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The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review 撒哈拉以南非洲自费支出造成的非传染性疾病财政负担:范围界定审查
IF 2.7 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-09-17 DOI: 10.1093/heapro/daae114
Adelakun Odunyemi, Md Tauhidul Islam, Khurshid Alam
The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.
在撒哈拉以南非洲地区,非传染性疾病(NCDs)造成的日益沉重的经济负担阻碍了可持续发展目标的实现。然而,在这方面还没有最新的证据综述。因此,我们的研究总结了目前文献中的证据并找出了差距。我们系统地搜索了 2015 年至 2023 年期间的相关数据库(PubMed、Scopus、ProQuest),重点关注有关非传染性疾病及其经济负担指标的实证研究,即撒哈拉以南非洲地区的灾难性医疗支出 (CHE)、贫困化、应对策略、挤出效应和因经济原因未满足的需求 (UNFRs)。我们研究了这些指标的分布、规模、方法和分析深度。所纳入的 71 项研究大多来自撒南非洲低收入国家(22 个)、中低收入国家(47 个)和中高收入国家(10 个)的单个国家研究(64 项)和基于设施的研究(52 项)。约 50%的国家缺乏研究(n = 25),其中 46%来自西非。癌症、心血管疾病 (CVD) 和糖尿病是最常研究的非传染性疾病,其中癌症和 CVD 造成的经济负担最大。研究显示,研究方法在深度、公平分析和稳健性方面存在不足。在中低收入国家,CHE 很高(高达 95.2%),但在低收入和中上收入国家,CHE 很低。在低收入和中低收入国家,联合国财务报告率几乎达到 100%。采用极端应对策略在低收入国家最为常见。目前还没有关于挤出效应和与大流行相关的联合国抵抗力量的研究。这项研究强调了扩大研究的重要性,即改进对撒哈拉以南非洲地区非传染性疾病经济负担的估算方法,以促进公平并提出政策建议。
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引用次数: 0
Diabetes in Liberia: a policy brief 利比里亚的糖尿病:政策简介
IF 2.7 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-23 DOI: 10.1093/heapro/daae109
Paulina Bleah, Joan Almost, Rosemary Wilson, Danielle Macdonald, Pilar Camargo-Plazas
There is increasing awareness that diabetes is a growing public health threat in Liberia. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and communities. The current response to diabetes in Liberia is limited to the management of acute complications. Long-term strategies for the prevention and control of diabetes are almost entirely absent from national health agendas. This brief provides policy options that Liberian policymakers can adopt to prevent diabetes, improve treatment and enhance the quality of life for people living with diabetes in Liberia.
人们日益认识到,糖尿病对利比里亚的公共健康构成日益严重的威胁。与糖尿病相关的高死亡率和发病率对个人、家庭和社区都有重大影响。利比里亚目前应对糖尿病的措施仅限于管理急性并发症。国家健康议程中几乎完全没有预防和控制糖尿病的长期战略。本简报提供了利比里亚决策者可以采取的政策选择,以预防糖尿病、改善治疗和提高利比里亚糖尿病患者的生活质量。
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引用次数: 0
The impact of media-based mental health campaigns on male help-seeking: a systematic review. 基于媒体的心理健康宣传对男性寻求帮助的影响:系统性综述。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae104
Grant Duthie, Nicola Reavley, Judith Wright, Amy Morgan

More than half of all men do not seek professional help for depression, suicide and anxiety. Although media-based campaigns represent a promising health promotion intervention to improve male help-seeking, it is unclear what communication strategies in extant mental health media-based campaigns are effective for men. The aim of this systematic review was to synthesize information about the effectiveness of these campaigns on male help-seeking outcomes. A search was conducted of electronic databases and gray literature. Studies were eligible if they examined the effectiveness of a media-based campaign targeting male help-seeking attitudes, beliefs, intentions or behaviors in relation to mental disorders, distress, suicide or self-harm. Twenty-two studies of varying quality met the eligibility criteria. Most studies targeting mental health or depression were found to positively influence male help-seeking. There were mixed results for suicide prevention campaigns. Some evidence suggests that overall, brochure-based campaigns impact help-seeking. The use of male or mixed-gender campaign imagery produced similar results. The choice of message framing appeared to influence help-seeking outcomes. Despite substantial heterogeneity in campaign approaches and difficulties isolating the effects of campaign delivery from messaging, the review indicates that media-based campaigns can play a role in improving male help-seeking for mental health difficulties. Mounting evidence suggests that messaging and delivery should align with male communication preferences. However, high-quality, targeted research is required to evaluate the circumstances in which various campaign delivery and messaging components are effective in improving male help-seeking for poor mental health and suicidality.

半数以上的男性不会因抑郁、自杀和焦虑而寻求专业帮助。尽管媒体宣传是一种很有前景的健康促进干预措施,可以提高男性的求助率,但目前还不清楚现有的心理健康媒体宣传中哪些沟通策略对男性有效。本系统性综述旨在综合这些活动对男性求助结果有效性的相关信息。我们对电子数据库和灰色文献进行了检索。只要是针对男性在精神障碍、痛苦、自杀或自残方面的求助态度、信念、意向或行为的媒体宣传活动的有效性进行研究的研究都符合条件。共有 22 项不同质量的研究符合资格标准。大多数针对精神健康或抑郁症的研究都发现,这些研究对男性寻求帮助产生了积极影响。关于预防自杀运动的研究结果不一。一些证据表明,总体而言,以小册子为基础的宣传活动会对求助产生影响。使用男性或男女混合的宣传形象产生了类似的结果。信息框架的选择似乎会影响求助结果。尽管活动方式存在很大的差异,而且很难将活动传递的效果与信息传递的效果区分开来,但综述表明,基于媒体的活动可以在改善男性因心理健康问题而寻求帮助方面发挥作用。越来越多的证据表明,信息传递和实施应符合男性的沟通偏好。然而,还需要开展高质量、有针对性的研究,以评估在何种情况下,各种宣传活动和信息传递内容能够有效改善男性因心理健康状况不佳和自杀而寻求帮助的情况。
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引用次数: 0
Coming back for more: individual participation patterns in the physical activity initiative parkrun in Australia. 再来一次:澳大利亚体育活动倡议跑酷的个人参与模式。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae098
Anne C Grunseit, Bo-Huei Huang, Dafna Merom, Leonie Cranney, Adrian Bauman, Kris Rogers

Most physical activity (PA) maintenance research has concerned adherence to small-scale interventions or infrequent observation in cohort studies. We analysed individual attendance trajectories and their drivers in a large-scale 'real-world' community-based weekly PA event (parkrun) cohort in Australia. Data were weekly attendance (walking/running) of 223 224 unique parkrun participants over their first 3 years of participation. An unweighted moving average of participation in the preceding 12 weeks from the 12th week since the first participation to the 156th week was calculated and submitted to a cluster analysis of attendance patterns. Association of individual- (demographic, personal parkrun performance) and site-level (aggregated site-level participant characteristics and area-level measures) covariates with cluster membership was estimated with multinomial logistic regression models. We identified four groups: Few-Timers (76.4%), Decliners (12.4%), Low Maintainers (6.9%) and High Maintainers (4.3%). In the first 12 weeks, attendances averaged 2, 6, 5 and 7.5 times for each cluster, respectively, and by 52 weeks, they were 0.17, 1.9, 3.4 and 7.6 times, respectively. Continuing participation (vs Few-Timers) was strongly associated with faster personal finish times, but slower performance at the site level. Higher running club/group membership at a participant's parkrun predicted higher odds of being a High Maintainer. Our identification of a Low Maintainer group shows a community-based initiative may sustain interest, despite not requiring continuous or near-continuous attendance. Where someone is placed 'in the pack' locally and degree of identification with others in the group may be bidirectionally associated with attendance, underscoring the importance of considering social environment of PA maintenance.

大多数体育锻炼(PA)维持研究都是针对小规模干预措施的坚持情况或队列研究中不经常观察到的情况。我们分析了澳大利亚大规模 "真实世界 "社区每周体育锻炼活动(跑酷)队列中的个人出席轨迹及其驱动因素。数据是 223 224 名独特的跑酷参与者在参加跑酷前三年的每周出勤率(步行/跑步)。从首次参加的第 12 周到第 156 周,计算了前 12 周参加情况的非加权移动平均值,并对参加模式进行了聚类分析。通过多项式逻辑回归模型估算了个人(人口统计学、个人跑酷表现)和场地水平(场地水平的参与者特征和地区水平的衡量标准)协变量与群组成员资格的关系。我们确定了四个组别:很少参加者(76.4%)、放弃者(12.4%)、低维持者(6.9%)和高维持者(4.3%)。在最初的 12 周内,每个组群的平均参加次数分别为 2、6、5 和 7.5 次,到 52 周时,分别为 0.17、1.9、3.4 和 7.6 次。持续参与(与很少参加者相比)与更快的个人完赛时间密切相关,但在场地水平上的成绩较慢。参加者所在跑马场的跑步俱乐部/团体会员人数越多,成为 "高保持者 "的几率就越高。我们对 "低维持者 "群体的识别表明,以社区为基础的活动尽管不要求连续或接近连续的参加,但仍能保持人们的兴趣。一个人在当地的 "群体 "中的位置以及与群体中其他人的认同程度可能与出席率有双向关系,这强调了考虑PA维持的社会环境的重要性。
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引用次数: 0
Identifying barriers and facilitators to physical activity and perceptions of Traditional Indigenous Games among Aboriginal and Torres Strait Islander women: a qualitative study. 确定土著居民和托雷斯海峡岛民妇女参加体育活动的障碍和促进因素以及对传统土著游戏的看法:一项定性研究。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae108
Tiana Thorne, Sean Taylor, Karla Canuto, Anthony S Leicht

Aboriginal and Torres Strait Islander women are key members of the community who have specific roles within their families that may result in lower levels of physical activity (PA) undertaken. Clearly identifying barriers for women to engage with PA, and exploring culturally based activities (i.e. Traditional Indigenous Games), may help to improve long-term health benefits. Subsequently, the aim of this study was to identify the barriers and facilitators for Aboriginal and Torres Strait Islander women engaging in PA, and their interest in participating in Traditional Indigenous Games. Seventeen Aboriginal and Torres Strait Islander women (34.3 ± 10.2 years) participated in focus groups. Through thematic analysis, participants experienced a range of common barriers such as lack of time due to family commitments, limited finances, ageing and poor physical and/or mental health. Common facilitators were also identified such as fun, access and improving mental and/or physical health. Importantly, unique themes were identified for Aboriginal and Torres Strait Islander women including barriers (e.g. racism, shame) and facilitators (e.g. culture, interactions with other Aboriginal and Torres Strait Islander women) that influenced PA participation. Notably, Traditional Indigenous Games were considered as an appealing PA mode to engage with their culture, experience nostalgia and be around other Aboriginal and Torres Strait Islander women. These key findings will guide future PA programs including Traditional Indigenous Games to improve health outcomes of Aboriginal and Torres Strait Islander women, vital members of the community.

原住民和托雷斯海峡岛民妇女是社区的重要成员,她们在家庭中扮演着特殊的角色,这可能导致她们的体育锻炼(PA)水平较低。明确妇女参与体育锻炼的障碍,并探索基于文化的活动(即传统土著游戏),可能有助于提高长期健康效益。因此,本研究旨在确定原住民和托雷斯海峡岛民妇女参与体育锻炼的障碍和促进因素,以及她们对参与传统土著游戏的兴趣。17 名原住民和托雷斯海峡岛民妇女(34.3 ± 10.2 岁)参加了焦点小组。通过主题分析,参与者遇到了一系列共同的障碍,如由于家庭负担、经济条件有限、年龄增长以及身体和/或心理健康状况不佳而缺乏时间。此外,还发现了一些共同的促进因素,如乐趣、机会以及改善心理和/或身体健康。重要的是,为土著和托雷斯海峡岛民妇女确定了独特的主题,包括影响参与表演艺术的障碍(如种族主义、羞耻感)和促进因素(如文化、与其他土著和托雷斯海峡岛民妇女的互动)。值得注意的是,传统土著游戏被认为是一种有吸引力的参与性活动模式,可以让她们参与到自己的文化中,体验怀旧感,并与其他土著和托雷斯海峡岛民妇女在一起。这些重要发现将指导未来的体育活动计划,包括传统土著游戏,以改善土著妇女和托雷斯海峡岛民妇女的健康状况,她们是社区的重要成员。
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引用次数: 0
How loss of nature through clear-cutting forestry affects well-being. 砍伐森林造成的自然损失如何影响人们的福祉。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae110
Solvor Nesbakken, Grete Eide Rønningen, Steffen Torp

The United Nations declares that the global degradation of ecosystems represents a danger to human health. Deterioration of forests is one of several threats against the natural systems. The aim of this exploratory study was to investigate people's experiences with clear-cutting and how it had affected their health and well-being. Qualitative data from six people who valued forest ecosystems were collected through semi-structured interviews and analyzed in accordance with Graneheim and Lundman's qualitative content analysis (Graneheim, U. H. and Lundman, B. (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112). Clear-cutting was not regarded as an environment-friendly forestry method. The interviewees described emotional reactions such as grief and poor mental well-being when beloved forests were clear-felled. The grief was partly because of a personal loss of place and recreation area that was important for their physical and emotional well-being. Another part was grief on behalf of nature itself, that is, the loss of habitats of animals and plants and a worsening of the global climate. The interviewees held that emotions related to loss of nature were insufficiently communicated in public discourse. They felt powerless and unable to influence forestry because of what they experienced as an impenetrable industry. Clear-cutting of forests may result in poor well-being among people who value forest ecosystems. More focus on planetary health is needed, including healthy public policy promoting forest management that considers people's need for nature experiences and possible ecological grief when forests are totally and abruptly cleared.

联合国宣布,全球生态系统退化对人类健康构成威胁。森林退化是自然系统面临的几种威胁之一。这项探索性研究旨在调查人们在砍伐森林方面的经历,以及砍伐森林对他们的健康和福祉产生了哪些影响。通过半结构式访谈收集了六位重视森林生态系统的人的定性数据,并根据 Graneheim 和 Lundman 的定性内容分析法(Graneheim, U. H. and Lundman, B. (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.今日护士教育》,24,105-112)。砍伐森林并不被认为是对环境友好的林业方法。受访者描述了当心爱的森林被砍伐时的情绪反应,如悲伤和精神不佳。悲伤的部分原因是个人失去了对身心健康非常重要的场所和休闲区。另一部分是对大自然本身的悲痛,即动植物栖息地的丧失和全球气候的恶化。受访者认为,与自然丧失有关的情绪在公共讨论中没有得到充分表达。他们感到无能为力,无法对林业施加影响,因为在他们看来,林业是一个难以渗透的行业。对森林的砍伐可能会导致重视森林生态系统的人们的生活质量下降。需要更多地关注地球健康,包括制定健康的公共政策,促进森林管理,考虑人们对自然体验的需求,以及森林被突然完全砍伐后可能造成的生态破坏。
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引用次数: 0
Sexual health interventions with social marketing approach targeting young people: a scoping review. 采用社会营销方法针对年轻人的性健康干预措施:范围界定综述。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae106
Hanna Putkonen, Hanna Kallio, Jari Kylmä, Tiina Rissanen, Marjorita Sormunen

In a fast-paced digital and global environment, sexual education must keep up with young people's sexual health needs. Social marketing is an approach that has been used in sexual health promotion for young people. The objective of the scoping review is to identify and map the use of social marketing in sexual health promotion for young people. Specifically, the content, delivery methods and effects of interventions on sexual health were researched. Six databases were systemically searched to capture the relevant peer-reviewed quantitative, qualitative and mixed methods articles without time restrictions that provided evidence of sexual health-related social marketing interventions targeting young people aged 11-25. An inductive and deductive content analysis was performed. Nineteen studies were included in the data. The content of interventions was dominated by sexual risks and risk prevention, focusing particularly on sexually transmitted diseases, unwanted pregnancies and sexual violence. Additionally, interventions included topics of morals of sexual relationships and changes in the body. The delivery of interventions occurred through various media channels, events and activities, while the effects of interventions were monitored as improvements in sexual perceptions and sexual behaviour, limited gender-related effects, limited evidence of intervention attributed to behaviour and effects in different age groups. The social marketing approach was mostly preventive and concentrated on the risks, whereas the delivery methods were diverse and creative, combining modern and already well-established channels. Sexuality should be seen comprehensively, and interventions should respond to the full range of young people's needs.

在快节奏的数字化和全球化环境中,性教育必须跟上年轻人的性健康需求。社会营销是一种已被用于青少年性健康促进的方法。此次范围界定审查的目的是确定并绘制社会营销在促进年轻人性健康方面的应用图。具体来说,研究内容、实施方法和干预措施对性健康的影响。我们系统地搜索了六个数据库,以获取相关的同行评审定量、定性和混合方法文章,这些文章没有时间限制,提供了针对 11-25 岁年轻人的性健康相关社会营销干预措施的证据。对内容进行了归纳和演绎分析。数据中包括 19 项研究。干预措施的内容以性风险和风险预防为主,尤其侧重于性传播疾病、意外怀孕和性暴力。此外,干预措施还包括性关系道德和身体变化等主题。干预措施是通过各种媒体渠道、事件和活动实施的,而对干预措施效果的监测则是性观念和性行为的改善、与性别有关的有限效果、干预措施对不同年龄组的行为和效果的有限证据。社会营销方法主要是预防性的,集中在风险方面,而提供的方法则是多样的、创造性的,结合了现代和已经成熟的渠道。应全面看待性问题,干预措施应满足年轻人的各种需求。
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引用次数: 0
Insights into the Belgian gambling advertising ban: the need for a comprehensive public policy approach. 比利时赌博广告禁令的启示:需要全面的公共政策方法。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae116
Bram Constandt, Steffi De Jans
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引用次数: 0
Cost-effectiveness analysis and return on investment of SunSmart Western Australia to prevent skin cancer. 西澳大利亚 "阳光智选 "预防皮肤癌的成本效益分析和投资回报。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae091
Louisa G Collins, Carolyn Minto, Melissa Ledger, Sally Blane, Delia Hendrie

Each year, malignant melanoma accounts for 57 000 deaths globally. If current rates continue, there will be an estimated 510 000 new cases annually and 96 000 deaths by 2040. Melanoma and keratinocyte cancers (KCs) incur a large societal burden. Using a mathematical population model, we performed an economic evaluation of the SunSmart program in the state of Western Australia (WA), a primary prevention program to reduce the incidence of skin cancer, versus no program. A societal perspective was taken combining costs to the health system, patients and lost productivity. The model combined data from pragmatic trial evidence of sun protection, epidemiological studies and national cost reports. The main outcomes modelled were societal and government costs, skin cancer counts, melanoma deaths, life years and quality-adjusted life years. Over the next 20 years, the model predicted that implementing the WA SunSmart program would prevent 13 728 KCs, 636 melanomas and 46 melanoma deaths per 100 000 population. Furthermore, 251 life years would be saved, 358 quality-adjusted life years gained and AU$2.95 million in cost savings to society per 100 000 population would be achieved. Key drivers of the model were the rate reduction of benign lesions from sunscreen use, the costs of purchasing sunscreen and the effectiveness of reducing KCs in sunscreen users. The likelihood of WA SunSmart being cost-effective was 90.1%. For the WA Government, the estimated return on investment was $8.70 gained for every $1 invested. Primary prevention of skin cancer is a cost-effective strategy for preventing skin cancers.

每年,全球有 57 000 人死于恶性黑色素瘤。如果按照目前的速度发展下去,到 2040 年,估计每年将新增病例 510 000 例,死亡 96 000 例。黑色素瘤和角质细胞癌(KCs)造成了巨大的社会负担。我们利用一个数学人口模型,对西澳大利亚州(WA)的 "阳光智选 "计划(一项旨在降低皮肤癌发病率的初级预防计划)与无计划进行了经济评估。我们从社会角度出发,综合考虑了医疗系统、患者和生产力损失的成本。该模型结合了来自防晒实用试验证据、流行病学研究和国家成本报告的数据。建模的主要结果包括社会和政府成本、皮肤癌数量、黑色素瘤死亡人数、生命年数和质量调整生命年数。根据模型预测,在未来 20 年内,实施西澳阳光智选计划每 10 万人口可预防 13 728 例皮肤癌、636 例黑色素瘤和 46 例黑色素瘤死亡。此外,每 10 万人口还将节省 251 个生命年、358 个质量调整生命年以及 295 万澳元的社会成本。该模型的主要驱动因素是使用防晒霜可降低良性病变的发生率、购买防晒霜的成本以及减少防晒霜使用者 KCs 的效果。西澳 SunSmart 具有成本效益的可能性为 90.1%。对西澳大利亚州政府而言,每投入 1 澳元,估计可获得 8.70 澳元的投资回报。皮肤癌的初级预防是一种具有成本效益的皮肤癌预防策略。
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引用次数: 0
Replicability, adaptability and long-term impact of the 'Healthy Youngsters, Healthy Dads' program in Newcastle, Australia. 澳大利亚纽卡斯尔 "健康青少年、健康父亲 "计划的可复制性、适应性和长期影响。
IF 2.3 4区 医学 Q2 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 DOI: 10.1093/heapro/daae095
Lee M Ashton, Jacqueline A Grounds, Alyce T Barnes, Emma R Pollock, Myles D Young, Stevie-Lee Kennedy, Anna T Rayward, Daniel R Lee, Philip J Morgan

'Healthy Youngsters, Healthy Dads' (HYHD) targets fathers to improve the health of their preschool-aged children. In a previous randomized trial, fathers and children experienced meaningful improvements in physical activity and eating behaviours. The next phase is to test the replicability and adaptability of HYHD when delivered in the community by trained facilitators. Fathers/father-figures and children aged 3-5 years were recruited from Newcastle, Australia into a 9-week, non-randomized trial with assessments at baseline, 10 weeks, and 12 months. The primary outcome was achievement of pre-registered targets for recruitment (≥ 96 dyads), attendance (≥ 70%), compliance (completing ≥ 70% of home-based tasks), fidelity (≥ 80% of content delivered as intended) and program satisfaction (≥ 4/5). Secondary outcomes included physical activity, nutrition, screen time and parenting measures. Process targets were surpassed for recruitment (140 fathers, 141 children), attendance (79% for fathers-only workshops, 81% for father-child sessions), compliance (80% of home-tasks completed), fidelity (99% for education, ≥ 97% for practical) and program satisfaction (4.8/5). Mixed effects regression models revealed significant effects in fathers for moderate-to-vigorous physical activity, co-physical activity, dietary intake and parenting practises, which were maintained at 12 months. Significant effects were also established for screen time at 10 weeks only. For children, significant effects were observed for screen time and dietary intake at 10 weeks, while effects on energy-dense, nutrient-poor foods and healthy, nutrient-dense core food intake were maintained at 12 months. Findings demonstrate the replicability and adaptability of HYHD when delivered in the community by local trained facilitators. Further investigation into how to optimally scale-up HYHD is warranted.

健康青少年,健康爸爸"(HYHD)以父亲为目标,旨在改善其学龄前子女的健康状况。在之前的随机试验中,父亲和孩子在体育锻炼和饮食行为方面都有了明显改善。下一阶段的工作是测试 HYHD 在社区由训练有素的辅导员开展时的可复制性和适应性。我们从澳大利亚纽卡斯尔市招募了父亲/父亲监护人和 3-5 岁的儿童,进行了为期 9 周的非随机试验,并在基线、10 周和 12 个月时进行了评估。主要结果是达到预先登记的招募目标(≥ 96 个家庭)、出勤率(≥ 70%)、依从性(完成≥ 70% 的家庭任务)、忠实度(≥ 80% 的内容按计划交付)和项目满意度(≥ 4/5)。次要结果包括体育活动、营养、屏幕时间和育儿措施。在招募(140 名父亲,141 名儿童)、出席率(79% 的父亲工作坊,81% 的父亲-儿童课程)、依从性(80% 的家庭任务已完成)、忠实度(99% 的教育,≥ 97% 的实践)和项目满意度(4.8/5)方面,均超过了过程目标。混合效应回归模型显示,父亲在中强度体育活动、共同体育活动、饮食摄入和养育实践方面具有显著效果,并在 12 个月后保持不变。仅在 10 周的屏幕时间方面也有显著影响。对于儿童来说,在 10 周时观察到屏幕时间和饮食摄入量的明显效果,而在 12 个月时观察到能量密度高、营养成分低的食物和健康、营养成分高的核心食物摄入量的效果保持不变。研究结果表明,由当地经过培训的促进者在社区开展 "健康生活方式 "活动具有可复制性和适应性。我们有必要进一步研究如何以最佳方式推广 "健康生活方式"。
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Health Promotion International
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