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Background: In recent decades, financial investment has been made in health-related programs and services to overcome inequities and improve Indigenous people's wellbeing in Australia and New Zealand. Despite policies aiming to 'close the gap', limited evaluation evidence has informed evidence-based policy and practice. Indigenous leaders have called for evaluation stakeholders to align their practices with Indigenous approaches. Methods: This study aimed to strengthen culturally safe evaluation practice in Indigenous settings by engaging evaluation stakeholders, in both countries, in a participatory concept mapping study. Concept maps for each country were generated from multi-dimensional scaling and hierarchical cluster analysis. Results: The 12-cluster Australia map identifies four cluster regions: An Evaluation Approach that Honours Community; Respect and Reciprocity; Core Heart of the Evaluation; and Cultural Integrity of the Evaluation. The 11-cluster New Zealand map identifies four cluster regions: Authentic Evaluation Practice; Building Māori Evaluation Expertise; Integrity in Māori Evaluation; and Putting Community First. Both maps highlight the importance of cultural integrity in evaluation. Differences include the distinctiveness of the 'Respecting Language Protocols' concept in the Australia map in contrast to language being embedded within the cluster of 'Knowing Yourself as an Evaluator in a Māori Evaluation Context' in the New Zealand map. Participant ratings highlight the importance of all clusters with some relatively more difficult to achieve, in practice. Notably, the 'Funding Responsive to Community Needs and Priorities' and 'Translating Evaluation Findings to Benefit Community' clusters were rated the least achievable, in Australia. The 'Conduct of the Evaluation' and the 'Prioritising Māori Interests' clusters were rated as least achievable in New Zealand. In both countries, clusters of strategies related to commissioning were deemed least achievable. Conclusions: The results suggest that the commissioning of evaluation is crucial as it sets the stage for whether evaluations: reflect Indigenous interests, are planned in ways that align with Indigenous ways of working and are translated to benefit Indigenous communities Identified strategies align with health promotion principles and relational accountability values of Indigenous approaches to research. These findings may be relevant to the commissioning and conduct of Indigenous health program evaluations in developed nations. [ABSTRACT FROM AUTHOR]

This study sought to assess factors associated with quality of life (QoL), and predictive of improvements in QoL over time, in a population-based cohort study. A 4-year longitudinal survey was administered to 2433 individuals at the study baseline; of these, 1828 individuals participated in Wave 2, and 1303 participated in Wave 3. QoL was measured by the Satisfaction with Life Domains Scale. Thirty-two variables were correlated with baseline QoL and together explained 58.2% of the variance. Eleven variables were independent predictors of improvement in QoL over time. Among these variables, social support and stress/coping showed the strongest association with QoL, and neighbourhood characteristics had an additional influence. Multidimensional modelling of a broad spectrum of the factors related to QoL enabled situating mental health and well-being in an ecological system with attendant implications for public health and social policy intervention to facilitate improvement of QoL in the population. [ABSTRACT FROM AUTHOR]

Background: Several papers report deficiencies in the reporting of information about the implementation of interventions in clinical trials. Information about implementation is also required in systematic reviews of complex interventions to facilitate the translation and uptake of evidence of provider-based prevention and treatment programs. To capture whether and how implementation is assessed within systematic effectiveness reviews, we developed a checklist for implementation (Ch-IMP) and piloted it in a cohort of reviews on provider-based prevention and treatment interventions for children and young people. This paper reports on the inter-rater reliability, feasibility and reasons for discrepant ratings. Methods: Checklist domains were informed by a framework for program theory; items within domains were generated from a literature review. The checklist was pilot-tested on a cohort of 27 effectiveness reviews targeting children and youth. Two raters independently extracted information on 47 items. Inter-rater reliability was evaluated using percentage agreement and unweighted kappa coefficients. Reasons for discrepant ratings were content analysed. Results: Kappa coefficients ranged from 0.37 to 1.00 and were not influenced by one-sided bias. Most kappa values were classified as excellent (n = 20) or good (n = 17) with a few items categorised as fair (n = 7) or poor (n = 1). Prevalence-adjusted kappa coefficients indicate good or excellent agreement for all but one item. Four areas contributed to scoring discrepancies: 1) clarity or sufficiency of information provided in the review; 2) information missed in the review; 3) issues encountered with the tool; and 4) issues encountered at the review level. Use of the tool demands time investment and it requires adjustment to improve its feasibility for wider use. Conclusions: The case of provider-based prevention and treatment interventions showed relevancy in developing and piloting the Ch-IMP as a useful tool for assessing the extent to which systematic reviews assess the quality of implementation. The checklist could be used by authors and editors to improve the quality of systematic reviews, and shows promise as a pedagogical tool to facilitate the extraction and reporting of implementation characteristics. [ABSTRACT FROM AUTHOR]

Background: Several papers report deficiencies in the reporting of information about the implementation of interventions in clinical trials. Information about implementation is also required in systematic reviews of complex interventions to facilitate the translation and uptake of evidence of provider-based prevention and treatment programs. To capture whether and how implementation is assessed within systematic effectiveness reviews, we developed a checklist for implementation (Ch-IMP) and piloted it in a cohort of reviews on provider-based prevention and treatment interventions for children and young people. This paper reports on the inter-rater reliability, feasibility and reasons for discrepant ratings. Methods: Checklist domains were informed by a framework for program theory; items within domains were generated from a literature review. The checklist was pilot-tested on a cohort of 27 effectiveness reviews targeting children and youth. Two raters independently extracted information on 47 items. Inter-rater reliability was evaluated using percentage agreement and unweighted kappa coefficients. Reasons for discrepant ratings were content analysed. Results: Kappa coefficients ranged from 0.37 to 1.00 and were not influenced by one-sided bias. Most kappa values were classified as excellent (n = 20) or good (n = 17) with a few items categorised as fair (n = 7) or poor (n = 1). Prevalence-adjusted kappa coefficients indicate good or excellent agreement for all but one item. Four areas contributed to scoring discrepancies: 1) clarity or sufficiency of information provided in the review; 2) information missed in the review; 3) issues encountered with the tool; and 4) issues encountered at the review level. Use of the tool demands time investment and it requires adjustment to improve its feasibility for wider use. Conclusions: The case of provider-based prevention and treatment interventions showed relevancy in developing and piloting the Ch-IMP as a useful tool for assessing the extent to which systematic reviews assess the quality of implementation. The checklist could be used by authors and editors to improve the quality of systematic reviews, and shows promise as a pedagogical tool to facilitate the extraction and reporting of implementation characteristics. [ABSTRACT FROM AUTHOR]

Background Ecological intervention programs are recommended to prevent overweight and obesity in children. The National Institute of Public Health (INSP) in Mexico implemented a successful ecological intervention program to to promote healthy lifestyle behaviors in school age children. This study assessed the integration of ecological principles and Social Cognitive Theory (SCT) constructs in this effective school-based obesity prevention program implemented in 15 elementary schools in Mexico City. Methods Two coders applied the Intervention Analysis Procedure (IAP) to “map” the program’s integration of ecological principles. A checklist gauged the use of SCT theory in program activities. Results Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%).The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Conclusions Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/ personnel change and strong political engagement and were most commonly underpinned by Reciprocal Determinism for both Nutrition and Physical Activity. [ABSTRACT FROM AUTHOR]

Background: Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6-12 months post-event, in central Australia. Methods: This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients' "typical" journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels. Results: Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. Conclusion: Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented to improve communication on all levels and reduce systemic barriers operating within the health system. [ABSTRACT FROM AUTHOR]

Little is known about the situational contexts in which individuals consume processed sources of dietary sugars. This study aimed to describe the situational contexts associated with the consumption of sweetened food and drink products in a Catholic Middle Eastern Canadian community. A two-stage exploratory sequential mixed-method design was employed with a rationale of triangulation. In stage 1 (n = 62), items and themes describing the situational contexts of sweetened food and drink product consumption were identified from semi-structured interviews and were used to develop the content for the Situational Context Instrument for Sweetened Product Consumption (SCISPC). Face validity, readability and cultural relevance of the instrument were assessed. In stage 2 (n = 192), a cross-sectional study was conducted and exploratory factor analysis was used to examine the structure of themes that emerged from the qualitative analysis as a means of furthering construct validation. The SCISPC reliability and predictive validity on the daily consumption of sweetened products were also assessed. In stage 1, six themes and 40-items describing the situational contexts of sweetened product consumption emerged from the qualitative analysis and were used to construct the first draft of the SCISPC. In stage 2, factor analysis enabled the clarification and/or expansion of the instrument's initial thematic structure. The revised SCISPC has seven factors and 31 items describing the situational contexts of sweetened product consumption. Initial validation of the instrument indicated it has excellent internal consistency and adequate test-retest reliability. Two factors of the SCISPC had predictive validity for the daily consumption of total sugar from sweetened products (Snacking and Energy demands) while the other factors (Socialization, Indulgence, Constraints, Visual Stimuli and Emotional needs) were rather associated to occasional consumption of these products. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander women experience higher rates of heart disease and type 2 diabetes than non-Indigenous Australian women. Increasing physical activity, improving diets and losing weight have been shown to reduce cardio metabolic risk. The primary aim was to evaluate the effectiveness of a 12-week structured exercise and nutrition program in a cohort of urban Indigenous Australian women on waist circumference, weight and biomedical markers of metabolic functioning from baseline (T1) to program completion (T2). The secondary aim assessed whether these outcomes were maintained at 3-month follow-up Methods: One hundred Aboriginal and/or Torres Strait Islander women aged 18-64 years living in the Adelaide metropolitan area were recruited. The program included two 60-minute group cardiovascular and resistance training classes per week, and four nutrition education workshops. Participants were randomly assigned to an 'active' group or 'waitlisted' control group. Body weight, height, waist and hip circumference, blood pressure, fasting glucose, fasting insulin, glycated haemoglobin (HbA1C), lipid profile and C-reactive protein (CRP) were assessed at baseline (T1), immediately after the program (T2) and three months post program (T3). Results: The active group showed modest reductions in weight and body mass index (BMI). Compared to the waitlisted group, the active group had a statistically significantly change in weight and BMI from baseline assessments; at T2, -1.65 kg and -0.66 kg/m² and at T3, -2.50 kg and -1.03 kg/m², respectively. Systolic and diastolic blood pressure also had a statistically significant difference from baseline in the active group compared to the waitlisted group at T2, -1.24 mmHg and -2.46 mmHg and at T3, -4.09 mmHg and -2.17 mmHg, respectively. The findings were independent of the baseline measure of the outcome variable, age, households with children and employment status. Changes in waist circumference and other clinical measures were not significant at T2 or T3. The primary outcome measure, waist circumference, proved problematic to assess reliably. Missing data and participants lost to follow-up were significant. Conclusions: This 12-week exercise program demonstrated modest reductions in weight, BMI and blood pressure at T2, which improved further at 3-month follow-up (T3). Positive intervention effects were observed despite low attendance at exercise classes. Structured exercise programs implemented in community settings require attention to understanding the barriers to participation for this high risk group. [ABSTRACT FROM AUTHOR]

Introduction: Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking. Methods: We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience in relation to quitting smoking were explored in 34 semi-structured interviews (with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text and interview notes. Results: Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting. Conclusions: Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community. [ABSTRACT FROM AUTHOR]

Purpose. To assess the evolution of perceived ownership of a university-Aboriginal community partnership across three project stages. Design. Survey administration to project partners during project formalization (1996—Ti), mobilization (1999—T2), and maintenance (2004—T3). Setting. Aboriginal community of Kahnawake, outside Montrea4 Qaebec, Canada. Participants. Partners involved in influencing decision making in the Kahnawake Schools Diabetes Prevention Project (KSTDPP). Measure and Analysis. A measure of perceived primaiy ownership subjected to linear trend analysis. Results. KSDPP staff were perceived as primary owner at TI and shared ownership with Community Advisory Board (CAB) members at T2 and T3. Trend tests indicated greater perceived ownership between TI and T3 for CAB (X21 = 12.3, p <.0001) and declining KSDPP staff (X21 = 10.5, p <.001) ownership over time. Academic partners were never perceived as primary owners. Conclusion. This project was community driven from the beginning It was not dependent on an external academic change agent to activate the community and develop the community's capacity to plan and implement a solution. It still took several years for the grassroots CAB to take responsibility from KSDPP staff thus indicating the need for sustained funding to build grassroots community capacity. [ABSTRACT FROM AUTHOR]

Background: Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. Methods: Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94). Results: 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP→ IND) and indirect intervention strategies (i.e., HP→ INT→ IND, HP→ POL → IND) were used most often; networking strategies, which link at least two targets (i.e., HP→[ORG-ORG]→IND), were used the least. The program did not become more ecological over time. Conclusions: The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability. [ABSTRACT FROM AUTHOR]

Background: Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. Methods: Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94). Results: 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP→ IND) and indirect intervention strategies (i.e., HP→ INT→ IND, HP→ POL → IND) were used most often; networking strategies, which link at least two targets (i.e., HP→[ORG-ORG]→IND), were used the least. The program did not become more ecological over time. Conclusions: The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability. [ABSTRACT FROM AUTHOR]

This study reports on the development and evaluation of a rating tool to assess the scientific utility and cultural appropriateness of community-level indicators for application with Indigenous populations. Indicator criteria proposed by the U.S. Institute of Medicine were culturally adapted through reviewing the literature and consultations with academic and Indigenous stakeholders. Pre-testing and collaborator feedback drove the iterative development of the tool with stakeholder groups in Canada, Aotearoa/New Zealand, and Australia. Pilot testing with 17 raters across countries involved rating the same selection of six health and social indicators using a six-point ordinal scale. The final version of the rating tool includes 16 questions within three criterion domains: importance, soundness, and viability. Academic and community stakeholder review established face and content validity. The indicator rating tool demonstrated good internal consistency and excellent inter-rater reliability for two of three pilot testing groups. Use of this instrument can strengthen collaborative research planning and evaluation with Indigenous communities through selection of relevant and culturally appropriate indicators for application to public health research, prevention programmes, and health and social policy. [ABSTRACT FROM AUTHOR]

The increasing use of participatory research (PR) approaches to address pressing public health issues reflects PR's potential for bridging gaps between research and practice, addressing social and environmental justice and enabling people to gain control over determinants of their health. Our critical review of the PR literature culminates in the development of an integrative practice framework that features five essential domains and provides a structured process for developing and maintaining PR partnerships, designing and implementing PR efforts, and evaluating the intermediate and long-term outcomes of descriptive, etiological, and intervention PR studies. We review the empirical and nonempirical literature in the context of this practice framework to distill the key challenges and added value of PR. Advances to the practice of PR over the next decade will require establishing the effectiveness of PR in achieving health outcomes and linking PR practices, processes, and core elements to health outcomes. [ABSTRACT FROM AUTHOR]

Health and social indicators that capture the distinct historical, social, and cultural contexts of Indigenous communities can play an important role in informing the planning and delivery of community interventions. There is currently considerable interest in cataloguing and vetting meaningful community-level health and social indicators that could be applied to research and health promotion activities in Indigenous communities in Australia, Canada, and New Zealand, inclusive of conventional indicators as well as measures developed specifically for use in or with Indigenous communities. To avoid haphazard selection of indicators, and to assure the comprehensiveness and relevance of any given set of indicators, a framework that can accommodate and conceptually classify indicators representing a full range of domains is required. We report here on the development of a conceptual framework, by which Indigenous community indicators, and more general community-level social indicators, can be sorted, catalogued, and systematically classified within four hierarchical levels. The indicator framework was developed across Canada, Australia and New Zealand in consultation with academic researchers and Indigenous community stakeholders, building from established health and social indicator systems. The Indigenous indicator framework permits Indigenous communities, public health researchers, and funding agencies to compare and select the most appropriate indicators for application in specific contexts from the multitude of existing indicators. [ABSTRACT FROM AUTHOR]

The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an ongoing participatory research and intervention project aimed at the primary prevention of type 2 diabetes. Formally initiated in 1994 with strong community support, KSDPP provides a fertile opportunity to learn about how a community came to identify the need for preventive action on a health problem such as diabetes. The purpose of our study was to describe the various conditions in the community of Kahnawake, which gave rise to its mobilization for the prevention of type 2 diabetes. Qualitative data consisted of 12 individual interviews and one focus group with key community members and health professionals living and/or working in the community of Kahnawake, along with historically relevant documents. The data collection and analysis procedures of the grounded theory method were applied. Results describe a preceding phase to formal KSDPP implementation, triggered by returning research results on the community prevalence of type 2 diabetes. This phase of ‘legitimizing diabetes as a community health issue’ is characterized by a shift in the perceived preventability of diabetes among community members; from a problem that was to be lived with to a problem that was to be prevented. The shift in perceptions was facilitated by the context in the community, described by structural developments, cognitive and relational elements. In addition to reaffirming the critical importance of utilizing lay knowledge during the planning of a health promotion intervention, our study has uncovered some of the key conditions through which individuals in the community came to participate in the identification and planning of a diabetes prevention project. [ABSTRACT FROM AUTHOR]

Background: Aboriginal children in Canada are at increased risk for type 2 diabetes. Given that physical inactivity is an important modifiable risk factor for type 2 diabetes, prevention efforts targeting Aboriginal children include interventions to enhance physical activity involvement. These types of interventions require adequate assessment of physical activity patterns to identify determinants, detect trends, and evaluate progress towards intervention goals. The purpose of this study was to develop a culturally appropriate interactive computer program to self-report physical activity for Kanien'kehá:ka (Mohawk) children that could be administered in a group setting. This was an ancillary study of the ongoing Kahnawake Schools Diabetes Prevention Project (KSDPP). Methods: During Phase I, focus groups were conducted to understand how children describe and graphically depict type, intensity and duration of physical activity. Sixty-six students (40 girls, 26 boys, mean age = 8.8 years, SD = 1.8) from four elementary schools in three eastern Canadian Kanien'kehá:ka communities participated in 15 focus groups. Children were asked to discuss and draw about physical activity. Content analysis of focus groups informed the development of a school-day and non-school-day version of the physical activity interactive recall (PAIR). In Phase II, pilot-tests were conducted in two waves with 17 and 28 children respectively to assess the content validity of PAIR. Observation, videotaping, and interviews were conducted to obtain children's feedback on PAIR content and format. Results: Children's representations of activity type and activity intensity were used to compile a total of 30 different physical activity and 14 non-physical activity response choices with accompanying intensity options. Findings from the pilot tests revealed that Kanien'kehá:ka children between nine and 13 years old could answer PAIR without assistance. Content validity of PAIR was judged to be adequate. PAIR was judged to be comprehensive, acceptable, and enjoyable by the children. Conclusions: Results indicate that PAIR may be acceptable to children between nine and 13 years old, with most in this age range able to complete PAIR without assistance. The flexibility of its programming makes PAIR an easily adaptable tool to accommodate diverse populations, different seasons, and changing trends in physical activity involvement. [ABSTRACT FROM AUTHOR]

Health promotion emphasizes the importance of community ownership in the governance of community-based programmes, yet little research has been conducted in this area. This study examined perceptions of community ownership among project partners taking responsibility for decision-making related to the Kahnawake Schools Diabetes Prevention Project (KSDPP). Project partners were surveyed cross-sectionally at 18 months (T1) and 60 months (T2) into the project. The perceived influence of each project partner was assessed at T1 and T2 for three domains: (i) KSDPP activities: (ii) KSDPP operations: and (iii) Community Advisory Board (CAB) activities. Project staff were perceived to have greatest influence on KSDPP activities, KSDPP operations and CAB activities at both T1 and T2. High mean scores of perceived influence for CAB members and community researchers, however, suggests that project decision-making was a shared responsibility among multiple community partners. Although academic researcher influence was consistently low, they were satisfied with their level of influence. This was unlike community affiliates, who were less satisfied with their lower level of influence. In keeping with Kanien'kehaku (Mohawk) culture, the findings suggest a participatory democracy or shared decision-making as the primary mode of governance of KSDPP. [ABSTRACT FROM AUTHOR]

Objective: To develop a theoretical framework of youth empowerment in the context of a participatory community health promotion intervention, a longitudinal qualitative study was conducted. Methods: Individual and group interviews, documents, and observations were analyzed using the constant comparative method and theoretical sampling. Results. Practitioners created an environment conducive to adolescents' taking responsibility for their quality-oflife issues by welcoming and en- abling youth. Power was transferred to youth as responsibility for voicing, decision making, and action. This led to positive changes in youth development and their social integration into community. Conclusion: Empowerment emerged as a transactional partnering process between adults and youth. [ABSTRACT FROM AUTHOR]

Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process. [Copyright &y& Elsevier]

Issue addressed: The health benefits for children of regular physical activity (PA) are well documented. This study examined relationships between organised sport participation in multiple settings and child and household‐level characteristics. Methods: Using a general population survey of Queensland children's health and lifestyle characteristics, participation in organised sport was examined in (a) club settings, (b) club‐based team and individual organised sport settings and (c) school settings. The association between organised sport participation in these settings and meeting the Australian PA guidelines was also considered. Results: Organised sport participation prevalence was 46% (both school and club settings), 16% (club sport only), 20% (school sport only) and 18% (neither setting). Multivariable logistic regression analysis indicated participation in one setting increased the odds of participation in other settings, exclusive participation in individual sport decreased the odds of school sport participation and organised sport participation was not associated with meeting recommended PA guidelines for children. Conclusions: The study highlights areas where the contribution of organised sport to PA more broadly could be strengthened. Organised sport participation, however, was not sufficient to meet the child PA guidelines. The home environment, availability of parents and guardians and PA opportunities in other settings, such as school, free time and active transport, are as important to increasing children's PA levels. So what?: While organised sport is an important component towards meeting PA guidelines, PA policy and program development should consider strategies to encourage PA in other settings to help children achieve health‐enhancing levels of PA that are sustained into adulthood. [ABSTRACT FROM AUTHOR]

Background: Several papers report deficiencies in the reporting of information about the implementation of interventions in clinical trials. Information about implementation is also required in systematic reviews of complex interventions to facilitate the translation and uptake of evidence of provider-based prevention and treatment programs. To capture whether and how implementation is assessed within systematic effectiveness reviews, we developed a checklist for implementation (Ch-IMP) and piloted it in a cohort of reviews on provider-based prevention and treatment interventions for children and young people. This paper reports on the inter-rater reliability, feasibility and reasons for discrepant ratings.Methods: Checklist domains were informed by a framework for program theory; items within domains were generated from a literature review. The checklist was pilot-tested on a cohort of 27 effectiveness reviews targeting children and youth. Two raters independently extracted information on 47 items. Inter-rater reliability was evaluated using percentage agreement and unweighted kappa coefficients. Reasons for discrepant ratings were content analysed.Results: Kappa coefficients ranged from 0.37 to 1.00 and were not influenced by one-sided bias. Most kappa values were classified as excellent (n = 20) or good (n = 17) with a few items categorised as fair (n = 7) or poor (n = 1). Prevalence-adjusted kappa coefficients indicate good or excellent agreement for all but one item. Four areas contributed to scoring discrepancies: 1) clarity or sufficiency of information provided in the review; 2) information missed in the review; 3) issues encountered with the tool; and 4) issues encountered at the review level. Use of the tool demands time investment and it requires adjustment to improve its feasibility for wider use.Conclusions: The case of provider-based prevention and treatment interventions showed relevancy in developing and piloting the Ch-IMP as a useful tool for assessing the extent to which systematic reviews assess the quality of implementation. The checklist could be used by authors and editors to improve the quality of systematic reviews, and shows promise as a pedagogical tool to facilitate the extraction and reporting of implementation characteristics. [ABSTRACT FROM AUTHOR]

A Theory of Change (ToC) is an approach to map programmes aimed at inducing change in a specific context, with the goal of increasing their impact. We applied this approach to the specific case of handwashing and sanitation practices in low- and middle-income countries and developed a ToC as part of a systematic review exercise. Different existing sources of information were used to inform the initial draft of the ToC. In addition, stakeholder involvement occurred and peer review took place. Our stakeholders included methodological (ToC/quantitative and qualitative research) and content experts (WASH (Water, Sanitation, Hygiene)/behaviour change), as well as end-users/practitioners, policy-makers and donors. In conclusion, the development of a ToC, and the involvement of stakeholders in its development, was critical in terms of understanding the context in which the promotional programmes are being implemented. We recommend ToC developers to work with stakeholders to create a ToC relevant for practice. [ABSTRACT FROM PUBLISHER]

Background: Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6-12 months post-event, in central Australia.Methods: This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients' "typical" journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels.Results: Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey.Conclusion: Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented to improve communication on all levels and reduce systemic barriers operating within the health system. [ABSTRACT FROM AUTHOR]

Issue addressed: There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non‐Indigenous practitioners culturally adapted and applied the Tri‐Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness. Methods: Aboriginal community‐controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12‐month follow‐up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks. Results: The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre‐defined issue, time and resource‐intensiveness of the process, and need to review appropriateness prior to implementation in other regions. Conclusion: The adapted CRT was valuable for evaluating the project and co‐designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. So what?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns. [ABSTRACT FROM AUTHOR]

Issue addressed: There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non‐Indigenous practitioners culturally adapted and applied the Tri‐Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness. Methods: Aboriginal community‐controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12‐month follow‐up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks. Results: The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre‐defined issue, time and resource‐intensiveness of the process, and need to review appropriateness prior to implementation in other regions. Conclusion: The adapted CRT was valuable for evaluating the project and co‐designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. So what?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns. [ABSTRACT FROM AUTHOR]

Background: Aboriginal Health Workers (AHWs) have a mandate to deliver smoking cessation support to Aboriginal people. However, a high proportion of AHWs are smokers and this undermines their delivery of smoking cessation programs. Smoking tobacco is the leading contributor to the burden of disease in Aboriginal Australians and must be prevented. Little is known about how to enable AHWs to quit smoking. An understanding of the factors that perpetuate smoking in AHWs is needed to inform the development of culturally relevant programs that enable AHWs to quit smoking. A reduction of smoking in AHWs is important to promote their health and also optimise the delivery of smoking cessation support to Aboriginal clients.Methods: We conducted a fundamental qualitative description study that was nested within a larger mixed method participatory research project. The individual and contextual factors that directly or indirectly promote (i.e. perpetuate) smoking behaviours in AHWs were explored in 34 interviews and 3 focus groups. AHWs, other health service staff and tobacco control personnel shared their perspectives. Data analysis was performed using a qualitative content analysis approach with collective member checking by AHW representatives.Results: AHWs were highly stressed, burdened by their responsibilities, felt powerless and undervalued, and used smoking to cope with and support a sense of social connectedness in their lives. Factors directly and indirectly associated with smoking were reported at six levels of behavioural influence: personal factors (e.g. stress, nicotine addiction), family (e.g. breakdown of family dynamics, grief and loss), interpersonal processes (e.g. socialisation and connection, domestic disputes), the health service (e.g. job insecurity and financial insecurity, demanding work), the community (e.g. racism, social disadvantage) and policy (e.g. short term and insecure funding).Conclusions: An extensive array of factors perpetuated smoking in AHWs. The multitude of personal, social and environmental stressors faced by AHWs and the accepted use of communal smoking to facilitate socialisation and connection were primary drivers of smoking in AHWs in addition to nicotine dependence. Culturally sensitive multidimensional smoking cessation programs that address these factors and can be tailored to local needs are indicated. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander women experience higher rates of heart disease and type 2 diabetes than non-Indigenous Australian women. Increasing physical activity, improving diets and losing weight have been shown to reduce cardio metabolic risk. The primary aim was to evaluate the effectiveness of a 12-week structured exercise and nutrition program in a cohort of urban Indigenous Australian women on waist circumference, weight and biomedical markers of metabolic functioning from baseline (T1) to program completion (T2). The secondary aim assessed whether these outcomes were maintained at 3-month follow-up.Methods: One hundred Aboriginal and/or Torres Strait Islander women aged 18-64 years living in the Adelaide metropolitan area were recruited. The program included two 60-minute group cardiovascular and resistance training classes per week, and four nutrition education workshops. Participants were randomly assigned to an 'active' group or 'waitlisted' control group. Body weight, height, waist and hip circumference, blood pressure, fasting glucose, fasting insulin, glycated haemoglobin (HbA1C), lipid profile and C-reactive protein (CRP) were assessed at baseline (T1), immediately after the program (T2) and three months post program (T3).Results: The active group showed modest reductions in weight and body mass index (BMI). Compared to the waitlisted group, the active group had a statistically significantly change in weight and BMI from baseline assessments; at T2, (-)1.65 kg and (-)0.66 kg/m(2) and at T3, (-)2.50 kg and (-)1.03 kg/m(2), respectively. Systolic and diastolic blood pressure also had a statistically significant difference from baseline in the active group compared to the waitlisted group at T2, (-)1.24 mmHg and (-)2.46 mmHg and at T3, (-)4.09 mmHg and (-)2.17 mmHg, respectively. The findings were independent of the baseline measure of the outcome variable, age, households with children and employment status. Changes in waist circumference and other clinical measures were not significant at T2 or T3. The primary outcome measure, waist circumference, proved problematic to assess reliably. Missing data and participants lost to follow-up were significant.Conclusions: This 12-week exercise program demonstrated modest reductions in weight, BMI and blood pressure at T2, which improved further at 3-month follow-up (T3). Positive intervention effects were observed despite low attendance at exercise classes. Structured exercise programs implemented in community settings require attention to understanding the barriers to participation for this high risk group.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12610000224022. [ABSTRACT FROM AUTHOR]

Background: Several stigma reduction intervention strategies have been developed and tested for effectiveness in terms of increasing human immunodeficiency virus (HIV) test uptake. These strategies have been more effective in some contexts and less effective in others. Individual factors, such as lack of knowledge and fear of disclosure, and social-contextual factors, such as poverty and illiteracy, might influence the effect of stigma reduction intervention strategies on HIV test uptake in low- and middle-income countries. So far, it is not clearly known how the stigma reduction intervention strategies interact with these contextual factors to increase HIV test uptake. Therefore, we will conduct a review that will synthesize existing studies on stigma reduction intervention strategies to increase HIV test uptake to better understand the mechanisms underlying this process in low- and middle-income countries. Methods: A realist review will be conducted to unpack context-mechanism-outcome configurations of the effect of stigma reduction intervention strategies on HIV test uptake. Based on a scoping review, we developed a preliminary theoretical framework outlining a potential mechanism of how the intervention strategies influence HIV test uptake. Our realist synthesis will be used to refine the preliminary theoretical framework to better reflect mechanisms that are supported by existing evidence. Journal articles and grey literature will be searched following a purposeful sampling strategy. Data will be extracted and tested against the preliminary theoretical framework. Data synthesis and analysis will be performed in five steps: organizing extracted data into evidence tables, theming, formulating chains of inference from the identified themes, linking the chains of inference and developing generative mechanisms, and refining the framework. Discussion: This will be the first realist review that offers both a quantitative and a qualitative exploration of the available evidence to develop and propose a theoretical framework that explains why and how HIV stigma reduction intervention strategies influence HIV test uptake in low- and middle-income countries. Our theoretical framework is meant to provide guidance to program managers on identifying the most effective stigma reduction intervention strategies to increase HIV test uptake. We also include advice on how to effectively implement these strategies to reduce the rate of HIV transmission. [ABSTRACT FROM AUTHOR]

Introduction The inequity of randomising participants to control groups in randomised controlled trials (RCTs) is often considered inappropriate, especially for research trials that include vulnerable populations such as Indigenous peoples. The Aboriginal and Torres Strait Islander Women's Fitness Program conducted a trial that randomly assigned participants to 'active' and 'waitlisted' groups. This paper reports on participant views of the randomisation protocol. Methods A pragmatic RCT was conducted in an urban setting to assess the effectiveness of the 12-week Aboriginal and Torres Strait Islander Women's Fitness Program on metabolic health outcomes and waist circumference. Qualitative interviews were conducted at follow-up, one of the objectives was to explore participant perspectives on the research protocol, including participant randomisation to 'Active' and 'Waitlisted' groups. Results A total of 49 interviews were conducted (26 Active and 23 Waitlisted participants).Two key factors influenced participant views on the protocol: 1) group assignment; and 2) how well they understood the research design, including the justification for randomisation. 'Active' participants were concerned about the inequity of the randomisation process but overall supported the study protocol. Although most Waitlisted participants were disappointed about having to wait 12-months for the program, some participants derived motivation from being waitlisted, whilst others lost motivation. Well-informed participants were more likely to express both support for the randomisation process and an understanding of the research benefits than participants not attending an information session prior to registration. Conclusions Participants were more accepting of the research protocol if it was clearly explained to them, if they understood the randomisation process and felt the randomisation was justified in terms of the potential for the results to benefit other Aboriginal and Torres Strait Islander women. Our study suggests that the time and resources required to adequately explain the research protocol in research trials should not be undervalued. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN12610000224022). [ABSTRACT FROM AUTHOR]

Background: Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. Methods: Healthy Beginnings is a nurse‐led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6‐ and 12‐month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). Results: Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6‐month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%‐65%) compared to those speaking English (70%‐80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. Conclusions: Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families. [ABSTRACT FROM AUTHOR]

ObjectiveThe present study describes the consumption patterns of sweetened food and drink products in a Catholic Middle Eastern Canadian community and examines its associations with physical activity, sedentary behaviours and BMI.DesignA two-stage cross-sectional design was used. In Stage 1 (n 42), 24 h recalls enabled the identification of sweetened products. In Stage 2 (n 192), an FFQ was administered to measure the daily consumption of these products and to collect sociodemographic and behavioural data. Sweetened products were defined as processed culinary ingredients and ultra-processed products for which total sugar content exceeded 20 % of total energy.SettingThree Catholic Middle Eastern churches located in Montreal, Canada.SubjectsNormoglycaemic men and women (18–60 years old).ResultsTwenty-six sweetened products represented an average consumption of 75·4 g total sugars/d or 15·1 % of daily energy intake (n 190, 56 % women). Soft drinks, juices, sweetened coffee, chocolate, cookies, cakes and muffins were the main sources of consumption and mostly consumed between meals. Age (exp (β) = 0·99; P < 0·01), physical activity (exp (β) = 1·08; P < 0·01) and recreational computer use (exp (β) = 1·17; P < 0·01) were independently associated with sweetened product consumption. The association between sweetened product consumption and physical activity was U-shaped. BMI was not significantly associated with sweetened product consumption but all participants regardless of BMI were above the WHO recommendation for free sugars.ConclusionsBeing physically active and spending less time using a computer may favour a reduced consumption of sweetened products. Very active individuals may, however, overconsume such products. [ABSTRACT FROM AUTHOR]

Issue addressed: This study aimed to analyse the relationship between peer‐delivered health promotion programmes and student well‐being and to expand the limited body of research examining peer‐to‐peer mental health promotion as experienced by student leaders. Methods: The study was cross‐sectional and focused on the experience of participants of a Sydney‐based University Mental Health Day event, including student leaders, student participants, university staff and industry partners. It adopted a mixed‐method approach to data collection, including a quantitative and a qualitative phase. Results: Results from the quantitative phase demonstrate the benefits of peer‐delivered health promotion programmes to students who receive the event. Results from the qualitative phase of the study provide a deeper insight into the delivery of the event, from both a student leader perspective, and also from the perspective of other stakeholders, who worked closely with student leaders. Two main themes emerged from the qualitative material and are explored in detail: enabling leadership and creating a sense of purpose. Conclusion: The study concludes that, while there is mounting evidence of the benefits of student‐led mental health programmes for both leaders and their peers, more research needs to be carried out to better understand how to optimise these experiences and unlock their full potential with reference to student mental health. So what?: With the ongoing pressure on university student services to support student well‐being not being met with appropriate resourcing, peer‐to‐peer programmes, like the Mental Health and Well‐being Student Ambassador Programme, have a real opportunity to make strides in supporting and promoting student mental health. [ABSTRACT FROM AUTHOR]

Objective: To evaluate population‐level implementation of Confident Body, Confident Child (CBCC); an evidence‐based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2‐6 years; with community child health nurses (CHNs). Methods: This study utilised an implementation‐effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC's effect on CHNs' knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre‐ and post‐intervention delivery to CHNs, respectively. Results: Twenty‐six CHNs (all female; mean age 52.7 ± 9.5 years) participated in the study by attending a 1‐day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non‐significant improvements in CHN knowledge (P =.077) and attitudes towards overweight (using Anti‐Fat Attitudes scale; significant improvements on willpower sub‐scale only (P <.05)). Discussion: This is the first study to evaluate population‐wide CBCC implementation in a real‐world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation‐focused methodologies to translate preventive eating disorder programs into community child health services. [ABSTRACT FROM AUTHOR]

Issue addressed: Poor sleep quality is common among university students and can have negative implications for physical, emotional, cognitive and academic wellbeing. Previous research has identified that sleep beliefs and sleep behaviours are associated with poor sleep quality. However, few studies have examined these variables simultaneously. This study explored associations between dysfunctional beliefs about sleep, sleep hygiene and sleep quality in a sample of university students. Methods: Participants were recruited from a pool of undergraduate psychology students and included 120 male students and 145 female students with an average age of 20 years (SD = 5.10). Participants completed an online survey including the Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes About Sleep Scale, Sleep Hygiene Index and demographic items. Results: Overall 60.4% of participants (59.4% of women, 40.6% of men) had poor sleep quality. Logistic regression indicated a significant positive association between sleep hygiene and sleep quality, OR = 1.16, P >.001, 95% CI (1.10, 1.23), and no significant relationship between dysfunctional beliefs about sleep and sleep quality, OR = 1.03, P >.79, 95% CI (0.84, 1.26), after adjusting for covariates. Conclusions: Sleep interventions for university students are needed and could focus on common hygiene components, such as using the bed for activities other than sleeping, engaging in arousing activities before bed and how to manage thinking and worrying before bed. So What? The results of the study demonstrate poor sleep quality is common among university students and indicates that sleep interventions are warranted. The positive association found between sleep hygiene and sleep quality highlights that interventions should focus on behavioural components of sleep. [ABSTRACT FROM AUTHOR]

Introduction: The Active Kids voucher is a universal, state‐wide voucher program, provided by the New South Wales (NSW) Government, Office of Sport. All school‐aged children in NSW are eligible to receive a voucher to reduce registration costs of structured physical activity programs. This study explores reasons behind lower uptake among children who are overweight or obese, from cultural and linguistically diverse families and those living in low socio‐economic areas. Methods: Participants were recruited through a convenience sample of parent/carers who participated in the NSW Health Go4Fun program. Qualitative data were collected using focus groups. The Framework method was adapted for the analysis, taking an interpretive phenomenological approach. Results: Study participants (n = 54) were all parents of children who were overweight or obese from both low and high socio‐economic status (SES). Most reported speaking a primary language other than English at home (65%). Parents were mostly aware of the Active Kids program (91%) and reported that the voucher had a positive impact on their children's participation in structured physical activity. A range of socio‐ecological factors, in addition to activity cost, influenced whether parents were able to use an Active Kids voucher and participate in structured physical activity. Conclusions: The Active Kids voucher does not alleviate all barriers, particularly for families living in low socio‐economic areas. Engagement of this population in structured physical activities using the Active Kids vouchers could be strengthened through the implementation of effective interventions which comprehensively address the remaining barriers, such as access and flexibility of programs with local stakeholders and activity providers. [ABSTRACT FROM AUTHOR]

Issue addressed: Ethical values underpin the health promotion discipline and profession, and competencies required for professional practice. Understanding how ethical values are translated into professional practice is critical. The aim of this exploratory sequential mixed methods study was to explore Australian health promotion stakeholder perspectives about ethical health promotion practice. Methods: A face‐to‐face group‐based workshop (n = 15), online survey (n = 77) and in‐depth individual interviews (n = 15) collected qualitative and quantitative data from health promotion stakeholders. Descriptive statistics were used to analyse quantitative and thematic analysis to analyse qualitative data. Results: Tensions emerged regarding the nomenclature of ethical health promotion practice, with ethics framed largely by participants as related to formal approval for research. A range of barriers and enablers to ethical practice were identified. Barriers related to obtaining ethical approvals and working with specific population groups and communities. Enablers included professional development opportunities, access to a specialised human research ethics committee and a better understanding of what is meant by 'ethical practice'. Conclusion: Findings suggest the need for an ethical health promotion practice framework and resources for practitioners and organisations throughout Australia. We propose a framework comprising two pillars: (a) developing critical practice; and (b) building the evidence‐based for health promotion. So what?: This study recognises the need for increased dialogue about the ethical foundations of health promotion. The development of a health promotion ethics framework can better support the development of ethical practice in the Australian health promotion discipline and profession. [ABSTRACT FROM AUTHOR]

Issue addressed: To describe the need for high school sleep education from the perspective of undergraduate university students. Methods: Undergraduate students who completed an online course on sleep and circadian health were surveyed 6 months after course completion. Students were asked whether a similar course would have benefited them as high school students, and about the need for sleep education in high schools. Thematic analysis of this qualitative data was carried out. Results: Eighty‐nine students who had attended 71 unique high schools provided responses. Eight‐one per cent thought they would have benefitted from a similar course during high school and identified domains of sleep knowledge particularly relevant to high school students. They cited environmental barriers to healthy sleep present during high school and believed that sleep education could improve students' lifestyle, sleep and performance. Nineteen per cent of students said they would not have benefited, because they perceived sleeping patterns during high school to be nonmodifiable or believed that previous sleep education was sufficient. Of the respondents who did not think students would benefit, 53% would still tell their high school principal that there was a need for sleep education. Conclusions: The findings support the need for engaging sleep education for high school students. Future studies should examine the perspectives of students in high school directly, rather than undergraduate students who have already shown an interest in sleep health. So what?: Sleep health is missing from the Australian school curriculum. Online courses may be an engaging method of promoting sleep and circadian health to high school students. [ABSTRACT FROM AUTHOR]

The Australian health system requires novel strategies to implement widespread primary prevention to reduce the burden of chronic illness. One approach is for health sectors to draw on resources available in communities of place and to form partnerships which maximize the relevance and uptake of initiatives designed to promote healthy lifestyles. This article presents a typology of conceptual approaches to community and health sector partnerships, developed through an extensive literature search and empirically tested using in-depth case studies across regional Australia. The article finds that the health sector’s orientation to primary prevention is generally instrumental involving highly targeted outcomes and pre-defined programmes. Communities of place have multifaceted priorities that include building the social and economic sustainability of their community. While these approaches might appear incompatible, careful ‘manipulation’ and ‘massaging’ of instrumental objectives to adjust to community agendas and the presence of ‘boundary crossers’ can lead to successful primary prevention outcomes. [ABSTRACT FROM AUTHOR]

A systematic review of qualitative studies was undertaken to understand the barriers to physical activity experienced by adolescents who were overweight or obese. From a search of electronic databases and 'grey' literature, published between 1950 and 2009, 15 studies met the inclusion criteria. Bronfenbrenner's model of human development provided an ecological lens for identifying and synthesising barriers to physical activity. Two reviewers appraised study quality. Miles and Huberman's cross-case analysis was integrated with thematic networking to synthesize the individual, interpersonal and environmental level barriers for boys and girls of different ethnicities and socioeconomic status, across school settings and generalised context. Thirty-five barriers were identified, 13 of which occurred in physical activity situations in the school setting, 18 were not linked to a specific setting, and the remainder were common across both contexts. The fact that these barriers emerged from studies that focused on topics such as victimisation and mental health is particularly poignant and reflects the potentially pervasive influence of adolescent's excessive weight not only in relation to physical activity situations but other aspects of their lives. Furthermore, socioeconomic status and ethnicity was poorly considered, with only one study linking these participant characteristics to quotations and discussing the potential implications. At present, there are few qualitative studies with sufficiently thick description or interpretive validity that provide insight into this vulnerable group of adolescents, and give them a voice to influence policy and practice. [ABSTRACT FROM AUTHOR]

This review examines environments in relation to cardiometabolic diseases in Indigenous populations in developed countries. Environmental factors are framed in terms of context (features of places) and composition (features of populations). Indigenous peoples are seen to have endured sociopolitical marginalization and material disadvantage spanning generations. Past adverse collective experiences, modified by culture, are reflected by current heterogeneity in environmental context and composition. As risk conditions, unfavorable contextual and compositional exposures influence the expression of cardiometabolic risk for individuals. Minimal research has evaluated heterogeneity in risk conditions against heterogeneity in cardiometabolic diseases between or within Indigenous populations. Thus far, the features of populations, not of places themselves, have been implicated in relation to cardiometabolic diseases. Behavioral, psychosocial, and stress-axis pathways may explain the relationships between risk conditions and cardiometabolic diseases. Implications of environmental factors and their pathways as well as important research needs are discussed in relation to ecological prevention to reduce cardiometabolic diseases. [ABSTRACT FROM AUTHOR]

This review establishes the relevance and frames the relationship of environmental factors to cardiometabolic risk factors and disease in Aboriginal populations. Environmental factors operate at the level of communities or populations. They include contextual measures of places and compositional measures of populations which together constitute “risk conditions” affecting individual risk factors. Environmental factors have been implicated by contrasting Aboriginal and non-Aboriginal populations in cardiometabolic risk factors and outcomes, or by geographic contrasts of Aboriginal populations in remote, rural and urban regions. It is unclear whether heterogeneity in contextual or compositional factors between and within Aboriginal populations is associated with heterogeneity in cardiometabolic risk factors and outcomes. Empirical literature that links environmental factors and cardiometabolic outcomes in Aboriginal populations is critically reviewed for three postulated pathways of influence: (1) behaviour; (2) psychosocial factors; and (3) stress response axes. These pathways, represented as interdependent, can explain how and why environments are associated with cardiometabolic outcomes. The need remains, however, to develop a robust quantitative evidence base in cardiometabolic research aimed at enhancing knowledge of the specific environmental factors related to the cardiometabolic health of Aboriginal populations as well as explicating the underlying mechanisms by which environmental risk conditions ‘get under the skin’. [Copyright &y& Elsevier]

Objective: Previous quantitative research has suggested that there is a link between housing, the urban environment, and mental health. However, methodological and design issues make it difficult to disentangle the relative influence of dwelling specific and wider urban environmental influences on individual mental health. The aim of this study was to explore the link between the dwelling, the immediate urban environment, and mental health to generate a new conceptual framework by which understanding of dwelling and urban environmental influences on mental health can be advanced. Design and participants: Qualitative interviews and focus groups were conducted with 32 inner city residents. Participants, stratified by sex and mental health status, were randomly recruited from a wider quantitative survey. An almost equal number of men and women as well as people with or without mental health problems participated, allowing for comparison of experience. Data were analysed inductively to generate an appropriate theoretical framework regarding dwelling and urban environmental influences on mental health. Setting: An inner city neighbourhood of about 6200 people in north west London. Most of that population live in public housing. Main results: The principal study finding is that between the dwelling unit and the neighbourhood unit, evidence was found for another meaningful contextual unit of analysis, the "residential bubble" through which effects on mental health can be mediated. The residential bubble describes a limited area of three dimensional space that surrounds a dwelling, encompassing immediate neighbours (above, below, and adjacent) and shared public space bordering the dwelling. Positive events and processes within the bubble had a beneficial influence on mental health whereas negative ones tended to have a damaging influence. These seemed to disproportionately have an impact on people with pre-existing mental health problems. Conclusion: The concept of the "residential bubble" may be a meaningful new contextual unit of analysis in urban mental health. This may have important implications with regards to interventions and measurement development. [ABSTRACT FROM AUTHOR]

Issue addressed: Internationally, universities have recognised the benefits of Pet Support Programs (PSPs). However, existing literature has predominately focused on quantitatively measuring health outcomes associated with a PSP amongst student populations. This research aimed to explore the feasibility of a PSP within an Australian university, as there is a need to explore practical considerations involved in implementation. Methods: This research used a qualitative descriptive approach. Participants were recruited via purposive snowball sampling. The sample included 17 participants across eight administrative divisions within an Australian university. Semi‐structured individual interviews were used to collect data. Data were analysed using thematic analysis. Results: Three main themes emerged from the data: Organisational Change, Program Management and Perceived Outcomes. Findings suggest several considerations from both an organisational and program level that need to be addressed prior to implementation, including the university's policies, the location and animal welfare. The main perceived outcomes were stress relief and social support. Ways to minimise risks to those who may have an aversion towards animals were also discussed. Conclusions: Participants believed implementing a PSP would be feasible in the university setting, provided all aforementioned considerations were adequately addressed. Considerations identified have the potential to act as a barrier or a facilitator depending on how they are managed. So what?: Where feasible and later implemented, a PSP could provide Australian university students and staff with an alternative means of improving mental health, providing stress relief and contributing towards the Health Promoting University framework. [ABSTRACT FROM AUTHOR]

Issues addressed: The significant investment in health research has resulted in an increased focus to determine suitable approaches to measure health promotion research impact. This research was undertaken at the request of a nationally competitive research organisation that funds health promotion research, to explore how Chief Investigators (CIs) on their funded projects understood research impact, its measurement and associated challenges. Methods: Participants were required to be or have been a CI on an Australian competitive research (exploratory or intervention) grant focussed on health promotion. The qualitative study used thematic analysis from one‐on‐one interviews. Themes were created and descriptive quotes were selected to illustrate the main findings. Results: The majority of participants were female (n = 13) working at a university (n = 13). Three themes emerged: a) defining health research impact; b) complexity and simplicity of measuring health research impact; c) challenges of measuring health research impact: i) differing language; ii) differing assessment; iii) attribution and timing; and iv) resourcing and skills. Conclusion: Researchers recognised that there are significant challenges in measuring the impact of health promotion research. The most significant factors identified by participants were the disciplinary background of the researchers undertaking the measurement, their skills and experience and the resources (including time) available to assess impact. So what?: Research impact assessment is complex, time consuming and requires specific skills to facilitate measurement of impact provision of funding for this activity in research grants and research impact training is required. [ABSTRACT FROM AUTHOR]

Issue addressed: Published evaluations of population‐level social marketing campaigns predominantly focus on impact and outcome evaluation. Evaluation of complementary locally implemented activities and programs, despite being common and important components of social marketing campaigns are rarely published. This study sought to examine the drivers of engagement of local implementers in the Make Healthy Normal campaign, implemented in New South Wales (NSW), Australia from 2015 to 2018, and to describe their engagement with the campaign as well as the scope and extent of complementary activities. Methods: We conducted 13 in‐depth semi‐structured qualitative interviews with health and nonhealth stakeholders from a range of urban, regional and rural settings across NSW. We analysed the interviews thematically, using an inductive and iterative approach. Results: We found stakeholder engagement (ie decision to buy into and commit resources) to the campaign was underpinned by two main drivers: "understanding", or how well they understood the campaign and their role in it, and "perceived fit", or how appropriate it was to their context. A third factor, "communication" functioned to enhance both understanding and perceived fit. Conclusion: Our results suggest that stakeholders would engage with the campaign more where they had a sound understanding of the campaign objectives and content, and an appreciation of how the campaign fits their strategic and procedural context. So What?: Campaign managers should incorporate clear, regular and efficient communication with local implementers and work with these groups early in the campaign development process. Organisers should also support and promote a "community of practice" approach to capitalise on the innovations of those promoting campaign messages at the community level. [ABSTRACT FROM AUTHOR]

Issue addressed: Osteoporosis presents a serious public health issue and physical activity is recognised as the most effective modifiable risk factor for the condition. The reasons behind physical activity participation, however, are complex. We therefore aimed to explore the experiences related to a bone‐targeted exercise intervention, determine enjoyment and acceptability of each exercise mode, and identify barriers and facilitators to osteogenic exercise for young adult women. Methods: The present study was conducted within the Osteoporosis Prevention Through Impact and Muscle‐loading Approaches to Exercise (OPTIMA‐Ex) trial, a three‐arm RCT comparing musculoskeletal outcomes from two supervised, high‐intensity, exercise programs (impact and resistance training) with an unsupervised low‐intensity exercise control. A mixed‐methods approach was used, including quality of life and physical activity enjoyment questionnaires and qualitative analysis of semi‐structured interviews. Results: All groups had improvements in the 'mental health' domain of the quality of life measure; however, the two supervised exercise groups had greater levels of physical activity enjoyment. The qualitative analysis revealed that overall the trial activities were positively, yet the two supervised groups had 'richer' exercise experiences. Motivations for participation, barriers to physical activity and desired continuation of participation differed between all three groups. Conclusions: Findings suggest that bone‐targeted exercise interventions for young adult women must address perceived time demands and environmental barriers to participation in order to maximise compliance and adherence. So what?: As physical activity is the most effective lifestyle strategy to improve bone health and young adulthood an important window for its augmentation, increasing convenience, accessibility and understanding of osteoporosis preventative behaviours in this demographic is vital. [ABSTRACT FROM AUTHOR]