This chapter provides insights into the complex and adaptive nature of systems and illustrates key characteristics of such systems. These contribute to an understanding of the challenges in health promotion and imply a need for more context-specific research to evaluate the health promotion interventions. CARA can address this need as it can be used to evaluate and support change in complex adaptive systems. To support and inspire other health promotion researchers who want to adopt CARA as their research approach, we have discussed our experiences and provided some guiding principles. Overall, complexity thinking can help to understand the challenges in health promotion, whereby CARA provides a possible strategy for health promotion researchers when dealing with the challenges of evaluating health promotion interventions in complex adaptive systems.
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Objectives Most complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions. Methods A scoping review was conducted using the Arksey and O’Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics,level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting. Results Among 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results. Conclusion SNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.
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The use of growth monitoring and promotion (GMP) has become widespread. It is a potential contributor towards achieving the Millennium Development Goals of halving hunger and reducing child mortality by two-thirds within 2015. Yet, GMP appears to be a prerequisite for good child health but several studies have shown that there is a discrepancy between the purpose and the practice of GMP. The high prevalence of malnutrition in many developing countries seems to confirm this fact. A descriptive qualitative study was carried out from April to September 2011. Focus group discussions and in-depth interviews were conducted amongst mothers and health workers. Data were analyzed using a qualitative content analysis technique, with the support of ATLAS.ti 5.0 software. The results suggest that most mothers were aware of the need for regular weight monitoring while health workers also seemed to be well-aware and to practise GMP according to the international guidelines. However, there was a deficit in maternal knowledge with regard to child-feeding and a lack of basic resources to keep and/or to buy healthful and nutritionally-rich food. Furthermore, the role of the husband was not always supportive of proper child-feeding. In general, GMP is unlikely to succeed if mothers lack awareness of proper child-feeding practices, and if they are not supported by their husbands.
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Background: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication.
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Reducing health inequalities is a policy priority in many developed countries. Little is known about effective strategies to reduce inequalities in obesity and its underlying behaviors. The goal of the study was to investigate differential effectiveness of interventions aimed at obesity prevention, the promotion of physical activity or a healthy diet by SES.Evidence acquisition: Subgroup analyses in 2010 and 2011 of 26 Dutch studies funded by The Netherlands Organization for Health Research and Development after 1990 (n=17) or identified by expert contact (n=9). Methodologic quality and differential effects were synthesized in harvest plots, subdivided by setting, age group, intensity, and time to follow-up.Evidence synthesis: Seven lifestyle interventions were rated more effective and four less effective in groups with high SES; for 15 studies no differential effects could be demonstrated. One study in the healthcare setting showed comparable effects in both socioeconomic groups. The only mass media campaign provided modest evidence for higher effectiveness among those with high SES.Individually tailored and workplace interventions were either more effective in higher-SES groups (n=4) or no differential effects were demonstrated (n=9). School-based studies (n=7) showed mixed results. Two of six community studies provided evidence for better effectiveness in lower-SES groups; none were more effective in higher-SES groups. One high-intensity community-based study provided best evidence for higher effectiveness in low-SES groups.Conclusions: Although for the majority of interventions aimed at obesity prevention, the promotion of physical activity, or a healthy diet, no differential effectiveness could be demonstrated, interventions may widen as well as reduce socioeconomic inequalities in these outcomes. Equityspecific subgroup analyses contribute to needed knowledge about what may work to reduce socioeconomic inequalities in obesity and underlying health behaviors.
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Mental health literacy (MHL) interventions in secondary schools may help to improve competencies that adolescents require to stay mentally healthy and seek help if mental health problems arise. These MHL interventions should be tailored to the needs of adolescents and educational professionals (EPs) to reach sustainable implementation and long-term effectiveness. However, evidence is lacking on these needs. Thus, our aim was to explore their experiences with, and perspectives on, mental health help seeking and needs regarding MHL interventions. We performed online focus group discussions and interviews with adolescents (n = 21; 13–19 years) and EPs (n = 12) and analyzed the data using directed content analysis. We identified three themes related to mental health help seeking: (1) Limited MHL competencies of adolescents, (2) Limited competencies of EP to provide mental health support, and (3) Limited mental health promotion in the school environment. We further identified three themes regarding MHL interventions: (1) Addressing basic mental health knowledge and skills, (2) Interactive and easily accessible, and (3) Sustainable implementation. Improving the MHL competencies of adolescents and EPs, and creating a mental health-literate school environment can promote adolescents’ mental health help seeking. Our findings highlight the importance of developing MHL interventions that are tailored to both adolescents’ and EPs needs.
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Diet related non-communicable diseases (NCDs), as well as micronutrient deficiencies, are of widespread and growing importance to public health. Authorities are developing programs to improve nutrient intakes via foods. To estimate the potential health andeconomic impact of these programs there is a wide variety of models. The aim of this review is to evaluate existing models to estimate the health and/or economic impact of nutrition interventions with a focus on reducing salt and sugar intake andincreasing vitamin D, iron, and folate/folic acid intake. The protocol of this systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42016050873). The final search was conducted onPubMed and Scopus electronic databases and search strings were developed for salt/sodium, sugar, vitamin D, iron, and folic acid intake. Predefined criteria related to scientific quality, applicability, and funding/interest were used to evaluate the publications. In total 122 publications were included for a critical appraisal: 45 for salt/sodium, 61 for sugar, 4 for vitamin D, 9 for folic acid, and 3 for iron. The complexity of modelling the health and economic impact of nutrition interventions is dependent on the purpose and data availability. Although most of the models have the potential to provide projections of future impact, the methodological challenges are considerable. There is a substantial need for more guidance and standardization for future modelling, to compare results ofdifferent studies and draw conclusions about the health and economic impact of nutrition interventions.
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SAMENVATTING Mensen met een ernstige psychiatrische aandoening (EPA) hebben een sterk verminderde levensverwachting in vergelijking met de algemene populatie, vooral veroorzaakt door fysieke aandoeningen. Een ongezonde leefstijl speelt een belangrijke rol in de verminderde levensverwachting bij mensen met EPA. Ter bevordering van de fysieke gezondheid van deze doelgroep is de nurse-led e-health-interventie GILL (Gezondheid in Lichaam en Leefstijl) ontwikkeld voor somatische screening en het stimuleren van een gezonde(re) leefstijl. Door het uitvoeren van een cluster-gerandomiseerde studie (RCT) wordt onderzocht of de GILL e-health-interventie effectiever is dan de standaardzorg in het verbeteren van de fysieke gezondheid en leefstijl van mensen met EPA. De primaire uitkomstmaat van deze studie is de score voor de ernst van het metabool syndroom. Naast de RCT wordt een procesevaluatie uitgevoerd om de implementatie en de ervaringen van zowel de deelnemende cliënten als de hulpverleners met de GILLinterventie systematisch te evalueren.
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This exploratory study aims to obtain a first impression of the wishes and needs of employees on the use of wearables at work for health promotion. 76 employ-ees with a mean age of 40 years old (SD ±11.7) filled in a survey after trying out a wearable. Most employees see the potential of using wearable devices for workplace health promotion. However, according to employees, some negative aspects should be overcome before wearables can effectively contribute to health promotion. The most mentioned negative aspects were poor visualization and un-pleasantness of wearing. Specifically for the workplace, employees were con-cerned about the privacy of data collection.
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Mental health is important for business. In the 21st century the mental health and well-being of your employees is crucial to the success of your organisation. But, how should you as an employer start to address mental health issues in your workplace? And what activities and policies do you need to set in place? In a European campaign work. in tune with life. move europe, the European Network for Workplace Health Promotion (ENWHP) has taken the initiative to help promote mental health in workplaces. This mental health promotion campaign aims to raise awareness amongst both employers and employees
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