Co-designing a health promotion program for Australian Aboriginal and Torres Strait Islander girls: lessons learnt.

Despite progression in the ethical and methodological conduct of Aboriginal and Torres Strait Islander health research, disparities still pervade, indicating limitations in knowledge translation. One identified gap is a lack of documented experiences detailing how ethical guidelines may be practically applied. This paper aims to (i) describe the research processes involved in co-designing a physical activity and psychosocial health program for Aboriginal and Torres Strait Islander girls and (ii) highlight learnings of the collaborative research journey. The Criteria for Strengthening Reporting of Health Research involving Indigenous Peoples (CONSIDER) statement was used to document participatory research activities undertaken with an Aboriginal community partner. Building upon the CONSIDER statement, Aboriginal (N = 3), Torres Strait Islander (N = 1) and non-Indigenous (N = 4) research team members engaged in critical reflection to identify lessons learnt. Researchers identified a tension between participatory research principles and the expectations of funding agencies and research institutions. Consequently, timelines must be flexible to foster meaningful community engagement and participatory processes. Additionally, researchers and community stakeholders are encouraged to embrace tensions that may associated with participatory research or the pressures Aboriginal and Torres Strait Islander researchers face from their community and organization. Furthermore, differences in professional (i.e. occupational) and cultural knowledge systems need to be acknowledged and accounted for within the early stages of a project to ensure informed decision-making. Identified lessons will assist relevant stakeholders in the development of future Aboriginal and Torres Strait Islander health programming, ensuring the most appropriate health solutions are devised with community.

The ethical and methodological quality of Aboriginal and Torres Strait Islander health research and associated community engagement has progressed significantly in the last thirty years. Despite this progress, improvements in Aboriginal and Torres Strait Islander health disparities have been slow and inconsistent, indicating there are limitations in the available information for health promotion stakeholders. One identified gap is a lack of documented experiences detailing how guidelines may be practically applied. This paper, therefore, details how an intercultural, intersectoral team engaged in a participatory Aboriginal and Torres Strait Islander health research project (i.e. Tidda Talk). In addition to documenting research processes, the paper also offers lessons learnt: (i) Prioritize a flexible response within the project plan, (ii) Embrace Aboriginal and Torres Strait Islander community empowerment whilst working at the cultural interface (i.e. a place of knowledge exchange between Aboriginal and Torres Strait Islander and Western culture, resulting in two-way learning) (iii) Plan to navigate different knowledge systems, (iv) Acknowledge the pressures and demands placed on Aboriginal and Torres Strait Islander researchers. These documented experiences and lessons learnt have the potential to benefit researchers and practitioners in future health service design and evaluation, allowing for culturally appropriate practices to be identified and replicated.

Netball Shoots for Physical and Mental Wellbeing in Samoa: A Natural Experiment.

Sport-for-development programs claim to address key determinants of recreational physical activity participation and subsequent development outcomes in low-income settings. We conducted a natural experiment with pre-post measures taken from women in the 12 villages in Samoa, some of which voluntarily participated in the sport-for-development intervention. The intervention comprised a six-week netball league delivered by local volunteers who attended coaching workshops, received ongoing support from the national governing body and were provided with infrastructure and equipment to conduct local training sessions. Changes in netball participation, recreational physical activity, body composition, mental wellbeing and socio-ecological determinants of physical activity were compared between intervention and comparison villages using a univariate ANOVA. The intervention reached women who participated in little recreational physical activity and had poor physical and mental wellbeing. Program uptake was higher in villages with the strongest social support for netball participation. Local social support and capacity to independently organize netball activities increased. There were concurrent improvements in netball participation, physical activity levels, mental wellbeing and body weight in the intervention villages. Our findings support scaling-up of the intervention in similar settings but preceding this with formative evaluation to identify low active communities that are "primed" to participate in the proposed activity.

"People say men don't talk, well that's bullshit": A focus group study exploring challenges and opportunities for men's mental health promotion.

Men's mental health promotion presents unique challenges including gender-related barriers and stigmas, which demand novel approaches to prevention, treatment, and management. The aim of this study was to explore men's perceptions of mental health and preferences for mental health promotion. Seven focus groups (N = 59) were conducted in Sydney, Australia, including 5 groups of men (M = 50.65, SD = 13.75 years) and 2 groups of stakeholders who had frontline experience working with men (e.g., men's groups, health clubs, mental health advocates). Data were analysed using thematic analysis and interpreted using a gender relations approach to explore connections between gender roles, relations and identities, and men's mental health. Three overarching themes were identified; (1) Roles, identities, and the conceptualisation and concealment of mental health challenges, revealing challenges to mental health promotion related to perceptions of men's restrictive emotionality and emotional awareness as well as difficulties with conceptualising the internalised experiences of mental health, (2) Constraining social contexts of stigma and gender relations, identifying how social context and the policing of gender roles often obscured opportunities for discussing mental health and help-seeking behaviour, (3) Anchoring mental health promotion to acceptable lifestyle practices, highlighting potential remedies included leveraging men's social practices related to reciprocity, normalising mental health promotion relative to other behaviours, and embedding mental health promotion within acceptable masculine practices. Discussed are directions for men's community-based mental health promotion and opportunities for how masculinities may be negotiated and expanded to embody mental health promoting values.

Better Late Than Never?! Five Compelling Reasons for Putting Physical Activity in Low- and Middle-Income Countries High Up on the Public Health Research Agenda.

Since 2020, the world has been navigating an epidemiologic transition with both infectious diseases (COVID-19) and noncommunicable diseases intertwined in complex and diverse ways. In fact, the pandemics of physical inactivity, noncommunicable diseases, and COVID-19 coincide in a tragically impactful ménage à trois with their detrimental long-term health consequences yet to be determined. We know that people in low- and middle-income countries not only have the highest risk of developing chronic diseases, they also develop the diseases at a younger age, they suffer longer, and they die earlier than people in high-income countries. This commentary features 5 compelling reasons for putting physical activity in low- and middle-income countries high up on the public health research agenda and calls for more commitment to inclusive and context-specific public health practices that are paired with locally relevant promotion and facilitation of PA practice, research, and policymaking.

Personal, Social, and Environmental Mediators Associated With Increased Recreational Physical Activity in Women and Girls in the Kingdom of Tonga.

BACKGROUND: The purpose of this paper was to identify personal, social, and environmental mediators of recreational physical activity (PA) in a 6-month netball-based intervention for women and girls in Tonga. METHODS: Tonga Netball's "low-engagement village program" was implemented in 10 villages and aimed to increase the recreational PA levels in women and girls through a comprehensive, structured community-level netball program addressing key barriers to participation. In a mixed-methods approach, these mediating barriers were identified through qualitative interviews based on the socioecological model. Quantitative measures for mediators and recreational PA were then developed, and data from 301 women and girls were collected. Standard mediation analyses methods were then applied. RESULTS: Program participation appeared to significantly increase PA levels. Statistically significant personal mediators were body issues, preferring competitions, and clothing. Social mediators were support from sports council, community leaders, friends, and church. Environmental mediators were travel time and access to balls, bibs, and umpires. CONCLUSION: A comprehensive community-level program addressing key participation barriers can increase recreational PA among women and girls in Tonga. Triangulating these results with mediation analyses of variables on the causal pathway can strengthen our understanding of causation and inform funding prioritization for critical program components in similar contexts.

Process evaluation of a walking programme delivered through the workplace in the South Pacific island Vanuatu.

BACKGROUND: The South Pacific region is experiencing significant rates of chronic diseases. Well-evaluated health promotion programmes are needed as a central piece of a strategic solution. Just as important as the evaluation itself is how that evaluation outcome can be communicated for future programme use by local programme planners. The objective of this study is to evaluate a physical activity (PA) programme that was designed for Pacific women in urban Vanuatu, and subsequently to develop new techniques to display data that support the understanding and communication of programme success and challenges. METHODS: Data collection methods included quantitative Likert scale questions and qualitative open-ended questions. A new analysis technique visualises open-ended process evaluation data. We present themes using word sizes proportional to the frequency of the themes identified through thematic analysis. RESULTS: The Likert scale technique revealed little meaningful information; almost all participants rated most elements of the programme highly. This may be related to Pacific people being frequently inclined to assent with external ideas. Open-ended questions provided more significant insights. For example, we found a stronger change in eating habits (68.9%) than in exercise behaviour (28.2%). CONCLUSION: We present an evaluation of the first pedometer-based PA intervention in the Pacific and respond to the paucity of process evaluations that have been carried out in the context of low- and middle-income countries. Moreover, the new thematic data visualisation (TDV) approach may aid in understanding complex and cluttered data in a constructive and coordinated way; we present a new approach in health promotion research.

Laefstael jenses: an investigation of barriers and facilitators for healthy lifestyles of women in an urban Pacific island context.

BACKGROUND: The Pacific region has experienced rapid urbanization and lifestyle changes, which lead to high rates of noncommunicable disease (NCD) prevalence. There is no information on barriers and facilitators for healthy lifestyles in this region. In response, we present the first stage of a rigorous development of an urban Pacific health intervention program. This paper describes formative work conducted in Port Vila, Vanuatu. The objective of this paper was to understand cultural barriers and facilitators in Pacific women to lifestyle change and use the findings to inform future health interventions. METHODS: Semistructured focus groups with 37 female civil servants divided into 6 groups were held verbally to understand barriers and facilitators for healthy lifestyles. RESULTS: Several perceived barriers and facilitators were identified. Inter alia, barriers include financial limitations, time issues, family commitments, environmental aspects, and motivational hindrances that limit time and opportunities for healthy lifestyle behavior. Facilitators include more supportive environments, social support mechanisms, and the implementation of rigorous health policies. CONCLUSIONS: Formative work is essential in designing health intervention programs. Uncovered barriers and facilitators help inform the development of culturally relevant health interventions.