A framework for the assessment of community exercise programmes: a tool to assist in modifying programmes to help reduce falls risk factors.

BACKGROUND: falls in older adults is a significant global public health challenge. Exercise interventions which incorporate the physiological components of balance and strength can reduce falls risk. However, the optimum qualities, such as type, duration and frequency of engagement in these exercise programmes, are yet to be established. OBJECTIVE: the overall research project aimed to develop and test a tool for the assessment of physiological criteria in community exercise programmes and to determine which community exercise programmes may be modified to help reduce falls risk factors. This initial phase of the research and the aim of this paper are to describe the development of the Community Exercise Program Assessment Matrix (the Matrix). METHODS: a review of the falls literature identified an existing classification system, which guided the development of the Matrix. An expert panel assisted in reviewing, testing and ongoing refinement of the Matrix. RESULTS: the Matrix contains a range of physiological and cognitive components as well as other items which capture non-physiological components. After testing some modifications were made to the Matrix to aid usage. CONCLUSION: this paper has outlined the development of the Matrix, which is intended to be used for the recording of physiological components (related to falls prevention) of an exercise programme in terms of type, duration and frequency. The next step is to use the Matrix in conjunction with pre- and post-physiological testing of participants to assess a range of exercise programmes and changes in participant physiological functioning.

Impact of a five-day short course on integration of health promotion into practice in north Queensland.

ISSUE ADDRESSED: Workforce development is one element of health promotion capacity building. This paper describes the extent to which participants in a five-day short course in health promotion, delivered three times in north Queensland during 2007, reported greater adoption of health promotion within their work roles, and the factors that affected the level of adoption. METHODS: Out of 54 course attendees, 39 completed a post-course survey five to nine months after completing the course (72% response rate). Additionally, 11 course attendees participated in a focus group or phone interview to explore survey findings. RESULTS: The courses succeeded in providing knowledge, skills, confidence and enthusiasm to undertake health promotion work. Eighty per cent of participants stated they had incorporated health promotion into their work frequently or all of the time since undertaking the course. Lack of understanding of health promotion from co-workers and managers, lack of organisational support and commitment, lack of resources, competing clinical priorities, and lack of time were cited as the main barriers for undertaking health promotion. CONCLUSIONS: The course met participant training needs. However, similar training across all levels of staff including management may help to develop organisational capacity, thereby building a more knowledgeable workforce that is supported to undertake health promotion as a core part of an organisation's business.

The injury iceberg: an ecological approach to planning sustainable community safety interventions.

ISSUE ADDRESSED: A systematic ecological framework in which to design sustainable, community-based, safety promotion interventions is presented. METHOD: A literature review was undertaken of English-language articles addressing the topics of 'ecological injury prevention or safety promotion', 'ecological health promotion', 'sustainable economic, health or ecological systems' and 'steady state', with 143 articles retrieved and reviewed. RESULTS: Injury prevention is a biomedical construct, in which injury is perceived to be a physical event resulting from the sudden release of environmental energy producing tissue damage in an individual. This reductionist perspective overlooks the importance of psychological and sociological determinants of injury. Safety has physical, psychological and sociological dimensions. It is inherently an ecological concept. Interventions aiming to achieve long-term improvements in community safety must seek to develop sustainable safety promoting characteristics within the target community. CONCLUSION: To reduce a community's risk of injury and sustain this lowered risk, the community 'ecological system' must have access to the resources necessary to maintain the desired outcome and the ability to mobilise these resources.

An evaluation of tobacco brief intervention training in three indigenous health care settings in north Queensland.

OBJECTIVE: To evaluate the pilot phase of a tobacco brief intervention program in three Indigenous health care settings in rural and remote north Queensland. METHODS: A combination of in-depth interviews with health staff and managers and focus groups with health staff and consumers. RESULTS: The tobacco brief intervention initiative resulted in changes in clinical practice among health care workers in all three sites. Although health workers had reported routinely raising the issue of smoking in a variety of settings prior to the intervention, the training provided them with an additional opportunity to become more aware of new approaches to smoking cessation. Indigenous health workers in particular reported that their own attempts to give up smoking following the training had given them confidence and empathy in offering smoking cessation advice. However, the study found no evidence that anybody had actually given up smoking at six months following the intervention. Integration of brief intervention into routine clinical practice was constrained by organisational, interpersonal and other factors in the broader socioenvironmental context. CONCLUSIONS/IMPLICATIONS: While modest health gains may be possible through brief intervention, the potential effectiveness in Indigenous settings will be limited in the absence of broader strategies aimed at tackling community-identified health priorities such as alcohol misuse, violence, employment and education. Tobacco and other forms of lifestyle brief intervention need to be part of multi-level health strategies. Training in tobacco brief intervention should address both the Indigenous context and the needs of Indigenous health care workers.