Promoting mental well-being in Western Australia: Act Belong Commit® mental health promotion campaign partners' perspectives.

The Act Belong Commit® mental health promotion campaign aims to improve population mental well-being. Based on a social-franchising model, partnerships are sought with organizations offering 'mentally healthy activities' that foster social connectedness and mental well-being. There are four categories of partner organizations sought: Site (government agencies and health services), Associate (organizations with state-wide or national services), Community (local, grass-roots community groups) and Schools. This research explored organizational perceptions of the Act Belong Commit® Partnership Program. A purposive sample of 14 organizational representatives across all four partner categories participated in semi-structured interviews online or face-to-face between July and September 2021. Reflexive thematic analysis was used to identify three main themes: (a) A passion for promoting mental health; (b) Implementation, innovation, adaption and creation (e.g. the ability to adapt, create and deliver activities aligned with the campaign message; and (c) Future sustainability (e.g. recommendations for the sustainability of the programme). The use of reflexive thematic analysis enabled deeper insights into the complexity of the partnerships. Findings describe how the Act Belong Commit® Partnership Program supports mutually desirable objectives and extends the campaign reach. Embedded in a shared belief system that incorporates a passion for good mental health, the model supports the flexibility to adapt, create and deliver fit-for-purpose activities that promote mental well-being in the places where people live, work and play.

Maternal mental health of adolescent mothers: a cross-sectional mixed-method study protocol to determine cultural and social factors and mental health needs in Lilongwe, Malawi.

INTRODUCTION: Adolescence marks a transition of life from childhood to adulthood. Becoming a mother during adolescence presents unique challenges that have a significant mental and physical burden and may increase the likelihood of developing common mental disorders (CMDs). Untreated CMDs have serious effects on both the mother and her child. Culture constitutes an important context for most experiences, and affects how individuals seek help. However, there is limited research that has investigated how culture and social factors influence the adolescent mother's mental health during the postpartum period in Malawi. METHODS/DESIGN: A cross-sectional sequential mixed methods design will be carried out in four phases. Phase one will include the preparatory phase and scoping review. The second phase will comprise a survey with adolescent mothers. The sample for the survey consists of adolescent postpartum mothers aged 14-19 years (with infants of up to 6 months of age) who have the capacity to consent for the study. Phase three will be a qualitative study in which in-depth interviews and focus group discussions will be employed to collect data from health workers and informal healthcare providers in the community (eg, traditional healers, traditional birth attendants). The fourth phase will involve developing recommendations for policy and practice ETHICS AND DISSEMINATION: This study will provide an understanding of the impact of culture and social factors that influence adolescent mother's mental health and well-being, including the identification of potential risk and protective factors. The findings will inform recommendations for an appropriate, culturally accepted spectrum of interventions, including universal, selective and indicated prevention strategies. The findings will be disseminated to stakeholders working in maternal health in Malawi. Ethical approval was received from the Curtin University Human Research Ethics Committee (HRE2021-0223) and (P.05/21/575) Malawian Ethics Board National Committee on Research Ethics in the Social Sciences and Humanities.

Exploring reasons for vaccine-hesitancy among higher-SES parents in Perth, Western Australia.

ISSUES ADDRESSED: The increasing prevalence among higher-socioeconomic (higher-SES) parents in Perth, Western Australia (WA), to be vaccine-hesitant (VH) is placing herd immunity at risk. METHODS: Eighteen one-on-one interviews were conducted; (n = 11) parents who earned >$125 000 pa and expressed ever having concerns surrounding vaccination; (n = 7) health care professionals (HCPs), who provided clinical services. Using grounded theory methodology, data were analysed by constant coding and comparison until themes emerged and an explanatory model was developed. RESULTS: Four main areas leading to vaccine-hesitancy emerged from the data: We are Educated; We Control our Health; Safe from Disease, At Risk from Vaccines; and What We Want. Parents believed themselves capable of making good vaccination decisions based on their higher education levels and self-sourced vaccination information, yet frequently sought reassurance. Healthism concepts were adopted and parents believed lifestyle factors could control for vaccine-preventable diseases (VPD). Risk perception of disease was low and influenced by the remote geographic location of Perth, whilst perceived negative consequences of vaccination were high. A reduced concept of the social responsibility for vaccination and understanding of herd immunity emerged. Parents called for vaccine contents to be listed and requested more information on why vaccination was necessary. CONCLUSION: Four areas of VH emerged and reflected parents' belief that higher educational and socioeconomic status, previous successes in life and where they live would result in positive health outcomes and reduce the risk of contracting VPDs. SO WHAT?: This study provides new research into the perceptions among higher-SES VH parents who live in Perth, WA. It provides a model that fills a significant gap in information that could be used effectively for future health promotion interventions.

A cross sectional evaluation of an alcohol intervention targeting young university students.

BACKGROUND: Hazardous drinking has been found to be higher among young university students compared to their non-university peers. Although young university students are exposed to new and exciting experiences, including greater availability and emphasis on social functions involving alcohol there are few multi strategy comprehensive interventions aimed at reducing alcohol-related harms. METHODS: Random cross sectional online surveys were administered to 18-24 year old students studying at the main campus of a large metropolitan university in Perth, Western Australia. Prior to the completion of the second survey an alcohol intervention was implemented on campus. Completed surveys were received from 2465 (Baseline; T1) and 2422 (Post Year 1: T2) students. Students who consumed alcohol in the past 12 months were categorised as low risk or hazardous drinkers using the Alcohol Use Disorders Identification Test (AUDIT). Due to the cross sectional nature of the two samples two-tailed two-proportion z-test and two sample t-tests were employed to determine statistical significance between the two time periods for categorical and continuous variables respectively. RESULTS: At T1 and T2 89.1 % and 87.2 % of the total sample reported drinking alcohol in the past month respectively. Hazardous levels of alcohol consumption reduced slightly between T1 (39.7 %) and T2 (38 %). In both time periods hazardous drinkers reported significantly higher mean scores for experienced harm, second-hand harm and witnessed harm scores compared to low risk drinkers (p <0.001). Hazardous drinkers were significantly more likely to experience academic problems due to their alcohol consumption and to report more positive alcohol expectations than low risk drinkers at both time periods (p <0.001). CONCLUSIONS: Harms and problems for students who report hazardous drinking are of concern and efforts should be made to ensure integrated and targeted strategies reach higher risk students and focus on specific issues such as driving while intoxicated and alcohol related unplanned sexual activity. However there is also a need for universal strategies targeting all students and low risk drinkers as they too are exposed to alcohol harms within the drinking and social environment. Changing the culture of the university environment is a long term aim and to effect change a sustained combination of organisational actions, partnerships and educational actions is required.

Supporting health promotion practitioners to undertake evaluation for program development.

BACKGROUND: The vital role of evaluation as integral to program planning and program development is well supported in the literature, yet we find little evidence of this in health promotion practice. Evaluation is often a requirement for organisations supported by public funds, and is duly undertaken, however the quality, comprehensiveness and use of evaluation findings are lacking. Practitioner peer-reviewed publications presenting evaluation work are also limited. There are few published examples where evaluation is conducted as part of a comprehensive program planning process or where evaluation findings are used for program development in order to improve health promotion practice. DISCUSSION: For even the smallest of programs, there is a diverse array of evaluation that is possible before, during and after program implementation. Some types of evaluation are less prevalent than others. Data that are easy to collect or that are required for compliance purposes are common. Data related to how and why programs work which could be used to refine and improve programs are less commonly collected. This finding is evident despite numerous resources and frameworks for practitioners on how to conduct effective evaluation and increasing pressure from funders to provide evidence of program effectiveness. We identify several organisational, evaluation capacity and knowledge translation factors which contribute to the limited collection of some types of data. In addition, we offer strategies for improving health promotion program evaluation and we identify collaboration of a range of stakeholders as a critical enabler for improved program evaluation. SUMMARY: Evaluation of health promotion programs does occur and resources for how to conduct evaluation are readily available to practitioners. For the purposes of program development, multi-level strategies involving multiple stakeholders are required to address the organisational, capacity and translational factors that affect practitioners' ability to undertake adequate evaluation.

Dietary outcomes of a community based intervention for mothers of young children: a randomised controlled trial.

BACKGROUND: Unhealthy dietary behaviours are one of the key risk factors for many lifestyle-related diseases worldwide. This randomised controlled trial aimed to increase the level of fruit, vegetable and fibre intake and decrease the fat and sugar consumption of mothers with young children (0-5 years) via the playgroup setting. METHODS: Playgroups located in 60 neighbourhoods in Perth, Western Australia were randomly assigned to an intervention (n = 249) or control group (n = 272). Those in the intervention group received a 6-month multi-strategy primarily home-based physical activity and nutrition program (data is only presented on dietary behaviours). Data on dietary consumption was collected via the Fat and Fibre Barometer and frequency of serves of fruit and vegetable and cups of soft drink, flavoured drink and fruit juice. The effects of the intervention on continuous outcome measures were assessed using analysis of variance (ANOVA), after adjusting for mother's age and the corresponding variables. RESULTS: The outcomes of the intervention were positive with the intervention group showing statistically significant improvements, when compared to the control group in the overall consumption of fat and fibre (p < 0.0005); of fibre (p < 0.0005) - fruit and vegetables (p < 0.0005), wholegrain (p = 0.002): and fat (p = 0.005) - dairy products (p = 0.006) and lean meat and chicken (p = 0.041). There were no significant changes in the consumption of sweet drinks. CONCLUSIONS: This intervention was successful in improving dietary intake in the intervention group participants. The moderate positive outcomes indicate that playgroups potentially provide quite a viable setting to recruit, engage and retain this hard to reach group of mothers of young children in programs that support the adoption of health-enhancing behaviours. This adds valuable information to this under researched area. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN12609000718246.

Results of a randomized controlled trial to promote physical activity behaviours in mothers with young children.

OBJECTIVE: Increasing levels of physical activity in mothers have long-term health benefits for the mother and family. The study aimed to evaluate the effect of a six-month, physical activity RCT for mothers of young children. METHODS: Women were recruited via playgroups and randomly assigned to intervention (n=394) or control group (n=322). The intervention group received a six-month multi-strategy programme delivered via playgroups in Perth, Australia. measures were mean minutes per week of moderate (M) and vigorous (V) intensity physical activity (PA), and number of days/week of muscle strength exercises. RESULTS: The intervention had a significant effect on mean time for vigorous (p=0.008), moderate (p=0.023) and total physical activity (p=0.001) when compared to the control group. The intervention group increased their vigorous activity by a mean of 24min/week, moderate activity by 23min/week and total physical activity by 72min/week. CONCLUSIONS: A relatively minimum home based intervention was able to demonstrate modest but statistically significant improvements in physical activity in a hard to reach group. These changes if maintained over a longer period are likely to improve the health of mothers and have a positive impact on their partners and children. Australian and New Zealand Clinical Trials Registry ACTRN12609000735257.

Education and support for fathers improves breastfeeding rates: a randomized controlled trial.

BACKGROUND: Studies have identified numerous factors affecting breastfeeding initiation and duration, including maternal education, mode of delivery, birth weight, socioeconomic status, and support of the infant's father. OBJECTIVE: The objective was to investigate the effects of an antenatal education session and postnatal support targeted to fathers. METHODS: The Fathers Infant Feeding Initiative (FIFI Study) is a randomized controlled trial to increase the initiation and duration of breastfeeding that was conducted in 8 public maternity hospitals in Perth, Western Australia. A total of 699 couples were randomized within hospitals to either intervention or control groups. The intervention consisted of a 2-hour antenatal education session and postnatal support provided to fathers. RESULTS: The any breastfeeding rate for the intervention group was significantly greater at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group, odds ratio 1.46 (95% CI, 1.01-2.13). After adjustment for age and hospital, the odds ratio for any breastfeeding in the intervention group was 1.58 (1.06-2.35) and for socioeconomic status (SES), 1.56 (1.06-2.30). The infants of older fathers were more likely to be breastfed at 6 weeks compared to infants of younger fathers (P < .01), and infants of fathers with high SES more likely than infants of fathers with low SES (P = .013). CONCLUSION: Even a small increase in breastfeeding rates brings public health benefits. In this study, a minimal intervention was found to significantly increase any breastfeeding at 6 weeks: 81.6% in the intervention group compared to 75.2% in the control group.

Supporting mothers to breastfeed: the development and process evaluation of a father inclusive perinatal education support program in Perth, Western Australia.

Entry into fatherhood is a challenging period with new responsibilities and changes in family dynamics. Hegemonic imagery of men portray them as capable, confident and able which can disadvantage expectant fathers who often struggle to make sense of the changes occurring around and within their own parenting journey. Although fathers historically have not been included in breastfeeding classes, antenatal education programs can be an opportunity to inform and support them in their new role. Forty-five antenatal sessions for fathers (n = 342) of 1h duration were conducted by five male educators between May 2008 and June 2009 in Perth, Western Australia. A theoretical framework from health promotion literature was used as a guide in the program's development. Fathers in the intervention group gained information about their role, the importance of communication and the benefits of breastfeeding to both mother and baby. An evaluation was obtained from fathers immediately after the session and again at 6 week post-birth, whilst mothers reported on the perception of their partners' support for breastfeeding in the 6 week survey. The aim of this paper is to describe the development and process evaluation of a perinatal education and support program for fathers to assist their partners to breastfeed.

The power of peers: why some students bully others to conform.

Utilizing an interactionist perspective, two associated sensitizing constructs, and a combination of social psychological theory, this article reports on the influence of the peer group on individual perceptions, and its impact on initiation and persistence of bullying. The specific research question, "How does the need to conform with peers and the peer group influence the initiation and persistence of bullying others?" is investigated. Semistructured, one-on-one interviews with a purposive sample of 51 Grade 7 students (aged 12 years) were conducted during school time to investigate factors that influence students to bully others and what might help them to stop. Emerging from the theme of peer group was the need for belonging and group status, in particular social norms or the need to conform, which was influential when students described why they initiated and persisted with bullying others. The influence of labeling, the group process, and the aspiration to be like others within their group emerged as key constructs. The implications of these data for schools will be described and recommendations made.

A survey of health promotion at international schools.

This study investigated health promotion efforts at international schools serving the education needs of expatriate communities abroad. Factors supporting the implementation of whole-school approaches to health promotion also were examined. Self-completed questionnaires were distributed by a combination of electronic and conventional mail. International school staff in 93 countries (n = 205) completed an adapted version of an instrument used for evaluating the Western Australian School Health Project (WASHP). This survey demonstrated usefulness of the WASHP instrument cross-culturally in a variety of school settings. The level of whole-school approaches to health promotion in the participating international schools varied but tended to be low. Demographic characteristics of schools were not associated with differences in the level of health promotion, with the exception school size. School organizational factors support implementation of health promotion programs.