Health Promotion Practice最新文献

Rural distrust in science, intensified during the COVID-19 pandemic, has led to concern about the ongoing uptake of pediatric vaccination. It is also unclear how to most effectively promote health behaviors within rural communities. This study was designed to explore how rural parents interpret vaccine promotion message components, including text, images, and sponsorships, and design their own messages to provide insights for public health. Rural-living parents in Wisconsin (n = 27) were recruited to participate in virtual, 90-minute focus groups/co-design sessions regarding vaccine promotion in which they were asked to evaluate the effectiveness of researcher-provided textual messages, images, and sponsorship and create final public service announcements (PSAs) with elements they believed would resonate with other rural parents. As the conceptual model guiding this work was the theory of planned behavior, our focus was on the interpretations and attitudes that participants brought to the task of creating PSAs and their perceptions of social norms in their community. Braun and Clarke's 6-step thematic analysis was applied to qualitative data. Participants created PSAs that affirmed active parental roles in health care and emphasized local context and "relatability." Feelings were mixed about national-level organizations. While some reported negative connotations, others recognized knowledge and competence. Participants had negative assessments of message elements that referred to rural communities as stereotypical or homogeneous. Tailoring to include local, familiar, and relatable messages, images, and sponsors that emphasize parent roles in health decision-making and the knowledge of local providers is preferred among rural parents.

Dissemination and Implementation (D&I) science increasingly recognizes the importance of equitable community engagement; yet, few models fully integrate community leadership and contextual knowledge throughout the research translation process. This paper introduces the Integrated Knowledge, Dissemination, and Action (IKDA) Framework, a novel model that combines the Knowledge to Action (K2A) Framework and Brownson's Model for Dissemination of Research, to guide the co-creation, dissemination and practice, and institutionalization of health information in community settings. Together, the IKDA Framework supports community-engaged approaches to collaboratively translate evidence into culturally resonant, actionable products and practices through multi-phased, iterative stages that leads to sustained utilization. The IKDA Framework's utility is demonstrated through two public health initiatives: the Health Promotion Through Environmental Design (HPTED) project and the National Network to Innovate for COVID-19 and Adult Vaccine Equity (NNICE). These case studies focus on research and dissemination phases of the IKDA and illustrate how community-driven dissemination strategies-such as tailored digital tools, infographics, and training-enhanced community awareness, trust, and engagement. Our use of the IKDA Framework within these projects is ongoing to facilitate continued implementation and institutionalization. The IKDA Framework moves beyond traditional knowledge dissemination to foster co-ownership, ethical community engagement, and long-term community-academic partnerships. It provides both researchers and practitioners with a structured yet flexible roadmap to support equitable, sustainable community-based health improvements. As public health continues to address complex, place-based challenges, the IKDA Framework offers a scalable and responsive approach to bridging research with community practice to facilitate real-world, positive community impact.

Infant sleep-related deaths remain a significant public health concern, particularly for families with limited access to primary care. This study examines the feasibility and effectiveness of a pediatric emergency department (PED)-based intervention aimed at promoting safe sleep practices by providing caregivers with home-delivered cribs and sleep sacks. A convenience sample of 50 caregivers with infants under 6 months old were enrolled during emergency department visits if they reported unsafe sleep practices or lacking appropriate sleep surfaces. Participants completed a pre-intervention survey assessing sleep practices, and a portable crib and sleep sack were shipped directly to their homes. One month later, caregivers filled out a follow-up survey to evaluate changes in infant sleep behaviors and their perceptions of the intervention. Using quantitative methods, paired analyses were conducted to compare pre- and post-intervention data. The study demonstrated that home delivery of safe sleep supplies was both feasible and well-received by caregivers, with 91% of participants successfully receiving and using the materials provided. Caregivers reported greater adherence to safe sleep recommendations, including reduced bed-sharing and fewer instances of unsafe sleep environments. The findings suggest that PEDs represent an underutilized setting for health promotion interventions and that integrating direct-to-home delivery of safety resources may be an effective strategy for improving infant sleep practices. Future research should explore the scalability and long-term impact of this approach in various health care settings.

Every year in the United States, thousands of children are injured or killed while walking or bicycling, highlighting the need for effective pedestrian and bicycle safety education programs. This pilot study evaluated the effectiveness of the 3D RoadPlay Set, a novel, small-scale, magnetic model composed of roads, signage, crosswalks, and vehicles, designed to promote safety knowledge through tactile, play-based learning. A total of 148 first- and second-grade students from the same public elementary school participated. All students received a standardized safety lesson; students were then randomly assigned to either a control group (coloring activity) or an experimental group (tactile learning with 3D RoadPlay Set). Results showed a significant increase in safety knowledge from pre- to post-test among students in the experimental group compared to controls (p < .001). The greatest improvement was observed in first-grade students in the intervention group, with an average score gain of +16.67 points versus +6.67 in controls. In addition, 91% of students in the intervention group reported the highest level of lesson satisfaction, compared to 86% in the control group. This low-cost, accessible tool shows strong potential for enhancing early childhood road safety education, particularly in underserved or diverse learning communities. Its universal, tactile design accommodates a range of learning needs and styles. Implications extend beyond the classroom: the 3D RoadPlay Set could be integrated into health department injury prevention programs or combined with built-environment education strategies to reinforce safety concepts. Future research should assess long-term behavioral outcomes and scalability across broader populations and delivery channels.

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.