Copenhagen Diabetes Consensus (CODIAC) 2021: User involvement in diabetes care, prevention and research.

AIMS: User involvement is pivotal for health development, but there are significant gaps in our understanding of the concept. The Copenhagen Diabetes Consensus on User Involvement in Diabetes Care, Prevention and Research (CODIAC) was established to address these gaps, share knowledge and develop best practices. METHODS: A literature review of user involvement was undertaken in diabetes care, prevention and research. Moreover, a Group Concept Mapping (GCM) survey synthesized the knowledge and opinions of researchers, healthcare professionals and people with diabetes and their carers to identify gaps between what is important for user involvement and what is being done in practice. Finally, a consensus conference discussed the main gaps in knowledge and practice while developing plans to address the shortcomings. RESULTS: The literature review demonstrated that user involvement is an effective strategy for diabetes care, prevention and research, given the right support and conditions, but gaps and key challenges regarding the value and impact of user involvement approaches were found. The GCM process identified 11 major gaps, where important issues were not being sufficiently practised. The conference considered these gaps and opportunities to develop new collaborative initiatives under eight overall themes. CONCLUSIONS: User involvement is effective and adds value to diabetes care, prevention and research when used under the right circumstances. CODIAC developed new learning about the way in which academic and research knowledge can be transferred to more practice-oriented knowledge and concrete collaborative initiatives. This approach may be a potential new framework for initiatives in which coherence of process can lead to coherent outputs.

A Community-Based, Participatory, Multi-Component Intervention Increased Sales of Healthy Foods in Local Supermarkets-The Health and Local Community Project (SoL).

Project SoL was a 19-month (September 2012 to April 2014) community-based multi-component intervention based on the supersetting approach that was designed to promote healthier eating and physical activity among children and their families. The aim of this study was to examine the effects of a multi-component intervention (level 1) and a mass media intervention alone (level 2) compared to a control area (level 3) on food sales. The design was quasi-experimental. Weekly sales data for all Coop supermarkets in the intervention and control areas were analysed via longitudinal linear mixed-effects analyses. Significant increases in the sales of fish (total) (29%; p = 0.003), canned fish (31%; p = 0.025) and oatmeal (31%; p = 0.003) were found for the level 1 intervention area compared to the control area. In the level 2 intervention area, significant increases in the sales of vegetables (total) (17%; p = 0.038), fresh vegetables (20%; p = 0.01), dried fruit (51%; p = 0.022), oatmeal (19%; p = 0.008) and wholegrain pasta (58%; p = 0.0007) were found compared to the control area. The sales of canned fish increased by 30% in the level 1 area compared to the level 2 area (p = 0.025). This study demonstrated significant increases in the sales of healthy foods, both in the areas with multi-component and mass media interventions alone compared to the control area.

Impact of school-based nutrition and physical activity intervention on body mass index eight years after cessation of randomized controlled trial (AVall study).

BACKGROUND & AIMS: The prevalence of obesity and overweight among children is increasing, representing a new and pressing societal problem. Excess weight in childhood is an independent risk factor for adult obesity. Although school-based interventions are generally considered effective in the short term, few studies analyze their longterm impact. The aim of study was to assess if the effect of the intervention on body mass Index (BMI) immediately after the intervention remained eight years later (AVall Study). METHODS: In 2006-2008, an intervention for primary school children promoted healthy eating habits and physical activity in the school setting using the Investigation, Vision, Action and Change (IVAC) educational methodology, which involves children as active participants in healthy change. At baseline, parents reported their weight, height and educational level by questionnaire. Children's weight and height were measured in situ in 2006, 2008, 2010, 2012 and 2016, and levels of physical activity were assessed by questionnaire. Multilevel mixed effects linear regression was used to assess changes in BMI over time. RESULTS: Increases in BMI from 2006 to 2016 were 0.68 kg/m2 (95% CI, 0.02, 1.34; P = 0.045) higher in the control group than in the intervention group. The prevalence of obesity and overweight combined in 2006 and 2016 was 22.2% and 27.9%, respectively, in the control group and 25.6% and 21.2% respectively, in the intervention group. Changes in BMI in the intervention group were maintained from 2006 on: at the end of the intervention in 2008, -0.4 kg/m2 (P = 0.001); in 2010, -0.23 g/m2 (P = 0.012); in 2012, -0.63 kg/m2 (P < 0.001) and in 2016, -0.27 kg/m2 (P = 0.025). The child's BMI increased by 0.52 kg/m2 (P = 0.046) if the father was obese, by 1.26 kg/m2 (p = 0.011) if the mother was obese, and by 2.37 kg/m2 (P < 0.001) if both parents were obese. Parental education levels were not associated with childhood obesity. CONCLUSIONS: A school-based healthy eating habits and physical activity intervention using IVAC methodology contributed to lower increases in BMI among children in primary school. Although parental BMI also influenced children's BMI, the intervention was effective. TRIAL REGISTRATION: ClinicalTrials.gov NCT01156805.

Project SoL-A Community-Based, Multi-Component Health Promotion Intervention to Improve Healthy Eating and Physical Activity Practices among Danish Families with Young Children Part 2: Evaluation.

Project SoL is implemented over a period of four years with the aim to promote healthy eating and physical activity among children aged 3⁻8 years by targeting the families in a Danish municipality based on the multi-component, supersetting strategy. Interventions are implemented in childcare centres, schools and supermarkets in three local communities as well as in local mass media and social media during a 19 months period in the Municipality of Bornholm. The matching Municipality of Odsherred serves as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper gives an account of the design used for the summative and formative evaluation based on a realistic evaluation and a mixed methods approach combining qualitative and quantitative methods. Summative studies are conducted on changes of health behaviours among the involved families and within the municipalities in general, changes in community awareness of the project, changes in purchase patterns, changes in overweight and obesity among the targeted children and changes in knowledge and preferences among children due to sensory education workshops. The formative research comprises studies on children's perceptions of health, perceptions of staff at supermarkets and media professionals on their roles in supporting the health promotion agenda, and motivations and barriers of community stakeholders to engage in health promotion at community level. The paper discusses operational issues and lessons learnt related to studying complex community interventions, cross-disciplinarily, interfaces between practice and research and research capacity strengthening; and suggests areas for future research. The development and implementation of the intervention and its theoretical foundation is described in a separate paper.

Project SoL-A Community-Based, Multi-Component Health Promotion Intervention to Improve Eating Habits and Physical Activity among Danish Families with Young Children. Part 1: Intervention Development and Implementation.

Project SoL was implemented over a period of four years from 2012⁻2015 with the aim to promote healthy eating and physical activity among families with children aged 3⁻8 years, living in selected communities in two Danish municipalities. This was done by applying the supersetting approach to implement complex multi-component interventions in a participatory, coordinated, and integrated manner in childcare centres, schools, and supermarkets in three local communities, as well as in local media during a 19-month period in the Regional Municipality of Bornholm, which served as the intervention site. The matching municipality of Odsherred served as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper describes the design of Project SoL as well as the processes of developing and implementing its complex interventions. Moreover, the theoretical and conceptual framework of the project is described together with its organisational structure, concrete activities, and sustainability measures. The paper discusses some of the key lessons learned related to participatory development and the implementation of a multi-component intervention. The paper concludes that coordinated and integrated health promotion activities that are implemented together with multiple stakeholders and across multiple settings in the local community are much more powerful than individual activities carried out in single settings. The supersetting approach was a useful conceptual framework for developing and implementing a complex multi-component health promotion intervention and for fostering ownership and sustainability of the intervention in the local community. The research and evaluation approach of the project is described in a separate paper (Part 2).

The involvement of young people in school- and community-based noncommunicable disease prevention interventions: a scoping review of designs and outcomes.

BACKGROUND: Since stakeholders' active engagement is essential for public health strategies to be effective, this review is focused on intervention designs and outcomes of school- and community-based noncommunicable disease (NCD) prevention interventions involving children and young people. METHODS: The review process was based on the principles of scoping reviews. A systematic search was conducted in eight major databases in October 2015. Empirical studies published in English, French, Portuguese, and Spanish were considered. Five selection criteria were applied. Included in the review were (1) empirical studies describing (2) a health intervention focused on diet and/or physical activity, (3) based on children's and young people's involvement that included (4) a relationship between school and local community while (5) providing explicit information about the outcomes of the intervention. The search provided 3995 hits, of which 3253 were screened by title and abstract, leading to the full-text screening of 24 papers. Ultimately, 12 papers were included in the review. The included papers were analysed independently by at least two reviewers. RESULTS: Few relevant papers were identified because interventions are often either based on children's involvement or are multi-setting, but rarely both. Children were involved through participation in needs assessments, health committees and advocacy. School-community collaboration ranged from shared activities, to joint interventions with common goals and activities. Most often, collaboration was school-initiated. Most papers provided a limited description of the outcomes. Positive effects were identified at the organisational level (policy, action plans, and healthy environments), in adult stakeholders (empowerment, healthy eating) and in children (knowledge, social norms, critical thinking, and health behaviour). Limitations related to the search and analytical methods are discussed. CONCLUSION: There are very few published studies on the effectiveness of interventions based on children's involvement in school- and community-based NCD prevention programmes. However, interventions with these characteristics show potential benefits, and the merits of complex multi-setting approaches should be further explored through intervention-based studies assessing their effectiveness and identifying which components contribute to the observed outcomes.

Designing for health in school buildings: between research and practice.

AIM: To investigate the kinds of knowledge practitioners use when planning and designing for health in school buildings. METHODS: Twelve semi-structured qualitative interviews were conducted with architects, teachers and officials to investigate use of knowledge in the making of school buildings. RESULTS: Practitioners drew on many kinds and sources of knowledge, but in particular they made use of concepts, examples or pictures or thought-provoking knowledge. However, the interviews indicate a number of hurdles for efficient knowledge sharing between research and practice: (1) a considerable discrepancy between kinds of knowledge used by practice and knowledge traditionally produced by research; (2) research-knowledge and practice-knowledge form two circuits and the flow from one circuit to the other is weak; (3) practitioners' knowledge was often based on experience and therefore person-dependent. It makes the knowledge vulnerable. CONCLUSIONS: Special attention has to be paid by research to concepts and principles to guide the decision-making in practice. Further is recommended to consider new kinds of collaboration between researchers and practitioners.

Revitalizing the setting approach - supersettings for sustainable impact in community health promotion.

BACKGROUND: The concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have further developed the setting approach in an effort to harmonise it with contemporary realities (and complexities) of health promotion and public health action. The paper introduces a modified concept, the supersetting approach, which builds on the optimised use of diverse and valuable resources embedded in local community settings and on the strengths of social interaction and local ownership as drivers of change processes. Interventions based on a supersetting approach are first and foremost characterised by being integrated, but also participatory, empowering, context-sensitive and knowledge-based. Based on a presentation of "Health and Local Community", a supersetting initiative addressing the prevention of lifestyle diseases in a Danish municipality, the paper discusses the potentials and challenges of supporting local community interventions using the supersetting approach. DISCUSSION: The supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable impact of supersetting initiatives. The supersetting approach is an ecological approach, which places the individual in a social, environmental and cultural context, and calls for a holistic perspective to change potentials and developmental processes with a starting point in the circumstances of people's everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society. SUMMARY: The supersetting approach is a relevant and useful conceptual framework for developing intervention-based initiatives for sustainable impact in community health promotion. It strives to attain synergistic effects from activities that are carried out in multiple settings in a coordinated manner. The supersetting approach is based on ecological and whole-systems thinking, and stipulates important principles and values of integration, participation, empowerment, context and knowledge-based development.

Involving students in learning and health promotion processes--clarifying why? what? and how?

The concept of student participation is currently a popular notion in health promoting schools as well as in general education. However, phrases such as 'involvement', 'participation', 'co-determination' and 'influence' are frequently used without careful definition. In this article two models, developed in the context of health promoting schools in two different cultures, are presented and discussed. The first model makes a fundamental distinction between token and genuine participation. Token participation in health promotion is characterised by focusing on prescribed knowledge, closed and convergent outcomes and targeting individuals isolated from the surrounding environment. In contrast, genuine participation stresses students' own construction of knowledge, open and divergent outcomes and targeting individuals in their context. Genuine participation is in accordance with a democratic health promoting school aiming at students' empowerment and action competence. The second model clarifies a number of different categories of students' participation in health promotion. The different categories illustrate how the teacher in various ways can play an active role in participatory approaches as a responsible professional. The more the students are involved in health projects, the more important it will be for the teacher to provide support, insight and knowledge to facilitate the learning processes. Furthermore, the different participation categories have to be related to a number of decisions which are normally included in a school health project. The model illustrates that participation should always be viewed in relation to the context and that it makes no sense to establish a single ideal way of working with participation in a health promoting school. The theoretical models are illuminated by concrete examples from health promoting schools. The overall conclusion is that participation is a complex term and rather than providing definitive answers, the models can be used as a framework for discussion among all stakeholders in planning, implementation, evaluation and managing projects involving student participation. Finally, specific implications and challenges for future health promoting schools are outlined. These are as follows: a participatory approach does not imply that health content should be regarded as vague or superfluous; teachers need flexible educational models and resources to manage participatory projects in health promoting schools; schools have to be acknowledged as cultural systems with firmly rooted rules and routines that are often difficult to change; a participatory approach has to influence all aspects of a democratic health promoting school rather than solely the teaching strategies.