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Our games our health: a cultural asset for promoting health in indigenous communities.

ISSUE ADDRESSED: Indigenous Australians have higher morbidity and mortality rates than non-Indigenous Australians. Until recently, few health promotion interventions have had more than limited success in Indigenous populations. METHODS: This community-based health promotion initiative introduced traditional Indigenous games into schools and community groups in Cherbourg and Stradbroke Island (Queensland, Australia). A joint community forum managed the project, and the Indigenous community-based project officers co-ordinated training in traditional games and undertook community asset audits and evaluations. RESULTS: The games have been included in the activities of a range of community organisations in Cherbourg and Stradbroke Island. Several other organisations and communities in Australia have included them in their projects. A games video and manual were produced to facilitate the initiative's transferability and sustainability. CONCLUSIONS: Conventional approaches to health promotion generally focus on individual risk factors and often ignore a more holistic perspective. This project adopted a culturally appropriate, holistic approach, embracing a paradigm that concentrated on the communities' cultural assets and contributed to sustainable and transferable outcomes. There is a need for appropriate evaluation tools for time-limited community engagement projects.

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Participation in workplace health promotion programs: the contribution of health and organizational factors.

Interest in workplace health promotion programs has raised important questions regarding these programs' ability to attract participants. Typically, participation has been examined as a function of personal characteristics of employees. But participation in a workplace health promotion program may be influenced as much by organizational characteristics as by health-related characteristics of employees. This preliminary study, conducted at AT&T Communications, used path analysis, a statistical technique for controlling for the effects of causally prior variables, to develop a model of participation. The influence of three sets of factors was detected: (1) Sex of employee was significant, with women more likely than men to participate in the program, (2) Increased perceived risk of illness led to decreased health satisfaction which in turn led to increased intention to change health habits culminating in increased participation, and (3) The organizational climate factor of perceived supportiveness of the supervisor contributed to participation. While several potential limitations require that these findings be replicated and extended, the study suggests that developers of workplace health promotion programs should attend to organizational work climate as well as personal health characteristics of employees in an effort to increase program impact.

Adult↗

Health promotion and managed care: surveys of California's health plans and population.

INTRODUCTION: The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competitive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans. METHODS: A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs. RESULTS: California's HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%-3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%-45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs. CONCLUSION: For the majority of California's PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.

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Application of health promotion theories and models for environmental health.

The field of environmental health promotion gained new prominence in recent years as awareness of physical environmental stressors and exposures increased in communities across the country and the world. Although many theories and conceptual models are used routinely to guide health promotion and health education interventions, they are rarely applied to environmental health issues. This article examine show health promotion theories and models can be applied in designing interventions to reduce exposure to environmental health hazards. Using the Community Action Against Asthma (CAAA) project as an example, this article describes the application of these theories and models to an intervention aimed at reducing environmental triggers for childhood asthma. Drawing on the multiple theories and models described, a composite ecological stress process model is presented, and its implications for environmental health promotion discussed.

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Selling health promotion programs: recommendations for occupational health nurses.

1. Although some suggest that health promotion programs should not be conducted in the workplace, there is generally strong support for workplace programs by both the public and private sectors. 2. Many published reports of cost savings attributed to health promotion programs are available. The calculations of cost savings contain many flaws and generally do not reflect a comprehensive analysis of all costs associated with programs, especially those associated with changes in death rates and longevity. 3. Specific recommendations for occupational health nurses include: analysis of the corporate situation; integration of programs with occupational health and safety activities; involvement of all levels of workers in planning and promoting the programs; evaluation through employee participation and satisfaction, not by cost benefit analysis; and consideration of offering programs to family members. 4. Nursing as a whole should provide leadership for implementing programs to promote health and prevent disease. The worksite offers unique opportunities for occupational health nurses to implement the Healthy People 2000 objectives to enhance the health of working adults.

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