Health Promotion International最新文献

Early childhood education and care (ECEC) services are a recommended setting to deliver interventions improving children's physical activity (PA). Indoor-outdoor free play, where children move freely between indoor-outdoor environments, can increase child PA. However, these programmes in ECECs are often not sustained. This study aims to assess the acceptability, feasibility, impact, adoption and cost of the Sustaining Play, Sustaining Health (SPSH) programme on sustainment of indoor-outdoor free play programmes in ECECs. A 6-month parallel-group pilot randomized controlled trial was conducted with 16 ECEC services across New South Wales, Australia, following removal of COronaVIrus Disease of 2019 (COVID-19) recommendations. Services implementing indoor-outdoor programmes were randomized to (i) SPSH programme (n = 8) or (ii) usual care control group (n = 8). The intervention included eight strategies to target identified barriers, informed by the Integrated Sustainability Framework. Primary outcomes at 6 months were acceptability, feasibility, adoption, cost, and barriers/facilitators. Potential impact (sustainment) was measured at 6 (primary) and 12 months using nonparametric analysis. Overall, 31.48% (17/54) of eligible services consented and 16 randomized. Statistically insignificant mean differences between groups in indoor-outdoor free play were 26.27 minutes at 6 months, and 2.87 minutes at 12 months, favouring the intervention group. The SPSH programme was considered acceptable and feasible and costed AUD $452.38 ($289.74 USD) to deliver per service. There were no changes in sustainability barriers/facilitators. This pilot found mean differences favouring the intervention group for sustaining indoor-outdoor free play programmes in ECECs, particularly at 12 months. Future fully powered trials should consider addressing broader barriers including staff turnover, motivation/attitudes, and fit within broader contexts to increase impact.

Early childhood education and care (ECEC) settings are crucial for promoting healthy eating (HE) and physical activity (PA) among young children. However, the implementation of health promotion strategies in these settings is often inconsistent and suboptimal. This study applied a systems thinking approach to identify potential leverage points for improving HE and PA promotion in Australian ECEC settings. The study involved qualitative systems mapping through a desktop review and interviews with a purposive sample of stakeholders from the ECEC sector, to explore gaps, opportunities, and strategies, for strengthening HE and PA promotion. Interview data were analysed in NVivo 14 using reflexive thematic analysis within a constructivist paradigm. The desktop review showed that although ECEC quality is regulated in Australia, the standards for HE and PA promotion are vague and inconsistently assessed. Implementation support is provided at the state/territory level, but the availability and intensity of this support vary widely across jurisdictions, resulting in fragmented practices. Interviews with 16 participants, including ECEC providers (n = 4), quality assurance bodies (n = 2), and health promotion support organizations (n = 10) identified three key themes: (i) a mismatch in problem perception, (ii) the 'carrot or stick' approach, and (iii) the need to build sector capacity. From a systems thinking perspective, these findings highlight the need for a nationally coordinated approach to align quality standards, implementation support, and workforce development in the ECEC sector.

The shift to a digitalized health system brings particular challenges for immigrant mothers who experience a triple adaptation: becoming a mother, navigating a new healthcare system and using technology. This study aims to explore digital health literacy barriers perceived by immigrant mothers and facilitators that could sustain their empowerment related to their health and that of their family. An ethnographic study based on the socioecological model was used to analyze data collected from three individual interviews and two focus groups. The results of the interviews and focus groups allowed us to understand the cultural impact of the lack of digital literacy in the context of healthcare for immigrant mothers in their host country, as well as the barriers and facilitators to access and use digital health information. This study identifies individual, organizational and global level barriers to accessing digital health services amongst immigrant mothers. It also highlighted potential strategies that could support their empowerment in accessing and using digital health resources for their health and that of their family. For instance, training and coaching to help immigrant mothers navigate the health care system are needed. It is also important to adapt public policies to better support the integration of immigrant families in their host country.

Social media increasingly shapes how visitors engage with aquatic locations in national parks, where risky behaviours contribute to drowning and injury risk. Selfies and photography with mobile phones have been implicated in fatal and non-fatal injury, due to distraction leading to a loss of awareness of a person's surroundings. We partnered with Queensland Parks and Wildlife Service (QPWS) to co-produce and evaluate a targeted Instagram water safety campaign at an injury hotspot, with specific focus on campaign design, audience engagement, message recall, and user perceptions. Campaign development was informed by social media user and influencer interviews, surveys with social media users, frontline ranger observations, and patterns of visitor behaviour on social media. Between January and February 2024, Instagram posts highlighting site-specific risks were disseminated. The campaign generated strong engagement: over 4000 link clicks, more than 100 shares, and 254 post saves. Content analysis showed polarized user responses: 20% found the messaging informative and useful, while another 20% found it patronizing. In-person surveys at the site (n = 50) found that 32% of visitors reported social media influenced their decision to visit. Separately, a third (32%) of participants recalled at least one of the campaign's safety messages, with Post B being the most recalled. The findings suggest that social media can be a low-cost and impactful tool for aquatic risk communication at high-visitation sites. Future work should focus on refining tone, testing co-design approaches with target audiences, and exploring the potential role of influencer partnerships to enhance reach and resonance.

Support structures are available to schools worldwide for the implementation of Health Promoting School (HPS) programs. To get more insight in these structures, this multiple case study aimed to map variation in levels of support within eight Public Health Service (PHS) regions in the Netherlands and associations with contextual factors. Designed together with a Community of Practice, the study included two rounds of semistructured group interviews (N = 1-4 employees; ±3.5 hours per case) and document analysis. Data were collected on eight indicators of the level of support (e.g. intensity and reach) and 24 contextual factors relating to Healthy School Advisers, PHSs, stakeholder collaboration, and the wider context. Scores were assigned for all indicators and factors per region, and patterns were examined. Results showed large variation in the level of support across cases, mainly in intensity of provided support, integration in the PHS, and reach in terms of percentage of certified HPS schools. Some aspects such as advisers' context sensitivity scored low in all cases. Key contextual factors were related to the PHS: its policy, internal support, capacity, and (structural) budget. Other important factors related to collaboration with regional stakeholders: coordination, division of responsibilities, and communication structure. Structural budget and strategic stakeholder coordination could be improved in all cases. In conclusion, there is much room for improvement toward sufficient and higher quality HPS implementation support for all schools in the Netherlands. To strengthen support, it is important to establish commitment of the PHS organization, strong coordination between stakeholders, and strong national positioning of the HPS program. These conclusions might also apply to other countries.

Childcare settings have a central role in feeding pre-school-aged infants and children. One of the ways in which childcare settings plan nutritious, balanced, and varied meals and snacks for preschool-aged infants and children (0-5 years) is through the use of a menu. Nevertheless, international studies indicate an overwhelming heterogeneity in uptake of menus, as well as use and format, with variable details of food and drinks provided. Thus, in the context of a nationally representative survey on food provision in early years settings in England, we invited respondents to upload sample menus. Of the 322 settings that completed the survey, 56 submitted menus (17.4%). Five were excluded because the attachment was either not a menu or was illegible. Data contained in the 51 readable menus was extracted into an Excel spreadsheet designed deductively from available guidance on menus and inductively based on patterns emerging from the menus themselves. The menus demonstrated great variations in depth of information, completeness and clarity. Breakfasts, snacks, and beverages were often excluded from menus or the information about them was unclear. Menus also sometimes contained dishes with names that were unclear. Early years settings are expected to promote healthy eating, but their ability to do so is shaped by wider structural factors. Thus while childcare settings can play a crucial role in the health promotion of young children during a time of vital development, the wider policy context and challenges faced by childcare settings and families must be addressed.

Schools represent strategic settings for adolescent health promotion across multiple domains, including physical activity (PA). Despite the development of numerous effective programs, sustaining their impact within the school context remains a key challenge. This process evaluation explores how mechanisms, participant experiences, and contextual factors shaped the design, implementation and potential sustainability of the replicated Sigue la Huella (SLH) program (originally designed to increase PA and reduce sedentary time) in a new secondary school in Spain. Grounded in the Replicating Effective Programs framework and co-creation principles, the intervention was co-adapted and implemented over a three-year period through an iterative, collaborative process. The approach emphasized contextual relevance, gradual transfer of responsibility, and long-term sustainability. Participants (ntotal = 43) included teachers (i.e. school implementers), the school principal, students, parents, and policymakers. Data were collected through field notes, focus groups, and interviews. Using the Framework Analysis, findings were organized into thematic matrices capturing stakeholder perspectives across co-adaptation and three implementation phases. While the core structure of SLH was retained, delivery strategies were adapted to reflect school priorities and constraints. Key enablers of sustainability included strategic planning, flexible implementation, stakeholder empowerment, and institutionalization. However, challenges such as training needs, coordination gaps, and competing initiatives persisted. In essence, the processes of co-adaptation, accompanied by a staged withdrawal of research implementation support, have been found to foster school ownership, high-fidelity delivery, and institutionalization creating optimal conditions for autonomous sustainability while recognizing context-dependent challenges.

Studies have consistently indicated that university students are at risk of experiencing poor mental health. This study analysed survey waves at an Australian university in 2019 and 2022 preceding and following implementation of a student mental health strategy to evaluate progress on supporting student mental health. Key indicators for mental health and wellbeing; diversity and inclusion; and risk and protective factors for psychological distress were assessed. Regression analyses examined change between survey waves and risk and protective factors within waves. For mental health measures, the findings demonstrate that in 2022 more students found university stressful while no improvement was seen for risk of mental illness, wellbeing, and coping. Students were also less able to identify a mental health problem, more likely to deal with a mental health problem alone, and less aware of the confidentiality of university-based health services. However, help seeking intention increased and diversity and inclusion indicators improved with more students feeling included and accepted. Risk and protective factors were generally consistent across waves with elevated risks associated with non-Australian country of birth, LGBTQI+ status, current health condition, and current financial stress. Protective factors were age, social inclusion, social acceptance, and satisfaction. Limited progress on key indicators may be due to the COVID-19 pandemic and deterioration in economic conditions. The findings suggest universities can support student mental health by making students feel included, accepted, and satisfied, but that universities should also consider how to address the broader social and economic pressures that students face.

Screening and treatment of maternal perinatal depression is well established, yet existing health care services rarely focus on fathers, and even fewer on Aboriginal and Torres Strait Islander fathers. This study examined the engagement with the Mood Checker (MC) mental health screening tool among Aboriginal and Torres Strait Islander (Indigenous) fathers enrolled in the SMS4dads/SMS4DeadlyDads programme. The MC prompts self-reflection on parenting and wellbeing topics and offers referral to mental health support when needed. Routinely collected programme data from participants enrolled between September 2021 and 30 June 2024 were analysed to assess engagement across 14 MCs, including link clicks, self-assessment responses, and access to linked supports. A total of 571 fathers received an average of eight MC texts. Across 4545 texts sent, 19% of MC links were clicked, and of these, 29% were completed. The MC 'Antenatal stress' had the highest proportion of link clicks, while 'Will I be a good father' had the highest completion rate followed by 'Antenatal stress'. MC responses indicating higher concern were related to 'Exercise', 'Intimacy', and 'Sleep'. Thirty-four participants were offered a mental health support link. Participants who did not click on any MC link and those who clicked but did not complete had significantly higher distress at enrolment compared to those who engaged with the MC. These findings highlight the potential of culturally appropriate digital fathering programmes to identify distress and support timely mental health referral for Indigenous fathers during the perinatal period.