Dataset Information

A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH).

ABSTRACT: BACKGROUND:Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The aim of this study was to evaluate if the operational program improved implementation of CHP in clinical hospital departments, as measured by health status of patients and staff, frequency of CHP service delivery, and standards compliance. METHODS:Forty-eight hospital departments were recruited via open call and stratified by country. Departments were assigned to the operational program (intervention) or usual routine (control group). Data for analyses included 36 of these departments and their 5285 patients (median 147 per department; range 29-201), 2529 staff members (70; 10-393), 1750 medical records (50; 50-50), and standards compliance assessments. Follow-up was measured after 1 year. The outcomes were health status, service delivery, and standards compliance. RESULTS:No health differences between groups were found, but the intervention group had higher identification of lifestyle risk (81% versus 60%, p?

SUBMITTER: Svane JK

PROVIDER: S-EPMC6304000 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH).

Svane Jeff Kirk JK Chiou Shu-Ti ST Groene Oliver O Kalvachova Milena M Brkić Mirna Zagrajski MZ Fukuba Isao I Härm Tiiu T Farkas Jerneja J Ang Yen Y Andersen Mikkel Østerheden MØ Tønnesen Hanne H

Implementation science : IS 20181222 1

<h4>Background</h4>Implementation of clinical health promotion (CHP) aiming at better health gain is slow despite its effect. CHP focuses on potentially modifiable lifestyle risks such as smoking, alcohol, diet, and physical inactivity. An operational program was created to improve implementation. It included patients, staff, and the organization, and it combined existing standards, indicators, documentation models, a performance recognition process, and a fast-track implementation model. The ai ...[more]

PMID: 30577871

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Project description:BackgroundThis pilot study aimed to test the potential effectiveness and acceptability of an intervention to support the implementation of 16 recommended policies and practices to improve the health promotion environment of junior sporting clubs. Reported child exposure to health promoting practices at clubs was also assessed.MethodsA cluster randomised trial was conducted with eight football leagues. Fourty-one junior football clubs belonging to four leagues in the intervention group received support (e.g. physical resources, recognition and rewards, systems and prompts) to implement 16 policies and practices that targeted child exposure to alcohol, tobacco, healthy food and beverages, and participation in physical activity. Thirty-eight clubs belonging to the four control group leagues did not receive the implementation intervention. Study outcomes were assessed via telephone interviews with nominated club representatives and parents of junior players. Between group differences in the mean number of policies and practices implemented at the club level at follow-up were examined using a multiple linear regression model.ResultsWhile the intervention was found to be acceptable, there was no significant difference between the mean number of practices and policies reported to be implemented by intervention and control clubs at post-intervention (Estimate - 0.05; 95% CI -0.91, 0.80; p = 0.90). There was also no significant difference in the proportion of children reported to be exposed to: alcohol (OR 1.16; 95% CI 0.41, 3.28; p = 0.78); tobacco (OR 0.97; CI 0.45, 2.10; p = 0.94); healthy food purchases (OR 0.49; CI 0.11, 2.27; p = 0.35); healthy drink purchases (OR 1.48; CI 0.72, 3.05; p = 0.27); or participation in physical activity (OR 0.76; CI 0.14, 4.08; p = 0.74).ConclusionsSupport strategies that better address barriers to the implementation of health promotion interventions in junior sports clubs are required.Trial registrationRetrospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12617001044314 ).

Project description:BACKGROUND:The South Asian population in Canada is growing and has elevated risk of cardiovascular disease and diabetes. This study sought to adapt an evidence-based community risk assessment and health promotion program for a South Asian community with a large proportion of recent immigrants. The aims were to assess the feasibility of implementing this program and also to describe the rates of cardiometabolic risk factors observed in this sample population. METHODS:This was a feasibility study adapting and implementing the Community Paramedicine at Clinic (CP@clinic) program for a South Asian population in an urban Canadian community for 14?months. CP@clinic is a free, drop-in chronic disease prevention and health promotion program implemented by paramedics who provide health assessments, health education, referrals and reports to family doctors. All adults attending the recreation centre and temple where CP@clinic was implemented were eligible. Volunteers provided Hindi, Punjabi and Urdu translation. The primary outcome of feasibility was evaluated using quantitative process measures and a qualitative key informant interview. For the secondary outcome of cardiometabolic risk factor, data were collected through the CP@clinic program risk assessments and descriptively analyzed. RESULTS:There were 26 CP@clinic sessions held and 71 participants, predominantly male (56.3-84.6%) and South Asian (87.3-92.3%). There was limited participation at the recreation centre (n?=?19) but CP@clinic was well-attended when relocated to the local Sikh temple (n?=?52). Having the volunteer translators was critical to the paramedics being able to collect the full risk factor data and there were some challenges with ensuring enough volunteers were available to staff each session; as a result, there were missing risk factor data for many participants. In the 26 participants with complete or almost complete risk factor data, 46.5% had elevated BP, 42.3% had moderate/high risk of developing diabetes, and 65.4% had an indicator of cardiometabolic disease. CONCLUSION:Implementing CP@clinic in places of worship is a feasible approach to adapting the program for the South Asian population, however having a funded translator in addition to the volunteers would improve the program. Also, there is substantial opportunity for addressing cardiometabolic risk factors in this population using CP@clinic.

Project description:BackgroundA healthy start predicts better health in later life. Many remote-living Aboriginal and Torres Strait Islander Australian families lack access to consistent, culturally-safe health services. This paper presents a study of implementation of the Baby One Program (BOP). The BOP was designed as a family-centred, Indigenous Healthworker-led, home-visiting model of care focused on promoting family health to give children the best start to life. It was developed by Aboriginal community-controlled Apunipima Cape York Health Council and delivered in Queensland Cape York remote communities. We aimed to determine how the BOP was implemented, enablers, strategies used and formative implementation outcomes.MethodsThe qualitative approach utilised theoretical and purposive sampling to explore people's experiences of a program implementation process. Data were generated from semi-structured interviews with four family members enrolled in the BOP and 24 Apunipima staff members. In addition, twenty community members, including two program users, participated in a men's community focus group. The findings are presented according to themes arising from the data.ResultsThe BOP was rolled out in nine remote Cape York communities between July 2014 and December 2015 and there was high uptake. Indigenous Healthworkers were supported by midwives and maternal and child health nurses to deliver health education to 161 eligible families. The key to effective implementation of family-centred care appeared to be the relationships formed between health practitioners, especially Indigenous Healthworkers, and families. The data revealed the following themes: challenging environments for new families and valuing cultural ways, resourcing program delivery, working towards a team approach, negotiating the cultural interface, engaging families, exchanging knowledge through 'yarning', strengthening the workforce, and seeing health changes in families. Healthworker education and training, and knowledge exchange between Healthworkers, midwives and nurses was critical to program effectiveness. The program continues to grow despite substantial logistic, financial and practical challenges.ConclusionsThis study describes an evolving process and explores how health providers connect with families and how the program responds to family and cultural issues. Program development is ongoing; strengthened by more community-level involvement, embedded strategies for ongoing self-evaluation and continuous quality improvements that are responsive to family needs.

Project description:BackgroundObesity is a major public health crisis in Latino youth. Mounting evidence implicates stress in the development and maintenance of obesity. This study examined the feasibility and acceptability of having community health workers, i.e., promotoras, deliver Adaptando Dieta y Acción Para Todos (ADAPT)+, a family-based health promotion program integrating mindfulness strategies for stress reduction to underserved Latino families in rural communities.MethodsIn an ORBIT model Phase IIb longitudinal quasi-cluster feasibility study, promotoras delivered the 6-session ADAPT+ intervention and 1-session Enhanced Usual Care (EUC) in rural Florida. Feasibility was assessed via sample size and recruitment, randomization by community, data collection completion, and intervention fidelity. Acceptability was assessed via participant retention and program satisfaction. Effect sizes of differences in parent stress and mindful eating between conditions at baseline, end of treatment, and 3-month follow-up were calculated.ResultsFeasibility and acceptability were demonstrated. The recruitment target was 99% met (n = 95 recruited). Randomization was limited to site level due to coronavirus disease 2019-related challenges. Data collection procedures were feasible (100% completion). Retention was 86% at post-assessment and 82.6% at 3-month follow-up. All sessions were completed (100% fidelity). Mean program satisfaction was 3.91/4.00. ADAPT+ parents reported lower stress (difference = -3.04, medium-to-large effect, d = .70) and more mindful eating (difference = 2.00, medium effect, d = .44) than EUC parents at 3-month follow-up.ConclusionStudy implementation and intervention delivery to rural Latino families using promotoras were feasible and acceptable. Promising findings regarding parent stress and mindful eating support a larger (ORBIT Phase III) efficacy trial.Clinical trial registrationThis trial was registered with ClinicalTrials.gov under identifier NCT04800432.

Project description:BACKGROUND:There are inequities in health status associated with ethnicity, which may limit older foreign-born persons' ability to age optimally. Health promotion for older persons who have experienced migration is thus an area of public health importance. However, since research related to this issue is very limited, the study 'Promoting Aging Migrants' Capabilities' was initiated to improve our understanding. The study aims to implement and evaluate a linguistically adapted, evidence-based, health-promoting intervention with a person-centred approach for two of the largest groups of aging persons who have migrated to Sweden: persons from Finland and persons from the Balkan Peninsula. METHODS/DESIGN:This study has a descriptive, analytical, and experimental design. It is both a randomised controlled trial and an implementation study, containing the collection and analysis of both qualitative and quantitative data. The setting is an urban district in a medium-sized Swedish city with a high proportion of persons who were born abroad and whose socio-economic status is low. The intervention comprises four group meetings ('senior meetings') and one follow-up home visit made by a multi-professional team. For the randomised controlled trial, the plan is to recruit at least 130 community-dwelling persons 70 years or older from the target group. Additional persons from involved organisations will participate in the study of the implementation. Both the intervention effects in the target group (outcome) and the results of the implementation process (output) will be evaluated. DISCUSSION:The results of this forthcoming randomised controlled trial and implementation study may be useful for optimising implementation of person-centred, health-promoting initiatives for older persons who have experienced migration. It is also hoped that this combined study will show that the capabilities for optimal aging among older persons born in Finland and the Balkan countries can be improved in the Swedish healthcare context. TRIAL REGISTRATION:The trial was registered at ClinicalTrials.gov April 10, 2013, identifier: NCT01841853.

Project description:Problems in infant mental health such as the ability to experience, regulate, and express emotional states is expressed in behavioral problems like excessive crying, feeding, and sleeping problems. Parenting programs are popular but their effectiveness on infant mental health remains uncertain. Possibly, because recent studies have focused only on parental and parent-child measures while they miss to assess infant behavioral measures. The goal of this pilot study is to fill in this gap by assessing infantile behavioral measures. We investigated the acceptance and first indicators of efficacy of the universal group parenting training Baby Triple P (BTP) compared to a care as usual (CAU) control condition focusing on early behavioral problems. In all, 49 couples were randomly allocated to receive either eight BTP sessions before birth and per telephone after birth or to take part in CAU. Infant behavior was assessed with a diary and a structured diagnostic interview. Parental self-report measures of partnership quality and parental competence were assessed before birth, 10 weeks after birth and at 6-month follow-up. Since the parent training was conducted before the birth of the child, the child's mental health could not be assessed before the parent training. Thus, for this variable no within measurement (pre-post) could be carried out and intention-to-treat analysis was not possible. However, a between group analysis comparing BTP against CAU took place to assess effectiveness of BTP on children's mental health. Mothers and fathers rated the program as feasible and relevant. Results indicate significant group differences in crying behavior 6 months after birth to the benefit of the intervention group. No beneficial outcomes were found for feeding and sleeping problems in infants or partnership quality, parental sense of competence in parents. Due to an unrepresentative high level of education of the participating parents and the small sample size, these findings can be considered preliminary. Nevertheless, these results allow to further investigate the effectivity of BTP in large-scale clinical trials. Behavioral diaries or diagnostic interviews for early mental health problems should be routinely implemented in randomized controlled trials (RCTs) in order not to miss possible behavioral changes in infants. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02313493.

Dataset Information

A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH).

Publications

A WHO-HPH operational program versus usual routines for implementing clinical health promotion: an RCT in health promoting hospitals (HPH).

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