Health Promotion Practice

Because of imposed rapid social change, Alaska Native youth are growing up in a context different from their elders and suffering far worse health and behavioral outcomes. This research seeks to understand (a) their everyday struggles and life challenges, (b) the practices and resources they rely on to get through challenges, and (c) the meaning they make from these experiences. Data were generated from interviews with 20 Alaska Native youth between the ages of 11 and 18 years, balanced by gender and age-group (early and late adolescence). Purposive sampling identified participants with a broad range of experiences. Following a semistructured guide, youth participated in face-to-face, audio-recorded interviews, transcribed verbatim. A codebook was developed using an iterative process and transcripts were coded using ATLAS.ti. The most commonly identified stressors were relationship loss, “not being there for me,” nonsupportive/hostile experiences, transitioning into adulthood, and boredom. Resilience strategies included developing and maintaining relationships with others, being responsible, creating systems of reciprocity, practicing subsistence living, and giving back to family and the community. These opportunities allowed youth to gain a sense of competence and mastery. When difficult experiences align with opportunities for being responsible and competent, youth are most likely to exhibit resilience.

Growing evidence highlights the benefits to youth of involvement in community-based participatory research. Less attention has been paid, however, to the contributions youth can make to helping change health-promoting policy through such work. We describe a multi-method case study of a policy-focused community-based participatory research project in the Skid Row area of downtown Los Angeles, California, where a small group of homeless youth worked with adult mentors to develop and conduct a survey of 96 homeless youth and used the findings to help secure health-promoting policy change. We review the partnership’s work at each stage of the policy-making process; its successes in changing policy regarding recreation, juvenile justice, and education; and the challenges encountered, especially with policy enforcement. We share lessons learned, including the importance of strong adult mentors and of policy environments conducive to sustainable, health-promoting change for marginalized youth.

There is strong evidence of the positive role that youth engagement programs and policies play in creating resiliency and producing positive outcomes among youth populations, such as delaying or avoiding the onset of risk-taking behaviors. Research also suggests that achieving positive outcomes ideally includes influence from the individual, the family, the school, the community, and the field of public health (available in A Research Report and Recommendations for Ontario Public Health Association). The authors conducted a comprehensive evaluation of a 2-year pilot project designed to increase the application of engagement and resiliency theory, knowledge, and skills among public health professionals engaging students from Grades 6, 7, and 8 (11- to 14-year-olds). Qualitative methods assessed public health satisfaction with training, resources, and networking activities, whereas quantitative methods assessed changes in capacity with respect to youth engagement knowledge, awareness, confidence, and skills. The findings have helped shed light on public health professional needs concerning capacity and confidence to undertake youth engagement work. Key lessons learned about making youth engagement possible and effective for public health professionals are presented.

An experiential approach to preventing teen pregnancy, “Baby Think It Over” is a popular option in schools. The current study used an experimental design and a 1-year longitudinal follow-up with 93 experimental group and 92 control group male and female, primarily African American and Mexican American, low–socioeconomic status students from two middle schools in a large, urban district in the Midwest (mean age = 13.24 years, range = 12-15 years). The program was evaluated for a wide array of outcomes, including sexual behavior, contraceptive use, realism about parenting responsibilities, personal intentions to avoid teenage pregnancy, self-efficacy to avoid sexual risk taking and pregnancy, sexual attitudes, plans for pregnancy, and actual pregnancy rates. The program successfully increased the Baby Think It Over group’s sense of realism regarding lack of readiness to be a teenage parent, although no behaviors were changed. Differences emerged by demographic subgroup. All results are discussed in light of several contexts that must be considered, including the need to examine both costs and benefits of this type of program. This has direct implication for organizational policies regarding the intervention selection and application.

This article presents an action research project as a method to combine science and practical expertise in order to develop the practices of the health care system. The project aimed at developing mental health promotion in the school community in general and at finding tools for timely help when mental health is at risk. The underlying idea is that mental health is an integral part of health and by promoting general well-being it is also possible to promote and ensure mental health at school. The study was conducted in a Finnish lower secondary school of 446 pupils where the pupils are aged between 12 and 15 years. The initial survey was conducted using the School Well-being Profile, a tool developed by Anne Konu. A well-being questionnaire was used to identify the areas in need of improvement, providing the basis for planning and implementing development measures together with the local actors. The instrument proved to be a usable way of collecting feedback of the well-being of the school environment. As a result of the action research project, the school’s physical conditions and social relationships improved and appropriate practices for future problem situations were set.

The HEALTHY trial evaluated the effectiveness of a multicomponent intervention program to reduce risk for type 2 diabetes in middle school students. The comprehensive intervention addressed nutrition, physical activity, and behavior in the context of a social marketing–based communications campaign to promote healthy energy balance. One element was a classroom-based program called FLASH (Fun Learning Activities for Student Health). Five FLASH modules were delivered, one per semester. Process evaluation data were collected from teachers at 21 schools and study staff at seven national sites via survey, interview, and in-class observation. Data from the first four modules were evaluated and showed that FLASH was delivered with high fidelity. Sessions that required peer interaction were rated as the most effective in engaging students and promoting knowledge. Study-provided material resources and on-site support were identified as key facilitators. Student misbehavior was viewed as the greatest barrier. Although the high level of support provided by the study is not likely to be replicated in school systems, those developing wellness policies, health curricula, and teacher training programs may benefit from using the evidence-supported, publicly available HEALTHY materials in their efforts to reduce diabetes risk factors in middle school youth.

There is gap between the enactment and implementation of local school wellness policies. Building the capacity of promotores to engage parents in strengthening local school wellness policy implementation is an innovative strategy. This evaluation study examines the effects of 6 hours of promotor advocacy training to improve local school wellness policy implementation. Consistent with psychological empowerment theory, the training and the related toolkit were designed to increase promotores’ knowledge and self-efficacy to engage parents in advocating for improved local school wellness policy implementation. Pre–post training questionnaires (n = 74), five posttraining participant focus groups, and four staff member focus groups explored changes in promotor and participating organization capacity. Findings show increased participant self-efficacy, knowledge, and attitudes to advocate for improved local school wellness policy implementation. Participating organizations reported intention to continue supporting promotor local school wellness policy advocacy. Findings illuminate strategies to strengthen promotor capacity to engage parents in local school wellness policy advocacy.

Community health workers (CHWs) are increasingly incorporated into research teams. Training them in research methodology and ethics, while relating these themes to a community’s characteristics, may help to better integrate these health promotion personnel into research teams. An interactive training course on research fundamentals for CHWs was designed and implemented jointly by a community agency serving a primarily Latino, rural population and an academic health center. A focus group of community members and input from community leaders comprised a community-based participatory research model to create three 3-hour interactive training sessions. The resulting curriculum was interactive and successfully stimulated dialogue between trainees and academic researchers. By choosing course activities that elicited community-specific responses into each session’s discussion, researchers learned about the community as much as the training course educated CHWs about research. The approach is readily adaptable, making it useful to other communities where CHWs are part of the health system.

Videos are powerful tools for enhancing the reach and effectiveness of health promotion programs. They can be used for program promotion and recruitment, for training program implementation staff/volunteers, and as elements of an intervention. Although certain brief videos may be produced without technical assistance, others often require collaboration and contracting with professional videographers. To get practitioners started and to facilitate interactions with professional videographers, this Tool includes a guide to the jargon of video production and suggestions for how to integrate videos into health education and promotion work. For each type of video, production principles and issues to consider when working with a professional videographer are provided. The Tool also includes links to examples in each category of video applications to health promotion.

Practical Health Promotion provides practical tips and steps equipping new health promotion students and practitioners with skills and competencies needed to be effective and successful in the field. The “health promotion through the life course” perspective enhances the depth and relevancy for health promotion needs assessment and tailored intervention development. Key health promotion strategies and methods with practical guides including one-to-one communication, health promotion with groups, and using mass media, print media, electronic media, and advocacy are discussed in the text. The discussion of settings in health promotion provides real-world case examples to assist understanding of concepts. Moreover, the authors provide a variety of practical tools for readers to employ immediately. Throughout the textbook, the authors suggested reflective and useful activities to further deepen learning. This text is an important contribution to advancing the practice of health promotion. Public health professionals, practitioners, students, and anyone interested in making positive changes in their community, facility, workplace, school, or institution are provided practical tips to promote healthy environment and health of the clients they serve.

Universities offering undergraduate degrees in health promotion or health education and/or graduate degrees in public health typically require an internship, practicum, or fieldwork experience. This type of mentored experience is an important aspect of career development for the next generation of public health professionals and benefits not only the students but also the profession and the communities in which they work. This article provides perspectives from four public health professionals who have recently graduated from designated minority-serving institutions and highlights the ways in which internship, practicum, or fieldwork experiences have contributed to their career development. From a career development perspective, internships provide unique opportunities to develop professional networks, practice competencies learned in the classroom, gain experience in different environments, and share lessons learned with others in our field. The diversification of the public health research and practice workforce is increasingly recognized as crucial in building health equity. Internship programs that focus specifically on the academic and professional development of students underrepresented in public health provide experiences that meet or supplement academic requirements, and provide students with real-world experience and an expanded network of mentors and role models.

Applying existing theories to research, in the form of a theoretical framework, is necessary to advance knowledge from what is already known toward the next steps to be taken. This article proposes a guide on how to develop a theoretical framework for complex community-based interventions using the Cardiovascular Health Awareness Program as an example. Developing a theoretical framework starts with identifying the intervention’s essential elements. Subsequent steps include the following: (a) identifying and defining the different variables (independent, dependent, mediating/intervening, moderating, and control); (b) postulating mechanisms how the independent variables will lead to the dependent variables; (c) identifying existing theoretical models supporting the theoretical framework under development; (d) scripting the theoretical framework into a figure or sets of statements as a series of hypotheses, ifthen logic statements, or a visual model; (e) content and face validation of the theoretical framework; and (f) revising the theoretical framework. In our example, we combined the “diffusion of innovation theory” and the “health belief model” to develop our framework. Using the Cardiovascular Health Awareness Program as the model, we demonstrated a stepwise process of developing a theoretical framework. The challenges encountered are described, and an overview of the strategies employed to overcome these challenges is presented.

Few comprehensive measures exist to assess contributors to childhood obesity within the home, specifically among low-income populations. The current study describes the modification and psychometric testing of the Comprehensive Home Environment Survey (CHES), an inclusive measure of the home food, physical activity, and media environment related to childhood obesity. The items were tested for content relevance by an expert panel and piloted in the priority population. The CHES was administered to low-income parents of children 5 to 17 years (N = 150), including a subsample of parents a second time and additional caregivers to establish test–retest and interrater reliabilities. Children older than 9 years (n = 95), as well as parents (N = 150) completed concurrent assessments of diet and physical activity behaviors (predictive validity). Analyses and item trimming resulted in 18 subscales and a total score, which displayed adequate internal consistency (α = .74-.92) and high test–retest reliability (r ≥ .73, ps < .01) and interrater reliability (r ≥ .42, ps < .01). The CHES score and a validated screener for the home environment were correlated (r = .37, p < .01; concurrent validity). CHES subscales were significantly correlated with behavioral measures (r = −.20-.55, p < .05; predictive validity). The CHES shows promise as a valid/reliable assessment of the home environment related to childhood obesity, including healthy diet and physical activity.

Health Compass is an innovative, multiphased project that aims to transform health care practice and shift organizational culture by building the capacity of Provincial Health Services Authority (PHSA) health care providers to further promote the mental health and well-being of patients and families accessing PHSA’s health care services. Health Compass was developed within a health promotion framework, which involved collaboration and engagement with stakeholders across all partnering PHSA agencies. This approach led to the development of an educational and training resource that contributes to increased capacity for mental health promotion within the health care setting. Based on interviews with Health Compass’ internal Project Team and findings from a Stakeholder Engagement Evaluation Report, this article outlines the participatory approach taken to develop the Health Compass Mental Health Promotion Resource and E-Learning Tool. A number of key facilitators for collaboration and engagement are discussed, which may be particularly applicable to the implementation of a mental health promotion program or initiative within a complex health care setting.

Background. Although churches are an important partner for improving health within the African American community, it is not known how congregants are best reached by health promotion activities and thus how best to target members in recruitment. This study examined how characteristics of churches and congregants’ beliefs and interests in faith-based health promotion related to their willingness to attend church-based health promotion activities. Method. We surveyed adult congregants (n = 1,204) of 11 predominately African American churches in North Carolina. Surveys collected data within four domains: demographics (age, sex, education), behavioral (church attendance, respondent food choices, and physical activity), cognitive (church-based health promotion belief, Bible-based healthy living interest, healthy living resource interest), or environmental (family health, church travel distance, church health ministry activity, church members’ food choices). Analyses used a dichotomous outcome, interest in attending programs offered by the health ministry. Domain-specific models were constructed. Logistic generalized estimating equations adjusted for clustering. Results. Of the 1,204 congregants, 72% were female, 57% were 50 years or older, 84% had a high school education or more, and 77% had a chronic health condition. In bivariate analyses and in models adjusting for all four domains, cognitive factors had the highest odds of willingness to attend. Conclusion. Congregants’ belief in the church’s role in health promotion and their desire to learn about healthy behaviors highlight the role of the African American church as a partner in addressing health disparities and the need to capitalize on this expectation through stronger partnerships between medical and faith communities.

The purpose of this study was to use the theory of planned behavior to explain two types of snack food consumption among boys and girls (girls n = 98; boys n = 69), which may have implications for future theory-based health promotion interventions. Between genders, there was a significant difference for calorie-dense/nutrient-poor snacks (p = .002), but no difference for fruit and vegetable snacks. Using stepwise multiple regression, attitudes, perceived behavioral control, and subjective norms accounted for a large amount of the variance of intentions (girls = 43.3%; boys = 55.9%); however, for girls, subjective norms accounted for the most variance, whereas for boys, attitudes accounted for the most variance. Calories from calorie-dense/nutrient-poor snacks and fruit and vegetable snacks were also predicted by intentions. For boys, intentions predicted 6.4% of the variance for fruit and vegetable snacks (p = .03) but was not significant for calorie-dense/nutrient-poor snacks, whereas for girls, intentions predicted 6.0% of the variance for fruit and vegetable snacks (p = .007), and 7.2% of the variance for calorie-dense/nutrient-poor snacks (p = .004). Results suggest that the theory of planned behavior is a useful framework for predicting snack foods among children; however, there are important differences between genders that should be considered in future health promotion interventions.