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Student participation: a democratic education perspective--experience from the health-promoting schools in Macedonia.

The paper addresses the issue of student participation from the perspective of the health-promoting schools initiative. It draws on experience from the Macedonian Network of Health-Promoting Schools and its collaboration with the Danish as well as other country networks within the European Network of Health-Promoting Schools. Student participation is viewed as one of the main focal points of the conceptual framework and model of a health-promoting school developed within the Macedonian context. This model and the model distinguishing between two different qualities of participation-genuine and token participation-are presented and discussed in the paper. Underpinning values that these models endorse as important for the processes of health promotion in schools include self-determination, participation, democracy, diversity and equity.

Adolescent↗

Assessment of the integration of the ecological approach in health promotion programs.

PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.

Canada↗

Role of trade unions in workplace health promotion.

Since the 19th century, workers have organized in trade unions and parties to strengthen their efforts at improving workplace health and safety, job conditions, working hours, wages, job contracts, and social security. Cooperation between workers and their organizations and professionals has been instrumental in improving regulation and legislation affecting workers' health. The authors give examples of participatory research in occupational health in Denmark and Finland. The social context of workplace health promotion, particularly the role of unions and workers' safety representatives, is described in an international feasibility study. Health promotion is rife with fundamental political, socioeconomic, philosophical, ethical, gender- and ethnicity-related, psychological, and biological problems. Analysis of power and context is crucial, focusing on political systems nationally, regionally, and globally. The authors advocate defending and supporting workers and their trade unions and strengthening their influence on workplace health promotion. In the face of rapid capitalist globalization, unions represent a barricade in defense of workers' health and safety. Health promoters and related professionals are encouraged to support trade unions in their efforts to promote health for workers and other less privileged groups.

Attitude to Health↗

Hospital health promotion: swimming or sinking in an upstream business?

Healthy People 2000 (HP 2000) calls on hospitals to offer health promotion programs addressing priority health needs of the community. Historically, this upstream initiative has not been present in health care. With the increasing provision of these programs, this case study examined their content to further understand potential public health impact. The health promotion programs offered to the community--both the general public and corporate employees--by an urban Midwest hospital were assessed over 1 year. This article presents a content analysis of 216 programs that was conducted by measuring seven variables: target group, presentation format, fee, health focus, program providers, contact frequency, and activity. Based on this single case study, hospitals appear to be addressing objectives set forth by HP 2000 for community hospitals. Although moving upstream with health promotion, an analysis of program content suggests modifications may be necessary in order to serve as effective interventions for health priorities.

Academic Medical Centers↗

Identifying problems in community health promotion: an illustration of the Nominal Group Technique in AIDS education.

Recognition of the extent and consequences of HIV/AIDS in Africa has resulted in many large scale health promotion programmes. These programmes usually provide information about how to avoid contracting HIV as well as information to dispel false beliefs about the virus. However there also exist anti-health promotion ideas about HIV/AIDS which often challenge the very premises on which health promotion messages are based. Such anti-health promotion ideas may represent reassuring benefits and these are likely to vary not only across cultures but also between different communities and 'at risk' groups within the same culture. The Nominal Group Technique (NGT) is a participative exercise which can be used with small groups to achieve a consensus concerning which anti-health promotion ideas are most influential in terms of encouraging people to ignore health promoting messages. The application of the NGT is illustrated with a group of Malawian students.

Adult↗

A framework for health promotion services for people with psychiatric disabilities.

The concepts of wellness and its complement, health promotion, have popularized the notion that health itself is more than simply the absence of disease. Furthermore, the wellness concept has advanced the idea of the importance of engaging in certain health promoting behaviors within healthy environments, not simply for the purpose of preventing or better managing a disease, but also to enhance one's well-being and quality of life (Green & Kreuter, 1991; Mullen, 1986). Encouraging this emphasis on wellness is Healthy People 2010 (U.S. Department of Health and Human Services, 2000), a national ten-year plan intended to increase quality and years of life and eliminate disparities which for the now features a new area that recognizes the importance of health promotion and disease prevention in the lives of people with disabilities. Increasingly, the value of promoting wellness--including for people with disabilities--is being recognized (Rimmer & Braddock, 2002).

Attitude to Health↗

An explanatory model of health promotion and quality of life for persons with post-polio syndrome.

Although previous studies have examined selected factors influencing health promoting behaviors or quality of life, the complex interplay of these variables in persons with different chronic disabling conditions has not been investigated. This study tested an explanatory model of variables influencing health promotion and quality of life originally developed with a sample of persons with multiple sclerosis in a new sample of persons living with post-polio syndrome (PPS) in the USA. The sample of 1603 persons with PPS (1123 females, 478 males and 2 unknown) completed a battery of instruments including measures of severity of polio-related impairment, barriers to health promoting behaviors, resources, self-efficacy, acceptance, health promoting behaviors and perceived quality of life. A model originally developed in a sample of 786 persons with multiple sclerosis was assessed and modified using the weighted least squares procedure (WLS) which is implemented by LISREL8. The structural equation analyses resulted in a proper solution that exhibited adequate fit: chi2 (8, N = 1549)=84.22, p<0.05; GFI=0.96, IFI=0.90, CFI=0.90. The antecedent variables accounted for 65% of the variance in the frequency of health promoting behaviors and 53% of the variance in perceived quality of life. The model test supports the hypothesis that quality of life is the outcome of a complex interplay between contextual factors (severity of impairment), antecedent variables, and health promoting behaviors. It also suggests that the relationships among these variables are similar in samples of persons with two different chronic conditions. Further research using a qualitative approach is needed to clarify other contributors to quality of life in persons with post-polio syndrome.

Activities of Daily Living↗

[Mental health promotion and prevention of mental diseases: are there population-based concepts? Looking abroad].

BACKGROUND: The rising public health relevance of mental health requires increased activities in the field of mental health promotion and prevention. In recent times interest in this sphere increases in Germany. OBJECTIVE: Which kinds of population-based mental health promotion programmes and prevention approaches are internationally available? What can be learned from their example? METHOD: Systematic search of the Internet and literature databases. Analysis and comparison of the available mental health promotion and prevention concepts with regard to targets, sub-targets, target groups, protagonists, settings, outcome indicators and evidence management. RESULTS: Concepts for mental health promotion and prevention programmes exist in England, Australia, the European Union and in Quebec, Canada. The concepts show similarities such as choosing similar settings like work place and schools or similar target groups like caretakers or adults in particular challenging life circumstances. CONCLUSIONS: Concepts for population-based mental health promotion and prevention have been created in some countries. For developing such programmes in Germany one should refer to internationally available experience as well as to own gathered experiences as to own expressions gathered pilot projects and the German Health Target Programme.

Australia↗

Determinants of health-promoting lifestyle behaviors in rural older women.

The purpose of this study was to: (a) describe the health-promoting lifestyle behaviors and attempts at change among 102 community-dwelling rural women aged 65 and older, and (b) determine the extent to which personal influences (demographics, definition of health, and perceived health status) and contextual influences (sources of health information and provider counseling) explain health-promoting lifestyle behaviors and attempts at change among those women. They scored highest on frequency of nutrition behaviors and lowest on frequency of physical activity behaviors. They had attempted change in from zero to five areas of health-promoting lifestyle within the past year. Multiple regression analyses revealed that younger age, living with other(s), defining health as wellness, better perceived mental health, more sources of health information and provider counseling were significantly associated with health-promoting lifestyle behaviors. Only younger age and more sources of health information were significantly associated with attempts at change. These findings provide information that is relevant in designing interventions to enhance health-promoting lifestyle behaviors among rural older women.

Aged↗

The hospital health-promotion facilitator: an evaluation.

This 1-year study tested the transferability of the Primary Care Facilitator model to the hospital setting, and was designed to assess and enhance existing hospital health-promotion activity. From work with nurses on three wards in an acute general hospital, the Primary Health Care model was found to be appropriate for the hospital setting. There were demonstrable changes in attitudes to health promotion and an increase in health-promotion activity. It now appears appropriate to evaluate the role of the hospital health-promotion facilitator on a wider basis. Areas for further research, beyond the scope of this particular project, should be the quality of the health-promotion activity and exploration of factors that encourage or inhibit utilization of health-promotion opportunities.

Education, Nursing, Continuing↗

[Health status, health perception, and health promotion behaviors of low-income community dwelling elderly].

PURPOSE: The purpose of the study was to investigate the health status(present illness, ADL and IADL), health perception, and health promotion behaviors of low-income elderly who are receiving the visiting nurse service in the community. METHOD: The sample of the study was 735 elderly over 65 years old with basic livelihood security, who were conveniently selected from 245 public health centers nation-wide. Data collection was done using a structured questionnaire through interviews by visiting nurses. RESULT: The average number of present illnesses in the study subjects was 4.18. The average scores of ADL and IADL were 15.903.39 and 9.772.97 respectively, which indicates a relatively independent everyday life. However, 64.2% of the subjects perceived their health status as 'not healthy'. In terms of health promotion behaviors, 77.8% of the subjects had ceased smoking, 83.9% stopped drinking, 56.4% had a regular diet, 45.8% received regular physical check-ups during the past two years, and 66% received flu shots. Approximately 50% of the subjects were practicing 3-4 health promotion behaviors. Significant factors associated with health promotion behaviors were ADL, IADL and self-efficacy. CONCLUSION: Health promotion programs which focus on regular diet, exercise, and regular physical check-ups should be developed to improve independence of everyday life and quality of life among low-income elderly.

Activities of Daily Living↗

Health promotion in hospitals: the attitudes, beliefs and practices of hospital nurses.

This research paper explores the attitudes, beliefs and health promotion practices of hospital nurses working on acute adult wards, as demonstrated through the use of semi-structured postal questionnaires. Responses were compared with those from hospital-based occupational therapists, physiotherapists, dietitians and medical consultants, in order to examine issues of consistency and continuity between professional groups and their interaction with patients in relation to health promotion activity. The nurses are considered both as a homogeneous group and also in relation to their seniority within the profession. Results demonstrate the lack of a coherent health promotion strategy within acute care settings and highlight the differing educational needs of nurses according to their professional role within the hospital. By addressing these issues, a strategy can be developed to enhance health promotion in hospital by building on the concerns and needs identified by the nurses themselves. Research literature and analysis of this study demonstrate that whilst the current position of health promotion in hospital is generally poor, nurses are keen to integrate health promotion into their practice.

Acute Disease↗

Worksite health promotion programs in the U.S.: factors associated with availability and participation.

PURPOSE: To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. DESIGN: Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. SUBJECTS: Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. MEASURES: Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. RESULTS: Smoking cessation programs had the highest mean availability (43%), followed by health education programs (31%) and screening tests (31%). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. CONCLUSIONS: Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.

Adult↗

Health-risk behaviors and health promotion in adolescent and young adult cancer survivors.

A diagnosis of cancer during adolescence, a period characterized by experimentation and risk-taking behaviors, has the potential to derail critical developmental tasks required for successful transition into adulthood. Health professionals caring for adolescents and young adults have an opportunity to influence behavioral practices by correcting knowledge deficits, addressing factors that enhance the survivor's sense of vulnerability to health problems, and providing personalized health counseling that encourages the practice of health promoting behaviors. The approach to health counseling in childhood cancer survivors should consider their unique educational needs related to their cancer experience. Previous investigations of adolescent and young adult survivor health behavior indicate that survivors perceive themselves as more vulnerable to health problems than their peers without cancer and recognize a need to protect their health. However, these perceptions of health vulnerability do not always correlate with health promoting behavioral practices, suggesting that factors other than health perceptions should be investigated to motivate behavioral change. Very few studies have been undertaken to prospectively evaluate the effectiveness of health promotion programs in adolescent and young adult survivors of cancer. The scarcity of knowledge in the issue of health promotion after childhood cancer underscores the need for more research to define 1) the optimal timing of health counseling; 2) the influence of developmental status and neurocognitive function; 3) the most effective methods and venues for health education; 4) the feasibility and cost-effectiveness of health promotion strategies; and 5) psychosocial and economic impediments to practice of healthy behaviors.

Adolescent↗

[Health promotion of the elderly: a conceptual matter].

Although community health nurses have to face the increasing needs in curative and palliative care, they still engage in health promotion activities for the elderly, mainly cognitive and behavioural ones. The Quebec community health nurses who choose the McGill model of nursing, are able to integrate health promotion interventions in their daily practice with old aged people. In fact, this model helps these nurses consider the elderly, health, sickness and nursing care in a way that makes them promote self-esteem, empowerment, development and coping through most of their interventions. Moreover, the elderly population would benefit from an increased implication of nurses in ecological, environmental and community health promotion projects.

Adaptation, Psychological↗

[Worker's health surveillance and health promotion: similarities and challenges].

This paper discusses the possible similarities between worker's health surveillance practices and the health promotion approach, as well as the differences and challenges of worker's health surveillance vis- -vis this other public health concept, seeking to reflect on the pertinence, relevance, and feasibility of the health promotion perspective for Worker's Health. The author contends that there are many theoretical and methodological points in common between the two approaches and raises the need for Worker's Health Surveillance to incorporate Health Promotion activities more effectively in order to make Worker's Health Surveillance activities more effective and consolidate itself as a public health field.

Health Promotion↗

Health promotion approaches to occupant protection: an epidemiologic framework.

The size of the problem, the potential for prevention, and the Nation's prevention priorities all support public health action to prevent injuries. A balanced approach to this problem should include both environmental and health promotion strategies. Centers for Disease Control (CDC) is encouraging development of health promotion capability at the community level; the approach bases planning and implementation of programs on epidemiologic analysis to define the problem. Behavioral risk factor surveillance data will help states and communities establish baselines and determine priorities. Baseline data from the state-based surveillance system illustrate risk levels of motor vehicle occupants, e.g., 58% of adults report "seldom" or "never" using seat belts, and one of every seven males ages 18-34 report driving after having too much to drink. A health promotion plan developed by the Oakland County, Michigan, Health Department illustrates the use of these kinds of data as an epidemiologic framework; this plan identifies child passenger safety as a priority for action and establishes measurable objectives to reduce risk through health promotion programs. Health promotion includes not only interventions that support individual behavior change but also community change. By acquiring epidemiologic data and conveying it both to individuals and community decision makers, the public health community supports increased community efforts to protect occupants of motor vehicles.

Adolescent↗