed at increasing screening rates through a creative, community-informed social media campaign. Interviews with parents, providers, and state health department staff revealed a common perception that lead poisoning was a relic of the past. Using these insights, the team developed humorous social media messaging comparing extinct animals to lead poisoning to capture attention and change attitudes about lead's current relevance. The "#GetLeadCheckedTexas" campaign ran on state health department channels during National Lead Poisoning Prevention Week in October 2020. Colorful graphics depicted extinct creatures like dinosaurs along with their babies, playing on childhood enthusiasm for such animals while evoking protective feelings in parents. Messaging highlighted lead's dangers for young children and encouraged viewers to discuss testing with providers. Website analytics showed the campaign drove substantial increases in page views for lead screening resources, particularly among providers. While originally designed with a parent audience in mind, the campaign seemed to resonate more with providers, likely due to timing during an awareness week and use of official health department channels. The initiative demonstrates the value of creative communications approaches employed in traditional advertising to raise awareness and promote public health priorities. Audience research, thoughtful use of humor, and designing human-focused messaging helped cut through information clutter and drive engagement with an important childhood health issue.

Thirty-five years after the Institute of Medicine report, The Future of Public Health (1988), multiple authors have considered what needs to be achieved to build a robust public health system that improves health for all. A central theme is the renewed emphasis on the role of evidence-based policy. This study provides clear evidence using a ranking methodology of how important policy is to achieving better health outcomes across the United States. The purpose of this study is to assess the association of state health rankings with well-established state health outcomes. Specifically, we calculate the strength of relationship of the rankings used in a previous study to six widely referenced health outcomes. Utilizing 88 predominantly health policy-oriented data elements found online for each of the United States, a state ranking was calculated across all actual, or behavioral, causes of death using the percent weightings attributable to each actual cause. These state rankings were correlated to state health outcomes. Findings indicated that state rankings correlated highly with five of the six health outcomes, excluding disability. States having supportive health policies ranked better in terms of the actual causes of death and population health outcomes. This finding is important to the field because it quantifies the degree that robust health policies matter to population health status and how these policies may be predictive of positive health outcomes. For practitioners, this finding supports greater emphasis on policy advocacy skills and encourages increased advocacy training in schools and programs of public health.