Community Organising Frameworks, Models, and Processes to Improve Health: A Systematic Scoping Review.

Community involvement engages, empowers, and mobilises people to achieve their shared goals by addressing structural inequalities in the social and built environment. Through this review, we summarised published information on models, frameworks, and/or processes of community organising used in the context of health initiatives or interventions and documented the outcomes following their use. A systematic scoping review was conducted in three databases with no restrictions on the date of publication, country, or written language. Out of 5044 studies, 38 met the inclusion criteria and were included in the review. The targeted health outcomes explored by the studies were diverse and included sub-domains such as the promotion of a healthy lifestyle, sexual and reproductive health, access to healthcare and equity, and substance abuse and chronic disease management. The outcomes of most initiatives or interventions were promising, with positive changes reported for the target populations. A wide variation was noted in the models, frameworks, or processes of community organising utilised in these studies. We concluded that variation implies that no single model, framework, or process seems to have predominance over others in implementing community organising as a vehicle of positive social change within the health domain. The review also highlighted the need for a more standardised approach to the implementation and evaluation of these initiatives. We recommend that it is essential to foster public and non-governmental sector partnerships to promote community-driven health promotion efforts for a more sustainable approach to these initiatives.

Using a Collective Impact framework to evaluate an Australian health alliance for improving health outcomes.

Complex social issues such as population health mean that no one person, organization or sector can resolve these problems alone and instead require a collaborative approach. This study applied the Collective Impact framework to evaluate the alliance responsible for delivering a large-scale health promotion initiative. Committee meeting minutes for a 4-year period and qualitative interviews with key stakeholders (N = 14) involved in the design and implementation of the initiative explored the factors that contributed to collaborative efforts and initiative outcomes. Major strengths of the Healthier Queensland Alliance (the Alliance) stemmed from identifying a common agenda and using frequent communication to develop trust among Alliance partners. These processes were important, particularly in improving key relationships to ensure inclusivity and equity. Reinforcing activities helped to support individual organizational efforts, while shared measurement systems promoted data-driven decision-making and learning, which contributed to continuous improvement and innovation. Current findings support the use of the Collective Impact framework as a scaffold to assist collaborative alliances in working effectively and efficiently when implementing large-scale initiatives aiming to create positive social impact. This study has identified the foundations of practice to establish a successful Collective Impact alliance.

Collective action to achieve social impact requires collaboration allowing organizations to expand their resources and abilities to enhance their collective capabilities. This paper reports on the use of the Collective Impact framework to show how a collaboration of partner organizations was developed to achieve social impact in a large health promotion initiative. The study identified six foundations for practice to enable successful collective partnerships that will be useful for practitioners and policy-makers when developing health promotion initiatives targeting a range of priority groups. The Collective Impact framework offers a strategic approach for building capacity in a range of communities to navigate power dynamics and find new ways of collaboration to achieve positive social impacts for their communities.

A Socio-Cognitive Review of Healthy Eating Programs in Australian Indigenous Communities.

PURPOSE: This paper aims to understand the challenges to healthy eating for Indigenous Australians using a Social Cognitive Theory lens. Understanding the environmental, cognitive, and behavioural barriers to healthy eating for Indigenous populations in Australia will help identify current gaps and highlight future actions needed in this area to close the gap for Indigenous Australians. STUDY DESIGN: Narrative review of interventions of healthy eating programs in Australian Indigenous communities sourced using a systematic search protocol to understand the environmental, cognitive, and behavioural barriers to healthy eating among Indigenous Australians and to identify gaps and future actions needed to address this from 2010-2020. RESULTS: The search produced 486 records, after duplicates were removed and the inclusion and exclusion process were utilised, seven interventions were retained in nine studies. The seven interventions had multiple study designs, from randomised control trials to case studies. CONCLUSIONS: Further work needs to explore the long-term feasibility of providing fruit and vegetable discounts and the impact of remoteness for the delivery of healthy food. Dietary interventions need to be clearly described, and fidelity and process of the design and implementation process to help with replication of work.

Geographic remoteness and socioeconomic disadvantage reduce the supportiveness of food and physical activity environments in Australia.

OBJECTIVE: An analysis of food and physical activity environments in relation to socioeconomic disadvantage was conducted in 25 communities across Queensland, Australia. METHODS: Physical activity and food environments were assessed in 25 Queensland communities using The Systematic Pedestrian and Cycling Environmental Scan (SPACES) and the Nutrition Environment Measurement Survey (NEMS). Spearman's correlation tested the association between physical activity and food environments and degree of remoteness and socioeconomic disadvantage of each region. RESULTS: A significant negative association was observed between the supermarket food environment and degree of remoteness and socioeconomic disadvantage. All regions have a moderately supportive environment for physical activity. Food availability and price varied in supermarkets with more remote communities having less supportive food environments. CONCLUSIONS: Areas with a high degree of remoteness and socioeconomic disadvantage were more likely to experience disadvantages in the physical activity, supermarket, and restaurant food environments than metropolitan areas and socioeconomically disadvantaged areas. IMPLICATIONS FOR PUBLIC HEALTH: Socioeconomic disadvantage and remoteness were associated with reduced supportiveness of the built environment hindering the ability of consumers to make healthy food and physical activity choices. Improving the food and physical activity environments in these areas may assist in reducing the health inequalities experienced by these communities.

A multi-component evaluation framework of a state-wide preventive health program: My health for life.

ISSUE: Chronic disease is a growing problem affecting approximately half of all Australian adults. In response to growing calls for action on chronic disease, the My health for life program was created, aimed at improving the health of individuals at high risk of developing preventable chronic disease. The preventive health program is multi-modal, cross-culturally tailored and contains complex social marketing, community engagement, risk assessment and health promotion components. Therefore, a multi-component evaluation framework is essential to understand the effectiveness of the My health for life program. This brief report details the evaluation. METHODS: The evaluation design uses non-randomised, longitudinal analysis using repeated measures, observational, program goal-based and pretest-posttest design features to assess the program, its specific modalities and its program adaptations. To ensure timely and credible evaluation, different evaluative implementation frameworks and methods are considered. Quantitative and qualitative methods collect an array of program data at differing levels to assess the processes, outcomes and impacts of My health for life. DISCUSSION: The implemented evaluation framework has allowed measurement of: (i) process impacts including uptake, retention and attrition, participant satisfaction, fidelity and program stakeholder engagement and (ii) outcomes relating to individual participant level changes in health behaviours. SO WHAT?: This evaluation is an example of an integrated evaluation approach in a large successful preventive health program. Findings from the evaluation will ultimately inform the applicability and transferability of the program and inform policy makers, stakeholders and other health professionals in preventive health practice.

Reducing health inequalities trough digital options in mental health: A physician's perspective.

This article explores the physicians' perspective regarding the potential of computerized cognitive behavioral therapies (cCBTs) to overcome inequalities in the context of mental health care provision. The main benefits were related to the ability of cCBTs to provide care in a convenient and efficient manner, enhancing its accessibility. These aspects were perceived more important than cost-effectivity of treatment, which is often claimed to be the key benefit of cCBTs. Age and general acceptance of CBT were the most significant individual-level separators of perceptions, while the sector in which the physician works was seen as the main structural-level separator.

Can a text message a week improve breastfeeding?

BACKGROUND: Breastfeeding is recognised as the optimal method for feeding infants with health gains made by reducing infectious diseases in infancy; and chronic diseases, including obesity, in childhood, adolescence and adulthood. Despite this, exclusivity and duration in developed countries remains resistant to improvement. The objectives of this research were to test if an automated mobile phone text messaging intervention, delivering one text message a week, could increase "any" breastfeeding rates and improve breastfeeding self-efficacy and coping. METHODS: Women were eligible to participate if they were: over eighteen years; had an infant less than three months old; were currently breastfeeding; no diagnosed mental illness; and used a mobile phone. Women in the intervention group received MumBubConnect, a text messaging service with automated responses delivered once a week for 8 weeks. Women in the comparison group received their usual care and were sampled two years after the intervention group. Data collection included online surveys at two time points, week zero and week nine, to measure breastfeeding exclusivity and duration, coping, emotions, accountability and self-efficacy. A range of statistical analyses were used to test for differences between groups. Hierarchical regression was used to investigate change in breastfeeding outcome, between groups, adjusting for co-variates. RESULTS: The intervention group had 120 participants at commencement and 114 at completion, the comparison group had 114 participants at commencement and 86 at completion. MumBubConnect had a positive impact on the primary outcome of breastfeeding behaviors with women receiving the intervention more likely to continue exclusive breastfeeding; with a 6% decrease in exclusive breastfeeding in the intervention group, compared to a 14% decrease in the comparison group (p < 0.001). This remained significant after controlling for infant age, mother's income, education and delivery type (p = 0.04). Women in the intervention group demonstrated active coping and were less likely to display emotions-focussed coping (p < .001). There was no discernible statistical effect on self-efficacy or accountability. CONCLUSIONS: A fully automated text messaging services appears to improve exclusive breastfeeding duration. The service provides a well-accepted, personalised support service that empowers women to actively resolve breastfeeding issues. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12614001091695.