Health Promotion Practice

For practitioners of health education and managers of health promotion programs, evaluation is consistently described as a challenge. Staff members often express the need for more expertise and guidance in evaluation. The newly published A Practical Guide to Program Evaluation Planning, edited by Debra J. Holden and Marc A. Zimmerman, is a compact and easily understood resource that promises to be of great value, especially to health promotion practitioners and students.

Advocacy and policy change have become increasingly important strategies in health promotion efforts. As a result, advocacy evaluation is emerging as a necessary competency for health promotion practitioners. This article introduces the growing field of advocacy evaluation by describing its typical features, which include using prospective evaluation designs, emphasizing real-time data collection and use, monitoring and responding to changing environmental conditions, and assessing both individual and organizational capacity building. A number of freely available resources for learning more about advocacy evaluation’s key concepts and methods are highlighted.

Effective efforts to eliminate health disparities must be grounded in strong community partnerships and trusting relationships between academic institutions and minority communities. However, there are often barriers to such efforts, including the frequent need to rely on time-limited funding mechanisms that take categorical approaches. This article provides an overview of health promotion and disease prevention projects implemented through the Community Outreach and Information Dissemination Core (COID) of the Center for Minority Health, within the Graduate School of Public Health at the University of Pittsburgh. The COID is one of five Cores that comprised the University of Pittsburgh’s NIH Excellence in Partnerships for Community Outreach, and Research on Disparities in Health and Training (EXPORT Health) funded from 2002 to 2007 by the National Center on Minority Health and Health Disparities. Based in large part on the success of the community engagement activities, in 2007, the National Center on Minority Health and Health Disparities, National Institutes of Health, designated the CMH as a Research Center of Excellence on Minority Health Disparities. COID major initiatives included the Community Research Advisory Board, Health Disparity Working Groups, Health Advocates in Reach, Healthy Class of 2010, and the Healthy Black Family Project. Lessons learned may provide guidance to other academic institutions, community-based organizations, and health departments who seek to engage minority communities in changing social norms to support health promotion and disease prevention.

Mobile communications are being used for many purposes, from instant messaging (IM), mobile or microblogging (Twitter), social networking sites (Facebook, MySpace), e-mail to basic voicemail. A brief background on cell phone and mobile technology use in public health is reviewed. The focus of the article is framing the use of mobile technologies in public health from a social marketer’s perspective—using the 4 Ps marketing mix as a guide.

In July 2007, a market research report was produced by Hezel Associates on behalf of five sponsoring health education profession member organizations and the National Commission for Health Education Credentialing. The purpose of the survey was to learn about current or potential employers’ knowledge, attitudes, and behaviors toward health educators and the health education profession and their future hiring practices. This article presents the background leading up to the production of this report, the major findings of the survey of employers, recommendations from the market research group regarding core messages, and implications for the profession having discovered for the first time information about employers’ understanding of professionally prepared health educators. The article discusses the umbrella and key messages that may be incorporated into a marketing plan and other recommendations by the firm that should assist health educators in marketing the profession. Furthermore, this article presents reactions by leaders in this field to these messages and recommendations and concludes with next steps in this project and a call for the overall need to market the profession of health education.

Taking a settings approach to health promotion means addressing the contexts within which people live, work, and play and making these the object of inquiry and intervention as well as the needs and capacities of people to be found in different settings. This approach can increase the likelihood of success because it offers opportunities to situate practice in its context. Members of the setting can optimize interventions for specific contextual contingencies, target crucial factors in the organizational context influencing behavior, and render settings themselves more health promoting. A number of attempts have been made to systematize evidence regarding the effectiveness of interventions in different types of settings (e.g., school-based health promotion, community development). Few, if any, attempts have been made to systematically develop a template or framework for analyzing those features of settings that should influence intervention design and delivery. This article lays out the core elements of such a framework in the form of a nested series of questions to guide analysis. Furthermore, it offers advice on additional considerations that should be taken into account when operationalizing a settings approach in the field.

Given the morbidity and mortality associated with domestic violence (DV), there is international recognition that the health sector has a responsibility to prevent violence. In North America, the health sector has commonly responded by developing protocols for identifying victims of abuse. This utilization-focused evaluation describes the process involved in the implementation of a universal DV screening protocol undertaken by nurses in the urgent care clinic of a community health center. Dealing with the challenges of the urgent care setting, the strong and supportive urgent care team approach helped integrate the screening procedure into routine nursing practice. Understanding the purpose of asking about DV, quickly recognizing problems, validating staff concerns, and adapting procedures resulted in a strong commitment to implementation. This research has implications for others looking to implement or evaluate screening protocols in other health care settings.

Policy advocacy is increasingly recognized as a crucial component of the training provided to health educators but relatively few universities offer advocacy training as part of their professional preparation programs for health educators. Historically Black colleges and universities (HBCUs) represent a natural setting for creating strong Black leaders in tobacco policy advocacy. This case study focuses on experiential education at an HBCU to develop advocacy skills around tobacco issues among Black college students. The authors describe the structure and content of two tobacco policy courses, their efforts to evaluate these courses, and the lessons they learned planning and conducting them. They believe their experience can prove useful to others developing curricula for teaching policy advocacy skills to health education students.

This study describes the design of the process evaluation of a collaborative effort among community partners to address health issues in central Oklahoma. The design is an application of a sound process evaluation planning framework that integrates the components of context, reach, dose delivered, dose received, fidelity, implementation, recruitment, barriers, and maintenance. The planning framework also provides guidance regarding the steps of designing and implementing the process evaluation. This planning process was conducted by utilizing a participatory research approach. At the end of the planning phase, the evaluation team accomplished the following: (a) development of an evaluation plan, (b) development of evaluation instruments (i.e., surveys, interview guides, observation forms), and (c) development of evaluation questions and process objectives. The information derived from this study can be valuable to practitioners and researchers involved in the planning of community partnerships or coalitions and interested in process evaluation that takes place in community settings.

This case study examines the comparative effect of no-use school tobacco policies and restricted-use tobacco policies on teacher and student smoking behaviors and attitudes. Data from teachers (n = 1,041) and ninth-grade students (n = 4,763) at 20 schools in five districts in southern Louisiana were available. No significant difference was observed between teacher smoking (11% vs. 13%, p = .42) or student smoking (24.6% vs. 25.2%, p = .75) at no-use versus restricted-use policy schools. The proportion of teachers smoking on campus at no-use or restricted-use schools was not significantly different. Teachers at restricted-use schools were however less concerned about students seeing teachers smoke and less supportive of a no-use policy than teachers at no-use schools. Tobacco use policies are often not promoted, and enforcement of policies impacting teachers is complex. Changing social norms for smoking at high schools through policy promotion and enforcement is understudied.

Providing training and planned learning experiences to practitioners and community partners is fundamental to effective public health. The extent to which principles of adult learning currently guide such training is unknown and likely varies widely. The purpose of this article is to introduce five principles of adult learning and discuss how each can be applied in assessing trainee needs, planning and delivering training, and evaluating training processes and outcomes. Training guided by these principles should facilitate adult learning, collaborative efforts, and mutual respect between agencies, practitioners, and community partners.

Health educators can help reduce cancer disparities in Latino populations through the creation of effective print materials. In this effort, the National Cancer Institute conducted a comprehensive needs assessment to identify key design elements of cancer education programs and create a cost-effective process that would ensure consistency in the development of materials. This article introduces the Checklist of Design Elements for the Development of Cancer Education Print Materials for Latina/o Audiences (CEMLA), which includes a total of 10 design elements related to the process of developing materials and content. Using social learning theory as a theoretical framework, design elements are included that reflect cultural sensitivity at the surface and deep structure levels. This is the most comprehensive effort to date to integrate and synthesize theory and application in the design of materials for this audience.

California Department of Health Services and California Distance Learning Health Network collaborated with the California Conference of Local Health Officers to produce the Pandemic Influenza and Public Health Law: What Public Health Departments Need to Know satellite broadcast and tabletop exercise training. Local health officers, county counsels, school superintendents, hospital administrators, and senior decision makers in California planned for ways stakeholders would make legal use of public health law in case of pandemic emergency. The training provided an opportunity for decision makers to become familiar with statutes and regulations in anticipation of such an event. Finding a legal balance between the need to mandate legal orders for the protection of the common good and the degree of infringement on individual rights was the thematic thread for the training. Although California specific, the instructional modalities and lessons learned from this training program serve as a guide for state and local governments.

Geographic information systems (GIS) mapping technologies have potential to advance public health promotion by mapping regional differences in attributes (e.g., disease burden, environmental exposures, access to health care services) to suggest priorities for public health interventions. Training in GIS for comprehensive cancer control (CCC) has been overlooked. State CCC programs’ GIS training needs were assessed by interviewing 49 state CCC directors. A majority perceived a need for GIS training, slightly more than half of state CCC programs had access to geocoded data, and the majority of programs did not require continuing education credits of their staff. CCC directors perceived judging maps and realizing their limitations as important skills and identified epidemiologists, CCC staff, public health officials, policy makers, and cancer coalition members as training audiences. They preferred in-class training sessions that last a few hours to a day. Lessons learned are shared to develop training programs with translatable GIS skills for CCC.

Most adults do not walk enough to obtain health benefits. Pedometers have been successfully utilized to motivate and increase walking. Given that libraries are a place where community members seek health resources, they are a logical setting for increasing community accessibility to pedometers. The purpose was to examine the feasibility of lending pedometers to library patrons to increase walking. In five Canadian public libraries, 90 pedometers were made available for 6 months. A total of 41 library patrons (33 women, 8 men, age range 18 to 65 or older) completed a survey about their walking patterns and pedometer use. More than 330 loans were made. Chisquare analysis found significant associations between walking and motivation to walk more (p < .05), walking and goal setting (p < .05), and motivation to walk more and setting a walking goal (p < .001). Results provide preliminary evidence that lending pedometers through local libraries is an effective, low-cost approach to enhance walking in community members.

Ninth grade health education classrooms were randomly assigned to conditions in which a 14-lesson unit on HIV and pregnancy prevention was provided either by the permanent classroom teacher or by a temporary health educator. Student data were collected prior to the lessons and approximately 3 weeks after the completion of the unit. Results indicate that students who learned the unit from the classroom teacher reported that that the instructor was more likeable and credible and that the classrooms were more motivational. Sexually active adolescents with regular classroom teachers reported greater increases in frequency of class discussion.

The newly established national Safe Routes to School (SRTS) program has the potential to positively influence individuals, communities, and the environment regardless of race, ethnicity, or socioeconomic status. Many communities are applying their interest in physical activity promotion toward creating policies and programs to encourage active travel, though many barriers exist. SRTS legislation provides funds to address some of the barriers and improve the ability of students to safely walk and bicycle to school. SRTS requires that 70% to 90% of the funds be used for infrastructure projects (i.e., engineering treatments, such as sidewalk construction), and 10% to 30% for noninfrastructure activities, such as education, encouragement, and enforcement. The socioecological model (SEM) is widely used in public health and includes five levels of influence on behavior, from individual to public policy. Application of the SEM to SRTS provides a framework for a comprehensive approach to improve active travel to school.