Global Health Promotion

Stress reactions and coping resources of adolescents in chronic and acute situations evoked by missile fire were examined. Data were gathered during August 2006 (Second Lebanon War) on a sample of 303 Israeli adolescents living in Northern Israel (acute state) and 114 youths from Sderot and the Negev, an area which has been exposed to frequent rocket attacks in the last seven years (chronic state). State anxiety and psychological distress were measured as stress reactions. Sense of coherence, family sense of coherence, sense of community and level of exposure were investigated as potential explanatory factors in reducing emotional distress. The overall magnitude of variance explanation was found to be different at each state: a relatively high amount explained variance of stress reactions was found in the chronic stress situation, but not in the acute state. These data support the value of developing a model that differentiates stress situations with the aim of understanding patterns of significant resources in moderating stress reactions in each state. (Global Health Promotion, 2009; 16 (4): pp. 5—15)

Background: The use of storytelling in qualitative research involving Inuit compliments the oral tradition of Inuit culture. The objective of the research was to explore the use of qualitative methods to gain understanding of the experience of living with diabetes, with the ultimate goal of better formulating health care delivery and health promotion among Inuit. Methods : In-depth interviews were analyzed and interpreted using thematic analysis, open coding, and structured narrative analysis. Inuit community members acted as partners through all stages of the research. Results: ‘‘Because the more we understand, the more we’re gonna do a prevention on it … What I want is use my, use my diabetes, what I have … so that it can be used by other people for prevention because they’ll have understanding about it’’ — an Inuk storyteller speaks to the value of education in health promotion. Key methodological issues found relevant to improving qualitative research with Indigenous Peoples include: (i) participatory research methods, grounded in principals of equity, through all phases of research; (ii) the presentation of narratives rather than only interpretations of narratives; (iii) understanding of culture, language, and place to frame the interpretation of the stories in the context within which storytellers experience living with their diabetes, and (iv) the value of multiple methods of analyses. Interpretation: This article comments on the challenges of conducting rigorous research in a cross-cultural setting and outlines methodologies that can improve qualitative narrative analyses research. The research highlighted experiences of living with diabetes and the ways in which storytellers coped and negotiated social support. (Global Health Promotion, 2009; 16 (4): pp. 16—26)

Evidence is accumulating that well-being in high-income societies may be static or in decline. One influential theory argues that this is because ‘modern’ societies are influenced by values of materialism, individualism and consumerism. Does this intellectual critique resonate with ordinary people? This article reports on interviews with purposefully selected groups in Scotland, where the relevance of the cultural critique was explored. Participants in the study believed that cultural values such as individualized consumerism do exert a damaging influence on well-being. They suggested that such values are given particular power in the context of widespread social change and increasing inequalities. Nevertheless, they also believed that individuals and communities possess the capacity to resist such trends. This article concludes that efforts to achieve material improvement for disadvantaged people may not suffice in redressing deep-seated inequalities, if the contribution of some subtle but pernicious effects of contemporary culture remains neglected. However, the research does suggest that positive responses are also possible. (Global Health Promotion, 2009; 16(4): pp. 27—34)

This study explores the relevance of health literacy, and its development through a health curriculum, as a necessary but insufficient component to facilitate healthy living among adolescents through comprehensive school health models. This paper presents qualitative findings from focus groups with students (N = 33) in four schools toward the end of their experience in a health class that focused on topics related to healthy living, healthy relationships, health information and decision-making. Students reported mostly negative experiences citing repetitive course content, routinely delivered by teachers and passively received by students. As well, students described their experiences of using health information sources beyond the classroom, such as the media. The findings suggest that the curriculum, and particularly its implementation, have had limited effect on health literacy: students’ abilities to access, understand, communicate and evaluate health information. The paper concludes with recommendations for improving health education. (Global Health Promotion, 2009; 16(4): pp. 35-42)

Objectives: the purpose of this research was to determine the feasibility of engaging incarcerated women in community-based participatory research and to identify, by and with the women, the health concerns to be addressed. Design: the integration of primary health care, community-based participatory research, a settings approach to health promotion and transformative action research guided the overall design of this study. Participants: Incarcerated women, correctional centre staff and academic researchers participated collaboratively. Setting. The study was conducted in the main short sentence (two years or less) minimum/medium security women’s correctional centre in a Canadian province. Results: In-depth interviews were conducted with 16 incarcerated women; in-depth group interviews were facilitated with 16 correctional centre staff. Twenty-one themes, which emerged from participatory, inductive and content analysis of the data, were presented at a face-to-face meeting attended by 120 incarcerated women, 10 correctional centre staff and 5 academic researchers. Underlying values and principles for the project were identified prior to a discussion of the results. During the course of this meeting, the themes were converged into five major categories: addictions and mental health; HIV, hepatitis and infections; health care in prison; life skills and re-entry into society (including homelessness and housing); and children, family and relationships. Numerous suggestions for health interventions and participatory projects were generated, each relating to one of the five major categories. Conclusions: this study was unique in that, to our knowledge, no other studies have utilized community-based participatory research methods in which incarcerated women played a role in designing the research questions and tools, collecting the data, analyzing the data, interpreting the data and authoring the publications and presentations. This study demonstrated that it is feasible for incarcerated women to engage in developing and utilizing community-based participatory research methods and that these methods can be grounded in a settings approach to whole prison health promotion. (Global Health Promotion, 2009; 16 (4): pp. 43—53)

In parallel with the neo-liberal retrenchment of the welfarist state, an increasing emphasis on the responsibility of individuals in managing their own affairs and their well-being has been evident. In the health arena for instance, this was a major theme permeating the UK government’s White Paper Choosing Health: Making Healthy Choices Easier (2004), which appealed to an ethos of autonomy and self-actualization through activity and consumption which merited esteem. As a counterpoint to this growing trend of informed responsibilization, constrained choices (constrained agency) provides a useful framework for a judicious balance and sense of proportion between an individual behavioural focus and a focus on societal, systemic, and structural determinants of health and well-being. Constrained choices is also a conceptual bridge between responsibilization and population health which could be further developed within an integrative biosocial perspective one might refer to as the social ecology of health and disease. (Global Health Promotion, 2009; 16 (4): pp. 54—57)

Following a series of international meetings on behavioral monitoring and surveillance, in 2007 the Italian Ministry of Health (Ministerio della Salute) and the Institute for Health (Istituto Superiore della Sanità) hosted the 5^th International Conference on Behavioral Risk Factor Surveillance (BRFS) in Rome. A key focus of the conference was on how current surveillance systems could be applied to the field of health promotion, particularly in building the evidence base for health promotion practice. As a result of these discussions, the World Alliance for Risk Factor Surveillance (WARFS), an IUHPE Global Working Group, was formed to work toward providing knowledge and expertise in surveillance as a tool for advancing health promotion. For those IUHPE members interested in participation, this article provides an overview on the strategic direction of WARFS and the newly formed sub-working groups. (Global Health Promotion, 2009; 16(4): pp. 58—60)

This commentary describes the development of the Health Nutrition programme carried out by University of Cagliari with 19 Italian scout groups. In total 353 children between the ages of 6 and 10 participated in the programme. The objectives were to develop children’s knowledge on the Mediterranean diet through games. The project was developed between January and June of 2006. The activities were carried out by the Cub Scout leaders with the objective to improve the Cub Scouts’ knowledge on nutrition. Every week they implemented a different game, which showed the Cub Scouts’ increased levels of interest and participation. This experience demonstrated that it is possible to involve children in a context outside of the school to carry out a health promotion programme. (Global Health Promotion, 2009; 16 (4): pp. 61—64)

Complementary and alternative medicine (CAM) are therapies used along with or in place of bio-medicine. Many forms of CAM originate in culture, referred to as culturally based alternative medicines. Usage of CAM is high with large numbers of patients using CAM for mental health, pain and musculoskeletal problems. Their desire for holistic care may be the impetus for this interest, as alternative care practitioners spend more time analyzing illness symptoms. These factors along with the global migration of immigrants accustomed to traditional medicine but now immersed in biomedical health care systems, has created potential for misunderstanding. Drug interactions for some forms of CAM taken with bio-medicine can occur. Insufficient scientific studies about CAM has reduced acceptance and educational opportunities to learn about CAM are limited. Ideas for policy and research are forming. (Global Health Promotion, 2009; 16 (4): pp. 65—68).

Schools across the world have been involved in health promotion and health education for nearly a century. Do school based initiatives make any difference to the education and health outcomes of young people? This article describes the process in developing the document Promoting health in schools: from evidence to action. The document was produced primarily for the Education sector. It develops an argument about why schools should be undertaking health related initiatives. It also highlights major findings from the literature about what is possible to achieve in school health and the circumstances under which the gains will occur. Attention is focused both on the evidence from the education sector, e.g. effective schools, learning and teaching approaches, and from the health sector, e.g. a whole of school or Health Promoting School (HPS) approach, as well as identifying outcomes from topic areas such as mental and emotional health, healthy eating and nutrition, physical activity, hygiene, sexual health and relationships, substance use and misuse. (Global Health Promotion, 2009; 16(4): pp. 69-71)

Tous les rapports qui se sont intéressés à l’articulation des politiques sanitaires nationales au niveau régional et local, à la rencontre des décideurs et des acteurs nationaux et locaux font tous ressortir la complexité de cette entreprise où se côtoient, s’enchevêtrent et se concurrencent de multiples niveaux décisionnels, et dispositifs de mise en œuvre des politiques et des actions. Cet intérêt pour le local comme lunette pour réfléchir et organiser l’action trouve aussi un écho dans la recherche. Depuis une vingtaine d’années, plusieurs équipes de disciplines variées ont tenté d’élucider comment les environnements sociaux façonnent la santé des individus et des populations et plus récemment, les inégalités sociales de santé. Dans cet article, les auteurs mettent en dialogue trois courants d’activités : 1) les efforts de réflexion des praticiens et des chercheurs de la francophonie ; 2) la recherche portant sur les lieux et la santé ; et 3) l’expérience globale concernant l’approche d’interventions sur les milieux de vie. Ce dialogue met en évidence le fait que dans beaucoup de pays l’approche territoriale de la programmation sanitaire en est encore à l’état d’expérimentation, quand, chez d’autres, elle est bien implantée. Cette approche reflète le souci de prendre en compte l’ensemble des déterminants de la santé, d’accorder une place importante aux environnements, d’être au plus proche de la préoccupation des personnes, de permettre une meilleure offre de service, d’optimiser les ressources disponibles et de lutter contre les inégalités. La décentralisation s’inscrit dans une culture dont il faut tenir compte avant d’en importer le modèle, car la diversité des acteurs d’horizon (santé, économique et social) et de culture (clinique, santé publique, planificateurs, professionnels de terrain, chercheurs) différents rend l’exercice riche mais extrêmement complexe. Ceci souligne l’importance de poursuivre des échanges entre différentes structures et différents pays. Le rôle de l’Union internationale de Promotion de la Santé et d’Éducation pour la Santé (UIPES) en tant que réseau mondial dont la mission est précisément de faciliter cette réflexion, la recherche, le partage et l’apprentissage des savoirs, des expériences et de l’expertise est à ce titre essentiel. (Global Health Promotion, 2009; 16 (4): pp. 75—82)