Do Crowding-Out Effects Explain the Low Effect of a Health Promotion Intervention among Young People at a Vocational School?

In recent years, school-based interventions have increasingly been used as a strategy to promote good eating habits and physical activity among young people at school. However, little is known about the effect that this kind of public involvement has on the overall behavior of young people. Economists refer to the existence of a crowding-out effect when public sector engagement in influencing behavior is counteracted by behaviors at the individual level. The aim of this study was to investigate the effects of a health promotion intervention program among young people at a vocational school on the overall behavior of the students and consider whether a crowding-out effect existed when it came to health behavior. This study used data from the Gearing up the Body (GUB) intervention that was carried out at the vocational school of Uddannelsescenter Holstebro, Denmark. The study included 130 students from two vocational programs. Answers were collected from survey questions in three waves. Our results showed that intervening in the school setting had the intended impact on physical activity but an unintended impact on eating behavior. In the GUB study, we found signs of countervailing behaviors in and out of school that need to be further explored.

A Six-Step Process to Reduce Bullying in Schools; The Content of a Health Promotion Intervention to Reduce Bullying Among Early Adolescents in a Rural School in Sri Lanka

Bullying is a form of aggression which has negative impacts on health. Bullying acts are reported to be common among early adolescents in rural schools in Sri Lanka. It is timely to design and implement interventions aiming to reduce bullying in schools in Sri Lanka. In this article, we aim to describe the process and the content of a health promotion intervention carried out aiming to reduce bullying among early adolescents in a rural school in Sri Lanka. The intervention is comprised of a six-step process. A logical framework developed based on Samarasinghe et al (2011) was used to guide the intervention. The content of the intervention was designed following health promotion principles. Health promotion aims for empowering people- to take collective community actions aiming to achieve desired health outcomes. The intervention for bullying was designed aiming for empowering early adolescents -to generate collective actions to reduce bullying in their school. In the intervention, adolescents not merely participated but also engaged and involved in modifying the planned intervention. Different activities, brainstorming sessions, facilitated discussions, role plays, etc. were carried out in the process. In this intervention, the health promotion approach we employed enabled engagement and involvement of adolescents beyond mere participation in the intervention.

Systematically developing a family-based health promotion intervention for women with prior gestational diabetes based on evidence, theory and co-production: the Face-it study

Background Women with prior gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes; however, this risk can be reduced by engaging in positive health behaviours e.g. healthy diet and regular physical activity. As such behaviours are difficult to obtain and maintain there is a need to develop sustainable behavioural interventions following GDM. We aimed to report the process of systematically developing a health promotion intervention to increase quality of life and reduce diabetes risk among women with prior GDM and their families. We distil general lessons about developing complex interventions through co-production and discuss our extensions to intervention development frameworks. Methods The development process draws on the Medical Research Council UK Development of complex interventions in primary care framework and an adaptation of a three-stage framework proposed by Hawkins et al. From May 2017 to May 2019, we iteratively developed the Face-it intervention in four stages: 1) Evidence review, qualitative research and stakeholder consultations; 2) Co-production of the intervention content; 3) Prototyping, feasibility- and pilot-testing and 4) Core outcome development. In all stages, we involved stakeholders from three study sites. Results During stage 1, we identified the target areas for health promotion in families where the mother had prior GDM, including applying a broad understanding of health and a multilevel and multi-determinant approach. We pinpointed municipal health visitors as deliverers and the potential of using digital technology. In stage 2, we tested intervention content and delivery methods. A health pedagogic dialogue tool and a digital health app were co-adapted as the main intervention components. In stage 3, the intervention content and delivery were further adapted in the local context of the three study sites. Suggestions for intervention manuals were refined to optimise flexibility, delivery, sequencing of activities and from this, specific training manuals were developed. Finally, at stage 4, all stakeholders were involved in developing realistic and relevant evaluation outcomes. Conclusions This comprehensive description of the development of the Face-it intervention provides an example of how to co-produce and prototype a complex intervention balancing evidence and local conditions. The thorough, four-stage development is expected to create ownership and feasibility among intervention participants, deliverers and local stakeholders. Trial registration ClinicalTrials.gov NCT03997773, registered retrospectively on 25 June 2019.

Barriers and facilitators in the implementation of an evidence-based health promotion intervention in a primary care setting: a qualitative study

PurposeThis study aims to elucidate the health care organization, management and policy barriers and facilitators associated with implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain.Design/methodology/approachSeven focus groups were conducted with 49 health professionals from six primary care centers participating in the Prescribing Healthy Life program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management and policy.FindingsThe health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow and (3) available resources to carry out the program. Specific barriers in these areas related to lack of financial and political support, consultation time constraints and difficulty managing competing day-to-day demands. Other barriers and facilitators were related to the constructs networks and communication, culture, relative priority and leadership engagement. A set of six specific barrier-facilitator pairs emerged.Originality/valueImplementation science and, specifically, the CFIR constructs were used as a guide. Barriers and facilitators related to the implementation of a health promotion program in primary care were identified. Healthcare managers and policy makers can modify these factors to foster a more propitious implementation environment. These factors should be appropriately monitored, both in pre-implementation phases and during the implementation process, in order to ensure effective integration of health promotion into the primary care setting.

Health Promotion Intervention through Smartphone LINE Application for Increasing Physical Activity and Healthy Eating Behavior among Overweight Women in Urban Community in Bangkok, Thailand

Background: Lack of physical activity and unhealthy eating behavior are considered to be global issues and lead the risk of non-communicable diseases. The previous studies indicated that mobile applications have the potential for delivering health information to promote health behaviors. Objective: To evaluate the effect of health promotion intervention through smartphone LINE application to increase knowledge, perception, and practice of physical activity and healthy eating behavior among overweight women in urban community. Materials and Methods: A quasi-experimental study was conducted among 100 overweight women with a BMI between 25 and 29.9 kg/m², and aged between 35 and 65 years living in urban community in Bangkok between October 2017 and April 2018. Participants were selected to the intervention group and control group. The intervention program consisted of group education, self-monitoring, individual counseling, and smartphone LINE application group chatting about physical activity and healthy eating behavior. Data were collected at baseline and after the intervention ended at 24 weeks. Chi-square, paired samples t-test, and independent t-test were used to find the effect of the program. Results: At the end of 6-month, the results indicated that the intervention group had significantly increased in mean of knowledge (p<0.001) and perception (p<0.001) of physical activity and healthy eating behavior, food frequency scores (p<0.001), MET-physical activity (p=0.007) and decreased in mean of time spent sitting (p<0.001), body weight (p=0.043), and BMI (p<0.001) when compared to the control group. Conclusion: The use of LINE application was found effective to deliver health information, share and exchange their experienced, motivate, and monitor their physical activity and healthy eating behavior. This app can help the participants to increase the physical activity and healthy eating behavior, and to decrease their sedentary behavior resulting in weight loss. It is useful for healthcare providers to promote the health behaviors. Keywords: Smartphone; LINE application; Physical activity; Healthy eating behavior; Urban community

The Danish SoL Project: Effects of a Multi-Component Community-Based Health Promotion Intervention on Prevention of Overweight among 3–8-Year-Old Children

The aim of the study was to determine the effects of a multi-component community-based health promotion intervention on body mass index (BMI) z-scores and waist circumference (WC) in three- to eight-year-old children. A quasi-experimental design was adopted to evaluate the effects of the SoL intervention involving three intervention and three control communities. The 19-month intervention was based on the supersetting approach and was designed to promote healthier eating and physical activity among children and their families. BMI z-scores and WC were measured at baseline and follow-up. At baseline, 238 (54%) and 214 (51%) of all eligible children were measured from intervention and control, respectively. The change over time in the BMI z-scores of children from the intervention group was significantly different from that of the control group (p = 0.001). BMI z-scores increased over time in the intervention group in contrast to the control group, whose BMI z-scores decreased (difference in change between groups 0.19 z-scores 95% CI 0.08, 0.30). No significant differences were observed for WC. The results showed no favourable effects of the intervention of Project SoL on BMI z-scores and WC in children. Further studies based on a larger sample size and a longer intervention duration are needed.