Health Promotion Practice最新文献

According to the U.S. Department of Agriculture (USDA) Economic Research Service, 13.5% of U.S. households experienced food insecurity in 2023, representing a notable increase from the previous year and emphasizing the urgent need for innovative enhancements to food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP). This paper presents a case study of the CalFresh Fruit and Vegetable EBT (Electronic Benefit Transfer) Pilot Project, a pioneering initiative in California that enables SNAP recipients to earn a dollar-for-dollar rebate, up to $60 per month, on fresh fruits and vegetables purchased at participating grocery stores and farmers markets. Incentives earned through this program were automatically credited to recipients' EBT accounts and could be redeemed for any SNAP-eligible foods at authorized USDA Food and Nutrition Service (FNS) retailers. At its launch, this was the only program in the U.S. to integrate nutrition incentives directly into SNAP EBT accounts for use at grocery stores. The Pilot Project achieved high satisfaction among both retailers and participants, resulting in nearly $18 million in incentives earned by approximately 93,000 SNAP recipients. This case study highlights key learnings and implications for practice, policy, and research and explores opportunities to replicate this model in other states and communities. Integrating nutrition incentives into the SNAP EBT system represents a promising strategy to promote healthier food choices and reduce food insecurity nationwide.

Past Australian research has identified gaps in midwives' knowledge, confidence and skills to incorporate oral health promotion within routine antenatal care. The Midwifery Initiated Oral Health (MIOH) evidence-based online training program is designed to provide midwives with practical skills required to promote oral health. The long-term effectiveness of the MIOH program on midwives' oral health knowledge and confidence to incorporate oral health promotion into practice was assessed. A pre-post-test design was used with a convenience sample of midwives (pre vs. post and post versus long-term follow-up ≥12 month) participating in the program with questionnaires capturing self-reported oral health knowledge and confidence. Data was analyzed using descriptive and inferential statistics (McNemars test). Midwives (pre, n = 179; post, n = 173; long-term follow-up, n = 22) self-reported oral health knowledge significantly improved from pre to post and was sustained long-term. Knowledge gains were found in key areas such as the management of oral health in pregnancy, conditions associated with and prevalence of periodontal disease. Self-reported confidence in promoting oral health significantly improved among midwives post-training in most areas assessed, including answering questions about and conducting oral health assessments, assisting with referrals and determining public dental service eligibility. Confidence was largely sustained for all items at long-term follow-up. Findings provide evidence of the MIOH program's long-term impact on midwives' self-reported oral health knowledge and confidence to effectively promote oral health within their practice. The MIOH program is a useful evidence-based professional development resource to support the competencies of midwives to incorporate oral health promotion into their practice.

Modifications to evidence-based health-promotion programs are often required to enhance "real-world" sustainability. User-centered design (UCD) methodologies can support these re-design efforts. We describe how UCD methodologies were used to optimize an online, champion-delivered workplace health-promotion sit less/move more initiative (BeUpstanding) to promote sustainability. Three participant groups (core expert group, workplace end users, commercialization partners; n = 16 total) participated in three discovery cycles with data used to develop a working prototype. This prototype was tested in a 3-month beta-testing validation phase, involving four workplaces and 20 champion end users, with qualitative feedback collected. Optimizations were mapped to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, with desirability, viability, and feasibility parameters considered. The discovery cycles highlighted the need for a new user type-an "overseer"-to manage and help engage champions delivering the program. An enhanced user-experience to support implementation across users (i.e., overseers and champions) as well as additional engagement features were other identified requirements. Prototype testing found revised features to be both desirable and useful. Employing UCD methodologies to re-design BeUpstanding helped focus efforts on usability and effectiveness to promote sustainability. Iterative cycles of discovery and validation guided by the RE-AIM framework may provide a comprehensive approach to addressing the evolving needs of workplace health and wellbeing programs.

People with HIV (PWH) are at increased risk for lung cancer, but lung cancer screening (LCS) is understudied in this population. We previously adapted a shared decision-making (SDM) aid for PWH and demonstrated its efficacy in improving LCS knowledge. In this study, we conducted a mixed-methods evaluation of the implementation of this aid. Participants were LCS-eligible PWH. Forty participants reviewed HIV-adapted and individually tailored decision aids at SDM visits and completed pre-/post-visit surveys. Fifteen completed semi-structured interviews. Interviews were analyzed using thematic analysis guided by the Health Equity Implementation Framework and triangulated with surveys through joint displays. Participants generally approved of the SDM aid as it explained the risks and benefits of screening, but six key implementation tensions emerged: (1) Participants generally trusted clinician recommendations but highlighted how their lived experience with HIV informed some medical skepticism and desire for autonomy. (2) There was appreciation for HIV-focused material, but emphasis on individuality and the variable experiences of PWH. (3) Participants were interested and motivated regarding LCS but highlighted systemic barriers. (4) The aid improved comfort for many, but increased anxiety or confusion for others. (5) Some preferred SDM with their primary care clinician, while others prioritized the opinion of an LCS-focused clinician. (6) Several were motivated to quit smoking after SDM, while others were reassured to continue smoking by lower-than-expected risk estimates. This adapted decision aid was well-received, but interviews highlighted tensions in implementation. Iterative adaptation of the decision aid and communication strategies is needed to optimize SDM for PWH.

Gun violence is a global issue with substantial psychological, social, and health impacts requiring the integration of community voices, especially those with lived experience, into research, implementation, and evaluation. The objective of this paper is to describe how a community-based participatory research (CBPR) partnership used think tanks and the empowerment-theory based community forum to create dialogue between researchers and community members and form action plans to address gun violence. The Violence as a Health Disparity workgroup held two "think tanks" to gather academic and community members to discuss research, lived experiences, and community-based and driven solutions for gun violence impacting North Carolina. Think tanks were structured using the empowerment-theory based community forum method, which guided participants through Freire's three stages of listening, dialogue, and action; qualitative data were analyzed using constant comparison. Seventy-two total participants (68% community partners) attended the think tanks, generating twenty discussion themes, four proposed community-engaged research projects, and six submitted grants related to gun violence prevention, promotion, and response. This project shows how Freire's empowerment theory can be applied to gun violence prevention and response to further community voice and strengthen community-academic relationships. The think tanks facilitated academic and community exchange of information, created a space for dialogue among shareholders and constituents across many positionalities related to gun violence, and acted as a successful method to generate action. These think tanks showcase an important potential method for increasing dialogue with, research co-led by, and equity for communities impacted by gun violence.

Despite the evidence linking moderate intensity exercise with improved health outcomes and disease prevention, health care providers often fail to counsel and guide patients on exercise recommendations. Short visit times, personal exercise practices, and lack of knowledge are all cited as factors for omitting exercise counseling in health care appointments. In the context of these barriers, we investigated the use of GPT-3.5 in generating effective exercise recommendations. Thirty fictional patient cases were entered into GPT-3.5 and provided to two experts in lifestyle medicine. GPT-3.5 and experts were asked to create SMART and realistic goals for these patients, and to advise on when the patients could exercise, and what type of exercise they should complete. Three blinded reviewers graded the recommendations generated by GPT-3.5 and the experts in metrics of how (a) safe, (b) realistic, (c) personalized, (d) accessible (in line with the patient's social determinants of health) the recommendations were, and (e) the quality of the recommendations overall. Differences between experts and GPT-3.5 were assessed using a Mann-Whitney U test. Differences between the three reviewer ratings were assessed using the intra-rater correlation coefficient. BothGPT-3.5 and experts in lifestyle medicine produced highly rated results. Our findings suggest that GPT-3.5 may be able to create safe and effective preliminary exercise recommendations.

This article discusses the importance of effective communication tools in public health, highlighting innovations like Quick Response (QR) codes and QR wallet reference cards (QR cards) for enhancing outreach and education. QR codes are scannable barcodes that link to digital content. QR cards are compact cards, similar to business cards, with codes that lead to relevant health information. To our knowledge, there is little published literature on using QR codes and cards for public health programs and health communication outside of health care clinics and education settings. The North Carolina Department of Health and Human Services, Division of Public Health, Community and Clinical Connections for Prevention and Health Branch has successfully implemented QR codes in various public health programs, particularly in diabetes management and nutrition, physical activity, and obesity initiatives. Key lessons learned include using reputable QR code generators, ensuring visibility and scanability of the codes, testing links before use, providing clear calls to action, and considering dynamic versus static codes based on needs. QR codes can be leveraged in public health practice for program promotion, evaluation sharing, and community resource accessibility. However, limitations such as smartphone dependency among some populations should be acknowledged. In conclusion, while QR codes are a simple tool, they hold significant potential for improving public health communication. Research on QR code use in public health settings could help inform best practices for public health programs and health promotion across different contexts.

Explanations of Benefits (EOBs) are claims documents sent by health insurers to notify policyholders of charges for their and their covered dependents' medical care. EOBs can result in a breach of patient confidentiality for dependents; dependents may also avoid seeking health care services from fear of potential disclosure. We conducted an online survey in Fall 2021 with a convenience sample of adolescents and young adults (AYA) to gather pilot data on EOB-related barriers for AYA in Pennsylvania, which contributed to creating an informational toolkit. We characterized the sample using descriptive statistics and analyzed open-ended text responses using rapid-turnaround qualitative methods. Sixty-six AYA completed the survey; most were aged 18 to 25 and reported being dependent on a parent's or guardian's insurance plan. Key themes emerged, including health care avoidance due to fear of adult disapproval and desire for educational resources. Informed by these data and with the support of community organizations, we employed health communication strategies to develop a digital toolkit to engage AYA around this privacy issue and pending EOB-related legislation in Pennsylvania. The toolkit contains educational materials (e.g., text, images, infographics), social media prompts (e.g., templated text), and links to additional educational and advocacy resources to empower AYAs to make informed decisions about their health and health care needs.

Local health departments (LHDs) can promote physical activity and prevent chronic diseases by applying Public Health 3.0, which calls on them to serve as chief health strategists in their communities, engage community stakeholders, and use actionable, local-level data. In 2023, the New York State Department of Health supported 58 LHDs through a statewide initiative focused on built environment improvements using the Centers for Disease Control and Prevention's (CDC) Active Communities Tool (ACT) and action planning guide. This project aimed to assess whether the initiative led to (1) the convening of new or existing cross-sector partnerships in priority communities; (2) effective use of the ACT assessment tool in local communities; and (3) the creation of meaningful action plans. LHDs received training, prioritized disadvantaged communities, and completed ACT assessments and action plans. Of the 58 eligible LHDs, 46 (81%) participated. Most selected communities were on the state's priority list. All teams convened diverse partners, most frequently including public health, planning, public works, and residents. The most commonly completed ACT modules addressed pedestrian and bicycle infrastructure, street design, and parks and recreation. All teams developed action plans with at least three specific, measurable, achievable, relevant, and time-bound (SMART) goals, most commonly to improve access to parks and trails, enhance infrastructure, and support safe routes to schools. Findings suggest the ACT, when implemented through a structured, incentive-based program, can guide LHDs and partners in assessing local conditions and creating actionable plans. The project offers a scalable model for state-local collaboration and demonstrates how structured training, priority-setting, and use of existing tools can help address health inequities and promote active living.

Early childhood is a critical period for overall development and well-being, yet children from low-income and low-resourced families, such as Chinese American immigrant families, often have unmet mental health needs as they face additional barriers like limited English proficiency and health literacy. Cultural and linguistic adaptation is essential for equitable access to resources and care. Despite the need, early childhood mental health among Chinese American families remains significantly understudied. A digital mental health solution may pose greater access and convenience to address the mental health needs of this community. Thus, this study aims to collaboratively develop a web-based app called OurChild, which provides culturally and linguistically adapted early childhood mental health and development resources for Chinese American immigrant families in New York City. Using the Participatory Cultural Adaptation Framework for Implementation Research (PCAFIR), the project involves a multiphased participatory co-design process: 1. understanding community needs through formative research and engagement; 2. building a digital library with evidence-based and culturally tailored content; 3. designing a culturally tailored web-based app using a participatory approach; and 4. refining and validating the design through user testing. Informed by formative data from existing studies and programs; focus groups and interviews with community experts (n = 6) and parents (n = 11); user testing with parents (n = 11), and through an iterative re-design process, the app was designed to be user-friendly, culturally relevant, and evidence-based. This study described the co-design process and highlighted the lessons learned in developing culturally tailored digital health tools to promote digital health equity for underserved communities.