What works for vulnerable families? Interpretations of effective health promotion.

Under the umbrella of the Healthy Futures Nearby programme, 46 small-scale projects were funded to promote changes in health-related behaviours (smoking, alcohol, diet and exercise) and to improve perceived health among vulnerable families in the Netherlands. The evaluation of these health-related multiple project programmes is often based on funder-defined outcomes and strategies. However, within the funded projects, assumptions about improving the health of vulnerable families based on local knowledge and experiences will also shape the project outcomes and strategies. These additional outcomes and strategies are project-specific interpretations of effective health promotion. Knowing these interpretations is crucial for the policy related and scientific relevance of the evaluation. Therefore, we aimed to determine the interpretations of each project and how they translate into relevant inputs for the overall evaluation of the programme. Based on 46 semi-structured group interviews with local project stakeholders, we produced a list of assumptions about what health promotion for vulnerable families should look like and then identified five main clusters: (i) strategies of offering pre-defined, health (behaviour)-related activities to families, (ii) actively involving vulnerable families in the initiative, (iii) assumptions about how health promotion should start with or include non-health-related topics, (iv) assumptions on how one should build on what already exists in the local context of the families and (v) assumptions on the role of the (health) professional in health promotion among vulnerable families. These project interpretations of effective health promotion provide inputs and priorities for the HFN programme's overall evaluation.

Evaluating the Healthy Futures Nearby Program: Protocol for Unraveling Mechanisms in Health-Related Behavior Change and Improving Perceived Health Among Socially Vulnerable Families in the Netherlands.

BACKGROUND: The persistence of health inequalities within high-income societies such as the Netherlands indicates the importance of researching effective ways to reduce those inequalities. Multiple strategies for reducing health inequalities have been identified. Specifically targeting health-related behaviors among lower socioeconomic status groups is one of those strategies. All in all, it seems relatively clear what types of approaches in general lead to health-related behavior change. However, it is still unclear how these approaches, in interaction with context, trigger a specific desired change. In the Netherlands, the private funding organization, Fonds NutsOhra, funded 46 small-scale projects under the umbrella of the Healthy Futures Nearby program. The projects aim to reduce vulnerable families' health deprivation by triggering lifestyle changes. OBJECTIVE: This study aimed to outline and justify the protocol for the overall evaluation of the program. The evaluation aimed to find out to what extent and how the small-scale projects and approaches within the program affect (or not) health-related behaviors and improve perceived health. METHODS: The approach to the overall evaluation of the 46 projects builds on a combination of 3 frequently used evaluation models; it is theory-based, realist informed, and uses a mixed methodology design. Methods include analysis of quantitative project data, document analysis, focus groups, and interviews. A study design has been drawn up that values and uses the multifaceted development of the projects and the influence this might have on implementation and project outcomes. Also, it respects the complex nature of the projects and is suited to studying health promotion mechanisms in depth. Finally, it optimizes the usage of all-quantitative and qualitative-project evaluation data available. RESULTS: This study protocol included the design of at least 4 different studies. The results will hence provide information on (1) building and defining theories of change in health promotion practice, (2) mechanisms at work in promotion of healthy behavior among vulnerable families, (3) what works and what does not in professionals' practices in health promotion among those vulnerable groups, and (4) what works and what does not in health promotion projects with a participatory approach. In addition, data will be collected on the overall effectiveness of the 46 initiatives. Data collection started in 2016. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. CONCLUSIONS: This overall evaluation provides a unique opportunity. The diversity of projects allows for a study protocol that answers in greater depth questions of how specific health promotion approaches work while also elucidating their effectiveness in a more traditional way. Using a theory-based complexity-sensitive approach that is mainly realist informed, this study also provides an opportunity to see whether combining assumptions from different evaluation perspectives yields relevant information. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/11305.

Poverty-related diseases: factors that predict coping in two Cameroonian settings.

In this paper, we explore the connection between poverty and health (poverty-related diseases: PRDs) by investigating the factors that play a role in how two groups of people in Cameroon cope with health challenges: workers in a large agro-industrial organization (living in 'camps') and students in two major universities (living on 'campuses'). We investigated factors reported in the literature as being associated with coping, summarized under the 'salutogenic umbrella', as well as demographic, social and environmental factors. A total of 509 respondents from camps and campuses participated in this study. We used a combination of standardized and un-standardized survey instruments to measure coping. We used χ2 and ANOVA tests to investigate bivariate differences and multiple logistic regression analysis to determine which significant survey factors predicted coping. Our results showed expected and unexpected differences between the settings. Individual dispositional factors such as sense of coherence (SOC), self-efficacy (SE), subjective wellbeing and self-rated health differed significantly between the settings. Expected coping resources such as income and SE did not differ between non-copers and copers. Two factors emerged as predictors of coping: living environment (setting) and SOC. Our results highlight the need for a multidimensional perspective on poverty and also the need to apply the salutogenic approach in PRD research. In particular, the emphasis this approach puts on stressors and the capacity to employ a variety of resources to overcome stressors is a fruitful way to better understand PRDs and the importance of location-specific circumstances where poverty, health and diseases are connected.

Barriers and Facilitators for Health Behavior Change among Adults from Multi-Problem Households: A Qualitative Study.

Multi-problem households are households with problems on more than one of the following core problem areas: socio-economic problems, psycho-social problems, and problems related to child care. The aim of this study was to examine barriers and facilitators for health behavior change among adults from multi-problem households, as well as to identify ideas for a health promotion program. A qualitative study involving 25 semi-structured interviews was conducted among Dutch adults who received intensive family home care for multi-problem households. Results were discussed with eight social workers in a focus group interview. Data were analyzed using the Framework Method. The results revealed that the main reason for not engaging in sports were the costs. Physical activity was facilitated by physically active (transport to) work and by dog ownership. Respondents who received a food bank package reported this as a barrier for healthy eating. Those with medical conditions such as diabetes indicated that this motivated them to eat healthily. Smokers and former smokers reported that stress was a major barrier for quitting smoking but that medical conditions could motivate them to quit smoking. A reported reason for not using alcohol was having difficult past experiences such as violence and abuse by alcoholics. Mentioned intervention ideas were: something social, an outdoor sports event, cooking classes, a walking group, and children's activities in nature. Free or cheap activities that include social interaction and reduce stress are in line with the identified barriers and facilitators. Besides these activities, it may be important to influence the target group's environment by educating social workers and ensuring healthier food bank packages.