Nonformal education as health promotion method among European youth: the example of transitional Albania.

Nonformal education methodology is promoted by the European Union as a priority. Western Balkan countries are supported in using this methodology via access Community funds (Erasmus +, previously Youth in Action). Nonformal education (proven as the most effective education method for youth) is expected to have the same impact if used in Public Health. We aimed to explore how nonformal education methodology contributes to health promotion through elaborating the example of transitional Albania. An Exploratory Sequential Mixed Methods design was used. We organized two focus groups: one with students of medical sciences and another with none medical students. We randomly selected eight participants per focus group from the Beyond Barriers association database (Contact point for Erasmus+ Programme in Albania). We used conventional content analysis to analyze qualitative data. Exploratory group interviews were conducted previously, using a questionnaire, which was piloted prior to administration. Of a population of 581 youth who participated in nonformal education activities during 2007-2013, 113 youths were interviewed. Ninety percent of interviewees declared that nonformal education activities have influenced improvement of their skills/competences or helped to acquire new ones; 53% declared that they reflected a change into personal behavior/actions/attitudes. Trainees learned through practice. They intended to retain the healthy behavior even when the activity was finished. Nonformal education activities offered equal opportunities to all youth despite their gender or field of study. Nonformal education methodology is recommended to be used in health promotion campaigns targeting young people as a very effective tool.

Default-name and tasting nudges increase salsify soup choice without increasing overall soup choice.

Nudging is a popular behavior change technique but the conditions for its effectiveness have not been researched extensively. The current study aimed to test whether the effectiveness of nudging is limited to certain characteristics of the nudged product by focusing on a specific product (salsify soup) within a broader category (soups). Two parallel studies were conducted in two sandwich restaurants in a university setting at which a default-name nudge ("suggestion of the chef") and a tasting nudge were implemented aimed at increasing the choice for salsify soup using a non-randomized study design during 10 and 12 measurement days. The beta-regression model showed that the default-name nudge increased the proportion of customers that choose the salsify soup during intervention days compared to non-intervention days, p < .001, OR: 1.70. The tasting nudge also increased the proportion of customers that choose the salsify soup from baseline to intervention, p < .001, OR: 6.17 and from baseline to post-intervention, p < .01, OR: 1.87, and decreased from intervention to post-intervention, p < .001, OR: 0.30. Both nudges did not increase the choice for the overall category of soups. The results show that certain types of nudges are able to increase specific products of a category without increasing overall choice of a category in contrast to previous findings.

Evaluating the implementation fidelity of a multicomponent intervention for oral health promotion in preschool children.

This study evaluates the process of implementation of a longitudinal intervention program to promote oral health in preschool children in Flanders, Belgium. As the program was implemented in an existing preventive health care organization, the study also evaluates this setting as the context for implementation. Qualitative and quantitative methods were used to evaluate implementation fidelity, based on Carroll's theoretical framework of implementation fidelity (Carroll et al., Implementation Science 2:40, 2007). Questionnaire data from participants and health workers were analyzed, and document analyses were performed to compare registrations of the actions with the planning manual. Results were mixed. Whereas more than 88 % of all parents attended all home visits, only 57 % received at least 9 of the 11 planned consultations. Fifty-two percent of the families received all supporting materials, and on average, 73 % of all attending families received all information at a contact as described in the manual. Moderating factors such as the adequate use of facilitators and high participant responsiveness had a positive impact on implementation fidelity, whereas the quality of delivery differed to a great extent between the nurses who were involved during the entire intervention period and those who gave only a few sessions. Implementing an intervention in an existing well-baby program has many advantages, although lack of time presents a challenge to implementation fidelity. The results of this process evaluation allow a better understanding of the contribution of implementation fidelity to the effectiveness of health promotion programs.

Enhancing the effectiveness of diabetes self-management education: the diabetes literacy project.

Patient empowerment through self-management education is central to improving the quality of diabetes care and preventing Type 2 Diabetes. Although national programs exist, there is no EU-wide strategy for diabetes self-management education, and patients with limited literacy face barriers to effective self-management. The Diabetes Literacy project, initiated with the support of the European Commission, aims to fill this gap. The project investigates the effectiveness of diabetes self-management education, targeting people with or at risk of Type 2 Diabetes in the 28 EU Member States, as part of a comprehensive EU-wide diabetes strategy. National diabetes strategies in the EU, US, Taiwan, and Israel are compared, and diabetes self-management programs inventorized. The costs of the diabetes care pathway are assessed on a per person basis at national level. A comparison is made of the (cost)-effectiveness of different methods for diabetes self-management support, and the moderating role of health literacy, organization of the health services, and implementation fidelity of education programs are considered. Web-based materials are developed and evaluated by randomized trials to evaluate if interactive internet delivery can enhance self-management support for people with lower levels of health literacy. The 3-year project started in December 2012. Several literature reviews have been produced and protocol development and research design are in the final stages. Primary and secondary data collection and analysis take place in 2014. The results will inform policy decisions on improving the prevention, treatment, and care for persons with diabetes across literacy levels.

Oral health and oral health-related behaviour in preschool children: evidence for a social gradient.

This study aims to investigate the social gradient in the reported oral health-related behaviour and oral health status of preschool children. Participants were 1,057 children born between October 2003 and July 2004 in Flanders, Belgium. Oral health examinations were performed by trained dentists when the children were 3 and 5 years old (respectively, in 2007 and 2009); data on dietary habits, oral hygiene habits and dental attendance of the children were obtained through structured questionnaires completed by the parents. Maternal educational level, measured in four categories, was used as a proxy of socio-economic status. Logistic and ordinal regressions showed a social gradient for the oral health-related behaviours: a lower educational level of the mother was related to a higher consumption of sugared drinks between meals and to a lower brushing frequency and dental attendance of the child. Children from low-educated mothers also had seven times more chance to present with caries experience than children from mothers with a bachelor degree. Contrary to the expectations, there was a deviation from the gradient in 3-year-olds from the highest educational group showing an increased risk for caries experience (OR = 3.84, 95 % CI = 1.08-13.65). Conclusion. Already in very young children, a graded relationship is observed between socio-economic position, oral health and related behaviours. The results suggest that different approaches are required to promote oral health during early childhood depending on the mother's educational background. As children from the highest social group also have an increased caries risk, specific techniques may be needed.

Measuring determinants of oral health behaviour in parents of preschool children.

OBJECTIVE: The aim of this study was to develop a valid and reliable measure for oral health behaviour and its determinants in five-year-old Flemish children, based on the Theory of Planned Behaviour (TPB) and to test its predictive validity. METHODS: 1157 parents of five-year-olds completed a questionnaire measuring three behaviours related to oral health among children (dietary habits, oral hygiene, dental attendance) and their determinants (attitude, subjective norms, perceived behavioural control, intention). The sample was randomly split in two halves and principal component analyses were performed on one half sample to identify the factor structure. Confirmatory factor analyses were performed on the remaining half sample to obtain a cross-validation. Predictive validity was tested using multiple regression analyses. RESULTS: For each behaviour four component structures reflecting the TPB-dimensions, accounting for 44% to 55% of the variance were retrieved and confirmed in the cross-validation. Internal consistency (Cronbach's alpha) of the scales ranged from 0.52 to 0.80. A sizeable percentage of variance of intentions and behaviours was explained by the model. CONCLUSIONS: The TPB components were significant predictors of intentions and behaviours. These findings argue for the reliability and validity of the questionnaire for exploring determinants underlying parental oral health behaviour.

Intestinal helminthic infections: a narrative review to guide the hepatogastroenterologist.

Intestinal helminthic infections are not uncommon in Western Europe, mainly due to modern travel, emigration and globalization. Moreover, some helminthic infections are endemic in Western Europe and are part of the everyday clinical practice. The hepatogastroenterologist should therefore recognize and manage these patients or at least refer them to appropriate reference centers. Signs and symptoms are often unspecific or even absent. Discerning the disease at an early stage avoids expensive diagnostic testing, life-threatening complications and in some cases even further spread of the disease. This review article aims to guide the hepatogastroenterologist when suspecting a helminthic infection by addressing the most prevalent symptoms, summarizing the most probable associated helminthic entities, highlighting practical steps in diagnosis and available treatments.

Effects of time and socio-economic status on the determinants of oral health-related behaviours of parents of preschool children.

The oral health-related beliefs of parents have an important impact on the oral health status of their children; however, they are not stable over time. This study aimed to assess the changes, over time, in the determinants of parental oral health-related behaviour based on the Theory of Planned Behaviour and to investigate socio-economic inequalities. The cohort consisted of the parents - mainly the mothers - of 1,057 children born in 2003 and 2004 in Flanders (Belgium). According to the Theory of Planned Behaviour, validated questionnaires, completed at children's birth and at age 3 and 5 yr, assessed parental attitudes, social norms, perceived behavioural control, and intention towards three behaviours: dietary habits, oral hygiene habits, and dental attendance. Linear mixed-model analyses were applied. Positive parental attitudes towards oral health-related behaviours increased between birth and 3 yr of age, whereas the scores for subjective norms and intentions decreased. Scores remained stable for children between three and 5 yr of age. Highly educated mothers had significantly higher scores for attitudes, perceived behavioural control, and intentions than less-educated mothers. Health promotion campaigns should take these natural changes and inequalities of dental beliefs into account when developing and evaluating interventions.

Determinants of prebiotic vegetable consumption: the extended theory of planned behaviour.

BACKGROUND: Prebiotic vegetables such as leek and salsify may contribute to preventing obesity by changing the composition of the gut microbiota. To increase consumption of prebiotic vegetables, the aim of the study was to document the prevalence and determinants of (prebiotic) vegetable consumption. METHODS: An online, correlational questionnaire was administered to participants using a mixed approach (1078 online, 200 face-to-face). Participants were a representative sample (gender, age, level of education, province, population density and (un)employment) of 1278 adults of the Walloon region in Belgium. The frequency and determinants of prebiotic vegetable consumption were measured using an extension of the Theory of Planned Behaviour including habits, actual control and compensatory health beliefs. Descriptive analyses were performed followed by hierarchic multiple regression analyses. RESULTS: The descriptive results showed that for all categories (leek, salsify, vegetables in general) an improvement in both intentions and prevalence of the actual behaviour is necessary to experience the health benefits of (prebiotic) vegetables. Intentions and habits were important predictors of consumption for all types of vegetables, and hedonic attitudes and subjective norms were important predictors of intention. Perceived control and rational attitudes were predictors of intention to consume only for vegetables in general. Finally, environmental factors such as price, availability and actual control predict consumption but their influence differs depending on the vegetable. CONCLUSIONS: The findings can be used to inform interventions that aim to increase (prebiotic) vegetable consumption. Umbrella terms such as 'healthy food' or 'vegetables' do not capture the differences between the specific foods regarding the demographic and socio-psychological determinants of their consumption. This is the first research to investigate the determinants of prebiotic vegetable consumption.

Measuring determinants of occupational health related behavior in Flemish farmers: an application of the Theory of Planned Behavior.

PROBLEM: Preventive interventions to reduce occupational injuries and health problems in farmers require the identification of factors that contribute to unsafe and health damaging behavior. This paper describes the development and validation of a self-report questionnaire, which measures the determinants of occupational health-related behaviors in farmers. METHOD: A representative sample of 283 Flemish farmers completed a provisional 135 item questionnaire based on the Theory of Planned Behavior, measuring four behaviors related to occupational health (machinery use, animal handling, preventing falls, and pesticide use), as well as the intentions, attitudes, perceived social norms, and self-efficacy for each of these behaviors. RESULTS: The fit indices of the Confirmatory Factor Analysis turned out not to be sufficient to reproduce the dimensions of the TPB. Therefore exploratory factor analysis was use to determine the underlying dimensions. Principal Component Analyses (PCA) on the behavioral items yielded single component solutions explaining a considerable proportion of the variance for each behavior and for behavioral intentions. Principal component analyses toward an a priori three-component structure reflecting the TPB dimensions did not produce sufficient congruence for the determinants of the four behaviors. Subsequent Varimax rotations and discarding of redundant items resulted in three component solutions explaining 50% to 69% of the variance in the determinants of each behavior, corresponding with the dimensions of the TPB. Internal consistencies ranged from .25 to .89. Scale scores accounted for a significant proportion of the variance in intention and self-reported behavior. IMPACT: The study demonstrates the validity of the TPB in predicting behavior related to occupational safety and health in farmers, and provides a valid and reliable questionnaire to measure the cognitive concepts featured in this model. IMPACT ON INDUSTRY: Both authors share the same view on this study's impact on industry. In recent years, efforts have been made to create awareness among farmers about occupational hazards, and to encourage farmers to perform safer and healthier behavior. However, only a limited number of these interventions have proven to be successful. A possible reason for this relative lack of success is that interventions typically focus on risk analysis and raising awareness, whereas the literature on preventive health behavior change indicates that knowledge and awareness with regard to possible health risks are neither necessary nor sufficient to change behavior. To raise the effectiveness of prevention programs, other relevant determinants of behavior need to be addressed as well, such as: attitudes, perceived social norms, self efficacy, and elements of the physical environment that elicit or reinforce behavior. These determinants play a key role in psychological models of health related behavior, such as the Theory of Planned Behavior. Thus far, the use of these models within agricultural settings is fairly limited. This study demonstrates the validity of the Theory of Planned Behavior in predicting behavior related to occupational safety and health in farmers, and provides a valid and reliable questionnaire to measure the cognitive concepts featured in this model.

Measuring oral health behaviour in Flemish health care workers: an application of the theory of planned behaviour.

OBJECTIVE: This study describes the development and validation of a questionnaire to measure the determinants of oral health related behaviour in health care workers, based on the Theory of Planned Behaviour (TPB). RESEARCH DESIGN: A preliminary questionnaire was drafted containing 78 self report items measuring three behaviours related to oral health (i.e. dietary habits, oral hygiene habits and dental attendance), as well as the attitudes, perceived social norms and self-efficacy for each behaviour. The questionnaire was completed by 201 health care workers for the initial validation and 966 other health care workers for a replication. OUTCOMES: A principal component analysis with Procrustes rotation toward an a priori three component structure on the original sample yielded high congruence measures for reported dental attendance, but not for dietary habits and oral hygiene habits. Subsequent exploratory Varimax rotations and discarding of redundant items resulted in three component solutions explaining 43% of the variance in dietary habits, 57% in oral hygiene habits and 66% in dental attendance, respectively. For all three behaviours, these components corresponded to the dimensions of the TPB. Internal consistency of the scales was satisfactory, with Chronbach's alpha's ranging from 0.51 to 0.87. Scale scores accounted for a significant proportion of the variance in the intention to avoid sweet snacks, to brush teeth, and to attend dental check-ups, and of the frequency of consumption of sweet drinks and frequency of brushing. A confirmatory factor analysis on the larger sample of 966 health care workers provided excellent goodness of fit indices, confirming the construct validity of the scales.

Marital intimacy in patients with an eating disorder: a controlled self-report study.

The clinical literature on married patients with anorexia nervosa or bulimia nervosa suggests a lack of intimacy in these couples. This assumption was tested by comparing the scores on the Marital Intimacy Questionnaire of 21 eating-disordered (ED) couples with those of two matched control groups of 21 maritally distressed (MD) and 21 non-distressed (ND) couples. The overall level of intimacy attained by ED couples is lower than that of ND couples but higher than that of MD couples. Whereas this quantitative difference may reflect the couples' differences in marital satisfaction (as assessed by the Maudsley Marital Questionnaire), an additional qualitative discrimination can be made between ED couples and the two control groups on account of the former group's relatively low level of openness and high level of intimacy problems.

Psychological distress in husbands of eating disorder patients.

Psychological distress scores of 21 eating-disordered (ED) women and their husbands were compared with those of two matched groups of 21 maritally distressed (MD) and 21 maritally nondistressed (ND) control groups. In contrast to previous clinical reports, ED husbands in the present group did not report significantly more psychological distress than did ND husbands, and actually reported less interpersonal sensitivity and hostility than did MD husbands.

Ill health in spouses of psychiatric patients: cause or consequence?

1. In the literature on the marital relationship of psychiatric patients it often has been reported that the healthy spouses may show a considerable degree of psychological distress. 2. A correlation of psychiatric disorders in married couples commonly has been interpreted according to two models: assortative mating and pathogenic interaction, neither of which can sufficiently explain the spousal psychiatric illness correlation. 3. The issue of psychiatric illness in the spouses of patients merits more attention from both researchers and clinicians. A psychiatric illness in one spouse must be understood within the ongoing interaction of the marital relationship.

Psychological determinants of behaviors leading to occupational injuries and diseases in agriculture: a literature overview.

Agriculture is one of the most hazardous occupational sectors, with a high prevalence of occupational injuries and work-related health problems. Most of these problems are caused by the interplay of human behavior and ergonomic factors and are thus preventable. Interventions to prevent occupational injuries and diseases among agricultural workers should aim to change risk behaviors and conditions by addressing specific behavioral determinants. To identify these factors, social cognitive models can be use that explain and predict health-related behavior. This study reviews the literature on the application of social cognitive models for the prevention of occupational injuries and diseases among agricultural workers. Studies are reviewed that apply the Health Belief Model, Theory of ReasonedAction, Theory of Planned Behavior, Transtheoretical Model of Change, or their subcomponents, to predict or change preventive behavior. Only a limited number of studies were found describing interventions that make use of these models, and those that do are often poorly documented with regard to the effect sizes and the explanatory or predictive value. It is concluded that the application of social cognitive models could significantly contribute to the effectiveness of preventive interventions in agriculture.

Smoking status moderates the contribution of social-cognitive and environmental determinants to adolescents' smoking intentions.

In this study, it was tested whether attitudes, self-efficacy, social influences and the perception of the school and home environments had different associations with intentions for adolescent non-smokers, occasional smokers and daily smokers. A regression model allowing for separate slopes of social-cognitive and environment variables accounted for 72% of the variation in intentions. For non-smokers, ease of refusing to smoke (beta = -0.06) and social influences favouring smoking (beta = 0.05) were linked to intentions. Occasional and daily smokers' intentions were associated with health consequences (beta = -0.05 and beta = -0.06, respectively) and ease of smoking/buying cigarettes (beta = 0.05 and beta = 0.24, respectively). Social influences favouring smoking (beta = 0.10) were also associated with intentions in daily smokers. In an extended model for current smokers (adjusted R(2) = 0.45), context-cued nicotine cravings (beta = 0.27) were linked to daily smokers', but not occasional smokers' intentions. The results suggest that motivating adolescents to abstain from or to quit smoking implies working on different combinations of determinants in non-smokers, occasional smokers and daily smokers. Interventions for daily smokers should supplement motivational techniques with stratagems that allow smokers to reduce the number of cravings they experience in specific contexts.

Risk factors for the development of eating disorders in adolescent exchange students: an exploratory survey.

A pragmatic approach to the prevention of eating disorders involves the study of individuals at high risk for the development of these disorders. A clinical survey of 14 adolescent exchange students who were diagnosed as eating disorder patients confirms our hypothesis that several of the predisposing or precipitating factors mentioned in the literature must be present for the disorder to occur. It is concluded that the prevention of eating disorders among the high risk population of exchange students should focus on an early detection of adolescent identity problems, relational difficulties and an accentuated sensitivity to weight issues.