Recommendations for supporting healthcare workers' psychological well-being: Lessons learned during the COVID-19 pandemic.

Healthcare workers are at risk of adverse mental health outcomes due to occupational stress. Many organizations introduced initiatives to proactively support staff's psychological well-being in the face of the COVID-19 pandemic. One example is the STEADY wellness program, which was implemented in a large trauma centre in Toronto, Canada. Program implementors engaged teams in peer support sessions, psychoeducation workshops, critical incident stress debriefing, and community-building initiatives. As part of a project designed to illuminate the experiences of STEADY program implementors, this article describes recommendations for future hospital wellness programs. Participants described the importance of having the hospital and its leaders engage in supporting staff's psychological well-being. They recommended ways of doing so (e.g., incorporating conversations about wellness in staff onboarding and routine meetings), along with ways to increase program uptake and sustainability (e.g., using technology to increase accessibility). Results may be useful in future efforts to bolster hospital wellness programming.

The impact of India's accredited social health activist (ASHA) program on the utilization of maternity services: a nationally representative longitudinal modelling study.

BACKGROUND: In 2006, the Government of India launched the accredited social health activist (ASHA) program, with the goal to connect marginalized communities to the health care system. We assessed the effect of the ASHA program on the utilization of maternity services. METHODS: We used data from Indian Human Development Surveys done in 2004-2005 and in 2011-2012 to assess demographic and socioeconomic factors associated with the receipt of ASHA services, and used difference-in-difference analysis with cluster-level fixed effects to assess the effect of the program on the utilization of at least one antenatal care (ANC) visit, four or more ANC visits, skilled birth attendance (SBA), and giving birth at a health facility. RESULTS: Substantial variations in the receipt of ASHA services were reported with 66% of women in northeastern states, 30% in high-focus states, and 16% of women in other states. In areas where active ASHA activity was reported, the poorest women, and women belonging to scheduled castes and other backward castes, had the highest odds of receiving ASHA services. Exposure to ASHA services was associated with a 17% (95% CI 11.8-22.1) increase in ANC-1, 5% increase in four or more ANC visits (95% CI - 1.6-11.1), 26% increase in SBA (95% CI 20-31.1), and 28% increase (95% CI 22.4-32.8) in facility births. CONCLUSIONS: Our results suggest that the ASHA program is successfully connecting marginalized communities to maternity health services. Given the potential of the ASHA in impacting service utilization, we emphasize the need to strengthen strategies to recruit, train, incentivize, and retain ASHAs.

Health Advocacy for Busy Professionals: Effective Advocacy With Little Time.

Health advocacy is a central responsibility for health educators and public health practitioners, as documented clearly in our professional competencies. Professional organizations such as the Society for Public Health Education and the American Public Health Association undertake frequent advocacy initiatives and strive to engage their members in advocacy strategies on a regular basis. Despite this understanding and advocacy training requirements in academic preparation programs for public health professionals, students and emerging professionals often lack advocacy experience. In this article, we provide descriptions of multiple effective health advocacy strategies spread across the time intensity spectrum, in order of least time intensive to most. Advocates may select the best strategy based on the needs of their target audience, the amount of time and energy they have for the task, and the level of confidence they have in practicing the strategy itself.

Using Job Analysis Techniques to Understand Training Needs for Promotores de Salud.

Despite the value of community health worker programs, such as Promotores de Salud, for addressing health disparities in the Latino community, little consensus has been reached to formally define the unique roles and duties associated with the job, thereby creating unique job training challenges. Understanding the job tasks and worker attributes central to this work is a critical first step for developing the training and evaluation systems of promotores programs. Here, we present the process and findings of a job analysis conducted for promotores working for Planned Parenthood. We employed a systematic approach, the combination job analysis method, to define the job in terms of its work and worker requirements, identifying key job tasks, as well as the worker attributes necessary to effectively perform them. Our results suggest that the promotores' job encompasses a broad range of activities and requires an equally broad range of personal characteristics to perform. These results played an important role in the development of our training and evaluation protocols. In this article, we introduce the technique of job analysis, provide an overview of the results from our own application of this technique, and discuss how these findings can be used to inform a training and performance evaluation system. This article provides a template for other organizations implementing similar community health worker programs and illustrates the value of conducting a job analysis for clarifying job roles, developing and evaluating job training materials, and selecting qualified job candidates.

Public Health and School Health Education: Aligning Forces for Change.

The interdependent relationship between health and education has long been documented by leading health and education scholars. Children who are not physically, mentally, socially, or emotionally healthy will not be ready to learn and thus hampered to achieve their full potential as productive members of society. Despite this evidence, the United States has yet to bridge the divide between the health and education systems. This perspective introduces three manuscripts in this Special School Health Education Collection on the future of school health education in the United States, and provides a context for the challenges and recommendations each article outlines to improve the quantity and quality of school health education for preK-12 youth. Although some of the challenges and recommendations are not novel, what is exciting is the opportunity to move the agenda forward given the Whole School, Whole Community, Whole Child model and the Every Student Succeeds Act of 2015. Aligning the forces of public health and school health educators is essential to make school health education a societal imperative.

Promoting Health Through Policy and Systems Change: Public Health Students and Mentors on the Value of Policy Advocacy Experience in Academic Internships.

Emerging professionals and new Certified Health Education Specialists often lack academic training in and actual experience in National Commission for Health Education Credentialing Area of Responsibility VII: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession. For undergraduate and graduate students who have an opportunity to complete an internship or practicum experience, gaining experience in Competencies 7.2: Engage in advocacy for health and health education/promotion and 7.3: Influence policy and/or systems change to promote health and health education can have a profound impact on their career development and their ability to advocate for policies that promote health and health equity. Compelling evidence suggests that interventions that address social determinants of health such as poverty and education and those that change the context through improved policy or healthier environments have the greatest impact on public health, making it vital for emerging public health professionals to gain experience in policy advocacy and systems change. In this commentary, students and faculty from two large universities in the U.S.-Mexico border region reflect on the value of policy advocacy in academic internship/fieldwork experiences. Based on their experiences, they highly recommend that students seek out internship opportunities where they can participate in policy advocacy, and they encourage university faculty and practicum preceptors to provide more opportunities for policy advocacy in both classroom and fieldwork settings.

The emergence of integrated approaches to worker health, safety and wellbeing in Australia.

Integrated approaches to worker health, safety and wellbeing have been progressively developed and implemented internationally for over a decade; however, implementation in the Australian context is still in the early stages. Integrated workplace interventions recognise the interaction between health protection and health promotion to create a workplace culture in which health, safety and wellbeing are valued and managed efficiently, together with a view to improve organisational productivity. The present paper describes the progress of integrated approaches in six Victorian workplaces considered early adopters and identifies the drivers for further policy and program development in this area. Using a qualitative exploratory multiple case study design, organisational documents were systematically analysed and semi-structured interviews were conducted in six organisations that met criteria for an integrated approach. Key mechanisms to support this approach were observed, including active leadership, the development of an integrated committee for activities, clear strategies to engage employees and an existing commitment to safety practices. The prioritisation within a workplace to integrate health, safety and wellbeing, and ensure sustainability of these approaches, was detected as a gap for future development.

Strengthening the rural dietetics workforce: examining early effects of the Northern Ontario Dietetic Internship Program on recruitment and retention.

INTRODUCTION: As with other allied health professions, recruitment and retention of dietitians to positions in rural and isolated positions is challenging. The aim of this study was to examine the early effects of the Northern Ontario Dietetic Internship Program (NODIP) on recruitment and retention of dietitians to rural and northern dietetics practice. The program is unique in being the only postgraduate dietetics internship program in Canada that actively selects candidates who have a desire to live and work in northern and rural areas. Objectives of the survey were to track the early career experiences of the first five cohorts (2008-2012) of NODIP graduates, with an emphasis on employment in underserviced rural and northern areas of Ontario. METHODS: NODIP graduates (62) were invited to complete a 27-item, self-administered, mailed questionnaire approximately 22 months after graduation. The survey, reflecting issues identified in the rural allied health and dietetics literature, documented their work history, practice locations, employment settings, roles, future career intentions and rural background. Aggregated data were analyzed descriptively to assess their early work experiences, with a focus on their acceptance of positions in rural and northern communities. Items also assessed professional and personal factors influencing their most recent decisions concerning practice locations. RESULTS: Three-quarters of graduates chose organizations serving rural or northern communities for their first employment positions and two-thirds were practicing in rural and underserviced areas when surveyed. Most worked as clinical, community health or public health dietitians, in diverse settings including clinics, hospitals and diabetes care programs. Although most had found permanent positions, working for more than one employer at a time was not uncommon. Factors affecting practice choices included prior awareness of employers, prospects for full-time employment, flexible working conditions, access to interprofessional practice and continuing education, as well as community and family concerns. Intentions to remain in current positions were also shaped by a mixture of professional and personal considerations. Some would relocate in search of opportunities for specialization; a few would leave due to dissatisfaction with employment conditions and disinterest in work; others would move due to personal and family commitments. CONCLUSIONS: This study provides early evidence that the NODIP distributed and community-engaged learning model has been very successful in its goal of augmenting the rural and northern dietetics workforce, with a majority of graduates accepting and remaining in rural positions during their first 2 years of practice. Whether graduates remain in rural practice, however, depends on a number of other factors, including career aspirations, availability of professional supports and personal commitments. This suggests that additional supports, above and beyond the NODIP internship, may be needed to encourage graduate dietitians to stay in rural and northern practice locations over the longer term.

Strengthening the Engagement of Provinces in Health Workforce Planning and Management: A Case Study From Lao PDR.

The purpose of this health workforce plan is to provide guidance for the staffing of the Bolikhamxay. Province health services and the training of health service personnel to the year 2020. It must be stressed, however, that this plan is in its first iteration and does not provide all the solutions. Rather, it identifies issues that need to be further investigated and resolved at the local level. For example, the provincial health department (PHD) will need to further investigate the reasons for the significant variability in the utilization of services in different facilities and in the different ratios of staff in relation to the activities performed. The accuracy of the data must be validated and specific interventions must be determined. For Bolikhamxay, particular attention by PHD and district health authorities should be given to the following issues identified in the analysis:• Shortage of clinical staff, particularly in the age group 30 to 40 years old, to provide supervision, guidance, and support for junior staff in coming years;• The existence of health centers with less than minimum staffing level (<3), including a midwife and/or staff capable of properly addressing emergencies with particular reference to maternal and child health.• The median number of activities per staff per year is around 470 (Nakoun/Bolikhan), which means that, on average, a health worker will participate in fewer than two activities per day. The situation in some district hospitals and most health centers is even worse, with an annual average number of activities per staff of only 163, which means that, on average, one staff participates in one activity every 3 days, hardly enough to maintain skills and justify deployment.• This low level of staff activity raises questions about the need for further increase of staff supply to health centers and districts unless effective interventions are implemented to increase the demand and utilization of services in these facilities.• It is also necessary to document all relevant activities, including outreach activities and home visits, in order to give appropriate weight in the calculation of utilization and productivity.• Development of the provincial health workforce development plan requires validated human resources for health information and engagement of local health authorities, as well as strong collaboration with the national authorities and development partners, to ensure adequate support and resourcing.

Selection and performance of village health teams (VHTs) in Uganda: lessons from the natural helper model of health promotion.

BACKGROUND: Community health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion. METHODS: As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members. RESULTS: The VHT selection process created distrust, damaging the programme's legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community's members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work. CONCLUSION: As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.

Exploring competing experiences and expectations of the revitalized community health worker programme in Mozambique: an equity analysis.

INTRODUCTION: Mozambique launched its revitalized community health programme in 2010 in response to inequitable coverage and quality of health services. The programme is focused on health promotion and disease prevention, with 20 % of community health workers' (known in Mozambique as Agentes Polivalentes Elementares (APEs)) time spent on curative services and 80 % on activities promoting health and preventing illness. We set out to conduct a health system and equity analysis, exploring experiences and expectations of APEs, community members and healthcare workers supervising APEs. METHODS: This exploratory qualitative study captured the perspectives of a range of participants including women caring for children under 5 years (service clients), community leaders, service providers (APEs) and their supervisors. Participants in the Moamba and Manhiça districts, located in Maputo Province (Mozambique), were selected purposively. In total, 29 in-depth interviews and 9 focus group discussions were conducted in the local language and/or Portuguese. A framework approach was used for analysis, assisted by NVivo10 software. RESULTS: Our analysis revealed that health equity is viewed as linked to the quality and coverage of the APE programme. Demand and supply factors interplay to shape health equity. The availability of responsive and appropriate services led to tensions between community expectations for curative services (and APEs' willingness to perform them) and official policy focusing APE efforts mainly on preventive services and health promotion. The demand for more curative services by community members is a result of having limited access to healthcare services other than those offered by APEs. CONCLUSION: This study highlights the need to pay attention to the determinants of demand and supply of community interventions in health, to understand the opportunities and challenges of the difficult interface role played by APEs and to create communication among stakeholders in order to build a stronger, more effective and equitable community programme.

Professional development through policy advocacy: communicating and advocating for health and health equity.

Communicating and advocating for evidence-based public health policy is a key component of health promotion practice, but public health professionals often lack experience in policy advocacy. This article provides perspectives from public health professionals who participated in successful public health policy advocacy efforts in their community. Their experiences using evidence-based research to advocate for policies that promote health equity contributed significantly to their career development, and also contributed to community capacity to reduce tobacco-related disparities. This article builds on previous work emphasizing the value of career development opportunities that enhance and diversify the public health workforce, and provides practical tips and "lessons learned" that are relevant to a wide range of public health professionals.

Health promotion in smaller workplaces in the United States.

Most American workplaces are smaller, with fewer than 1,000 employees. Many of these employees are low-wage earners and at increased risk for chronic diseases. Owing to the challenges smaller workplaces face to offering health-promotion programs, their employees often lack access to health-promotion opportunities available at larger workplaces. Many smaller employers do not offer health insurance, which is currently the major funding vehicle for health-promotion services. They also have few health-promotion vendors to serve them and low internal capacity for, and commitment to, delivery of on-site programs. The programs they offer, whether aimed at health promotion alone or integrated with health protection, are rarely comprehensive and are understudied. Research priorities for health promotion in smaller workplaces include developing programs feasible for the smallest workplaces with fewer than 20 employees. Policy priorities include incentives for smaller workplaces to implement comprehensive programs and an ongoing system for monitoring and evaluation.

Effects of organisational-level interventions at work on employees' health: a systematic review.

BACKGROUND: Organisational-level workplace interventions are thought to produce more sustainable effects on the health of employees than interventions targeting individual behaviours. However, scientific evidence from intervention studies does not fully support this notion. It is therefore important to explore conditions of positive health effects by systematically reviewing available studies. We set out to evaluate the effectiveness of 39 health-related intervention studies targeting a variety of working conditions. METHODS: Systematic review. Organisational-level workplace interventions aiming at improving employees' health were identified in electronic databases and manual searches. The appraisal of studies was adapted from the Cochrane Back Review Group guidelines. To improve comparability of the widely varying studies we classified the interventions according to the main approaches towards modifying working conditions. Based on this classification we applied a logistic regression model to estimate significant intervention effects. RESULTS: 39 intervention studies published between 1993 and 2012 were included. In terms of methodology the majority of interventions were of medium quality, and four studies only had a high level of evidence. About half of the studies (19) reported significant effects. There was a marginally significant probability of reporting effects among interventions targeting several organisational-level modifications simultaneously (Odds ratio (OR) 2.71; 95% CI 0.94-11.12), compared to those targeting one dimension only. CONCLUSIONS: Despite the heterogeneity of the 39 organisational-level workplace interventions underlying this review, we were able to compare their effects by applying broad classification categories. Success rates were higher among more comprehensive interventions tackling material, organisational and work-time related conditions simultaneously. To increase the number of successful organisational-level interventions in the future, commonly reported obstacles against the implementation process should be addressed in developing these studies.

What's bad about wellness? What the disability rights perspective offers about the limitations of wellness.

With great interest, employers in the United States are using wellness programs to reduce insurance costs and monitor the health of their employees. While these programs are often embraced as benign in their assessments and positive in their outcomes, this perspective fails to consider the discriminatory effects on people with disabilities. The case of Seff v. Broward County in 2012 addressed the question of whether wellness programs violated the Americans with Disabilities Act (ADA). Finding a safe harbor in the ADA for bona fide insurance plans, the court concluded that the initiative did not violate the act, even though employees were penalized monetarily. This article argues that wellness programs institutionalize disability bias and a false perception of health attainability. People with substantial physical or mental impairments will not be able to control many aspects of their health, even with concerted efforts. Embedded in this approach is the notion of responsibility for and control over all aspects of one's health, including disability. This kind of orientation further perpetuates a neoliberal approach to society where autonomy trumps community-based supports and acceptance of differences.

Gamification as a Tool for Promoting Physical Exercise and Healthy Eating Habits in Healthcare Worker Women: Effects on Cardiometabolic Health and Physical Fitness at Workplace.

PURPOSE: To evaluate the effectiveness of gamified versus nongamified health promotion interventions on cardiometabolic health and fitness parameters in healthcare worker women. DESIGN: Randomized parallel group trial. SETTING: A public outpatient health center in Brazil. SUBJECTS: Women employees (included: n = 29; lost to follow-up: n = 1; analyzed: n = 28). INTERVENTIONS: 8 weeks of gamified (n = 15) or nongamified (n = 13) interventions, consisting of health lectures, nutritional counseling, and supervised exercise training. The gamified group was divided into teams that received points based on completion of health goals/tasks. MEASURES: Anthropometric, cardiometabolic and physical fitness parameters. ANALYSIS: Two-way ANOVA with repeated measures (group vs. time), and Bonferroni post hoc tests. RESULTS: Body mass (-1.5 ± 1.5 kg), waist circumference (-1.6 ± 3.0 cm), HbA1C (-.2 ± .3%), triglycerides (-21.5 ± 48.2 mg/dl), systolic (-11.1 ± 7.9 mmHg) and diastolic (-7.1 ± 5.8 mmHg) blood pressure, as well as sit and reach (3.9 ± 3.0 cm) and six-minute walking (56 ± 37 m) performance improved (P < .05) only after the gamified intervention. Sit-to-stand performance improved after both the gamified (-1.18 ± 1.24 s) and nongamified (-1.49 ± 1.87 s) interventions. CONCLUSION: The gamified intervention was more effective than the nongamified intervention for improving cardiometabolic and physical fitness parameters, suggesting that gamification may be an effective tool for promoting health in healthcare worker women.

School based youth health nurses and a true health promotion approach: the Ottawa what?

AIM: The purpose of this research is to examine School Based Youth Health Nurses (SBYHN) experience of a true health promotion approach. BACKGROUND: The School Based Youth Health Nurse Program is a state-wide school nursing initiative in Queensland, Australia. The programme employs more than 120 fulltime and fractional school nurses who provide health services in state high schools. The role incorporates two primary components: individual health consultations and health promotion strategies. DESIGN/METHODS: This study is a retrospective inquiry generated from a larger qualitative research project about the experience of school based youth health nursing. The original methodology was phenomenography. In-depth interviews were conducted with 16 school nurses recruited through purposeful and snowball sampling. This study accesses a specific set of raw data about SBYHN experience of a true health promotion approach. The Ottawa Charter for Health Promotion (1986) is used as a framework for deductive analysis. RESULTS: The findings indicate school nurses have neither an adverse or affirmative conceptual experience of a true health promotion approach and an adverse operational experience of a true health promotion approach based on the action areas of the Ottawa Charter. CONCLUSIONS: The findings of this research are important because they challenge the notion that school nurses are the most appropriate health professionals to undertake a true health promotion approach. If school nurses are the most appropriate health professionals to do a true health promotion approach, there are implications for recruitment and training and qualifications. If school nurses are not, who are the most appropriate health professionals to do school health promotion? IMPLICATIONS FOR PRACTICE: These findings can be applied to other models of school nursing in Australia which emphasises a true health promotion approach because they relate specifically to school nurses' experience of a true health promotion approach.

A stocktake of physical activity programs in the Pacific Islands.

Population non-communicable disease (NCD) risk is among the highest in the world in the Pacific region. Increasing physical activity (PA) levels may be effective in reducing NCD risk in the developing and culturally diverse Pacific region. To describe the current practice in promoting PA in the Pacific, program information was sourced from NCD representatives from 19 countries during the Pacific NCD Forum (2009). Additional online searches were undertaken; health officials from 22 countries and NCD key informants from the Secretariat of the Pacific Community and from the World Health Organization were contacted. Eighty-four PA initiatives were identified in 20 Pacific Island countries: 26 took place in the workplace setting, 17 occurred in the school setting, 37 in the community setting and 4 in a clinical or health sector setting. Seventeen programs reached 100-500 individuals, 9 programs reached 500-1000 participants, 13 programs reached over 1000 participants and 3 programs targeted the whole population. The majority (51 of 84) of the programs commenced since 2006. There is a notable increase in the development of PA programs in multiple settings across the Pacific. Lead agencies are often the Ministry of Health offices with leadership support from high-level government positions.

Measuring implementation of evidence-based guidance on promoting workers' health.

BACKGROUND: The National Health Service (NHS) employs 1.4 million people in England. In health care, improved workforce health has been associated with improved outcomes for patients. The UK's National Institute for Health and Clinical Excellence (NICE) has produced evidence-based guidance on improving workers' health. However, the extent of implementation of evidence-based guidance has not previously been measured. AIMS: To measure progress with implementation of NICE guidance on workplace health and identify opportunities to improve this. METHODS: All NHS organizations in England were invited to participate in an audit of implementation of NICE guidance. A web-based tool was developed to collect information on the extent to which each organization had implemented NICE guidance addressing health promotion in the workplace. RESULTS: The number of organizations that participated was 282. These employed a total of 868 979 workers. Organizations were more likely to involve staff in planning and designing an organizational approach to each topic where health and well-being was a regular board agenda item. Those with an overarching strategy were more likely to have staff health and well-being as a regular board agenda item (P < 0.05) and more likely to have specific policies for obesity, physical activity and promoting mental well-being (all P <0.01). CONCLUSIONS: Implementation of NICE guidance on health at work is incomplete across the NHS in England. Implementation was more complete where boards were leading health and well-being plans and the workforce were actively involved. There is scope to improve the implementation of evidence-based guidance to improve workers' health.