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1.
BMJ Glob Health ; 5(12)2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33298470

RESUMO

To effectively tackle population health challenges, we must address the fundamental determinants of behaviour and health. Among other things, this will entail devoting more attention to the evaluation of upstream intervention strategies. However, merely increasing the supply of such studies is not enough. The pivotal link between research and policy or practice should be the cumulation of insight from multiple studies. If conventional evidence synthesis can be thought of as analogous to building a wall, then we can increase the supply of bricks (the number of studies), their similarity (statistical commensurability) or the strength of the mortar (the statistical methods for holding them together). However, many contemporary public health challenges seem akin to herding sheep in mountainous terrain, where ordinary walls are of limited use and a more flexible way of combining dissimilar stones (pieces of evidence) may be required. This would entail shifting towards generalising the functions of interventions, rather than their effects; towards inference to the best explanation, rather than relying on binary hypothesis-testing; and towards embracing divergent findings, to be resolved by testing theories across a cumulated body of work. In this way we might channel a spirit of pragmatic pluralism into making sense of complex sets of evidence, robust enough to support more plausible causal inference to guide action, while accepting and adapting to the reality of the public health landscape rather than wishing it were otherwise. The traditional art of dry stone walling can serve as a metaphor for the more 'holistic sense-making' we propose.

2.
Children (Basel) ; 7(11)2020 Nov 17.
Artigo em Inglês | MEDLINE | ID: mdl-33212854

RESUMO

School-based multi-component physical activity (PA) promotion is advocated; however, research has indicated that a multi-component approach may not always be effective at increasing adolescent PA. Evaluation of the GoActive 12-week multi-component school-based intervention showed no effect on adolescent PA. A mixed-methods process evaluation was embedded to facilitate greater understanding of the results, to elicit subgroup perceptions, and to provide insight into contextual factors influencing intervention implementation. This paper presents the reach, recruitment, dose, and fidelity of GoActive, and identifies challenges to implementation. The process evaluation employed questionnaires (1543 Year 9s), individual interviews (16 Year 9s; 7 facilitators; 9 contact teachers), focus groups (48 Year 9s; 58 mentors), alongside GoActive website analytics and researcher observations. GoActive sessions reached 39.4% of Year 9s. Intervention satisfaction was relatively high for mentors (87.3%) and facilitators (85.7%), but lower for Year 9s (59.5%) and teachers (50%). Intervention fidelity was mixed within and between schools. Mentorship was the most implemented component. Factors potentially contributing to low implementation included ambiguity of the roles subgroups played within intervention delivery, Year 9 engagement, institutional support, and further school-level constraints. Multiple challenges and varying contextual considerations hindered the implementation of GoActive in multiple school sites. Methods to overcome contextual challenges to implementation warrant in-depth consideration and innovative approaches.

3.
Nutrients ; 12(11)2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33143309

RESUMO

Small Island Developing States (SIDS) have high and increasing rates of diet-related diseases. This situation is associated with a loss of food sovereignty and an increasing reliance on nutritionally poor food imports. A policy goal, therefore, is to improve local diets through improved local production of nutritious foods. Our aim in this study was to develop methods and collect preliminary data on the relationships between where people source their food, their socio-demographic characteristics and dietary quality in Fiji and Saint Vincent and the Grenadines (SVG) in order to inform further work towards this policy goal. We developed a toolkit of methods to collect individual-level data, including measures of dietary intake, food sources, socio-demographic and health indicators. Individuals aged ≥15 years were eligible to participate. From purposively sampled urban and rural areas, we recruited 186 individuals from 95 households in Fiji, and 147 individuals from 86 households in SVG. Descriptive statistics and multiple linear regression were used to investigate associations. The mean dietary diversity score, out of 10, was 3.7 (SD1.4) in Fiji and 3.8 (SD1.5) in SVG. In both settings, purchasing was the most common way of sourcing food. However, 68% (Fiji) and 45% (SVG) of participants regularly (>weekly) consumed their own produce, and 5% (Fiji) and 33% (SVG) regularly consumed borrowed/exchanged/bartered food. In regression models, independent positive associations with dietary diversity (DD) were: borrowing/exchanging/bartering food (ß = 0.73 (0.21, 1.25)); age (0.01 (0.00, 0.03)); and greater than primary education (0.44 (0.06, 0.82)). DD was negatively associated with small shop purchasing (-0.52 (95% CIs -0.91, -0.12)) and rural residence (-0.46 (-0.92, 0.00)). The findings highlight associations between dietary diversity and food sources and indicate avenues for further research to inform policy actions aimed at improving local food production and diet.

4.
Health Place ; 64: 102356, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32838882

RESUMO

This scoping review collates empirical and gray literature that examines how schools are acting to nurture healthier and more environmentally aware young people through integrated approaches. Over the last twenty years, integration has been increasing within school contexts. Approaches include teaching and learning, physical environmental adaptations, developing ecologically focused policy, and reorienting wider school culture. We noted a developing discourse around what constitutes evidence in this emerging interdisciplinary field. Developing a better understanding of integrated approaches and an evidence base of what works and how could inform interdisciplinary collaboration and enable a clearer message to be communicated to stakeholders about how the school context can nurture healthier and more environmentally aware young people.

5.
Soc Sci Med ; 262: 113241, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32777672

RESUMO

Increased attention to links between walking, health and wellbeing have contributed to a growth in the number of walking groups meeting on a regular basis to offer short, social walks. Walking group interventions are known to increase physical activity and to have wide-ranging health benefits, and there is evidence that drop out is generally low. The aim of this paper is to synthesise qualitative research on experiences and perceptions of group walking in order to develop a new conceptual understanding of the group walking experience. We conducted a systematic search of the literature and identified 22 such studies which we synthesised using meta-ethnography. Included studies were conducted in the UK, USA, Australia and Ireland. Most reported research was undertaken with outdoor walking groups, some of which catered specifically for people who shared a disease experience or a disability. A smaller number of studies examined indoor mall walking groups, while two looked at perceptions of non-participants of group walking as a potential activity. From the original constructs identified in the papers we derived five higher order constructs: seeking and enjoying health and fitness, attachment to walking, providing purpose and confidence, mobile companionship and a peaceful and contemplative shared respite from everyday life. We argue that participating in a walking group provides a set of experiences that together constitute a specific form of shared or communal therapeutic mobility that is not simply the accumulation of the constructs we have outlined. Rather, we suggest that an initial instrumental and disciplinary focus on health and fitness is transformed through the experience of group walking into a shared meaningful and enjoyable practice; an emergent communal therapeutic mobility, which recruits and retains large numbers of group walkers. However, this communal therapeutic mobility is not equally accessible to all.

6.
J Sport Health Sci ; 9(1): 28-40, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31921478

RESUMO

Purpose: To examine adolescent experiences and perspectives of the GoActive intervention (ISRCTN31583496) using mixed methods process evaluation to determine satisfaction with intervention components and interpret adolescents' experiences of the intervention process in order to provide insights for future intervention design. Methods: Participants (n = 1542; 13.2 ±  0.4 years, mean ± SD) provided questionnaire data at baseline (shyness, activity level) and post-intervention (intervention acceptability, satisfaction with components). Between-group differences (boys vs. girls and shy/inactive vs. others) were tested with linear regression models, accounting for school clustering. Data from 16 individual interviews (shy/inactive) and 11 focus groups with 48 participants (mean = 4; range 2-7) were thematically coded. Qualitative and quantitative data were merged in an integrative mixed methods convergence matrix, which denoted convergence and dissonance across datasets. Results: Effect sizes for quantitative results were small and may not represent substantial between-group differences. Boys (vs. girls) preferred class-based sessions (ß = 0.2, 95% confidence interval (CI): 0.1-0.3); qualitative data suggested that this was because boys preferred competition, which was supported quantitatively (ß = 0.2, 95%CI: 0.1-0.3). Shy/inactive students did not enjoy the competition (ß = -0.3, 95%CI: -0.5 to -0.1). Boys enjoyed trying new activities more (ß = 0.1, 95%CI: 0.1-0.2); qualitative data indicated a desire to try new activities across all subgroups but identified barriers to choosing unfamiliar activities with self-imposed choice restriction leading to boredom. Qualitative data highlighted critique of mentorship; adolescents liked the idea, but older mentors did not meet expectations. Conclusion: We interpreted adolescent perspectives of intervention components and implementation to provide insights into future complex interventions aimed at increasing young people's physical activity in school-based settings. The intervention component mentorship was liked in principle, but implementation issues undesirably impacted satisfaction; competition was disliked by girls and shy/inactive students. The results highlight the importance of considering gender differences in preference of competition and extensive mentorship training.

7.
Int J Behav Nutr Phys Act ; 16(1): 135, 2019 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864372

RESUMO

BACKGROUND: Innovative approaches are required to move beyond individual approaches to behaviour change and develop more appropriate insights for the complex challenge of increasing population levels of activity. Recent research has drawn on social practice theory to describe the recursive and relational character of active living but to date most evidence is limited to small-scale qualitative research studies. To 'upscale' insights from individual contexts, we pooled data from five qualitative studies and used machine learning software to explore gendered patterns in the context of active travel. METHODS: We drew on 280 transcripts from five research projects conducted in the UK, including studies of a range of populations, travel modes and settings, to conduct unsupervised 'topic modelling analysis'. Text analytics software, Leximancer, was used in the first phase of the analysis to produce inter-topic distance maps to illustrate inter-related 'concepts'. The outputs from this first phase guided a second researcher-led interpretive analysis of text excerpts to infer meaning from the computer-generated outputs. RESULTS: Guided by social practice theory, we identified 'interrelated' and 'relating' practices across the pooled datasets. For this study we particularly focused on respondents' commutes, travelling to and from work, and on differentiated experiences by gender. Women largely described their commute as multifunctional journeys that included the school run or shopping, whereas men described relatively linear journeys from A to B but highlighted 'relating' practices resulting from or due to their choice of commute mode or journey such as showering or relaxing. Secondly, we identify a difference in discourses about practices across the included datasets. Women spoke more about 'subjective', internal feelings of safety ('I feel unsafe'), whereas men spoke more about external conditions ('it is a dangerous road'). CONCLUSION: This rare application of machine learning to qualitative social science research has helped to identify potentially important differences in co-occurrence of practices and discourses about practice between men's and women's accounts of travel across diverse contexts. These findings can inform future research and policy decisions for promoting travel-related social practices associated with increased physical activity that are appropriate across genders.


Assuntos
Aprendizado de Máquina , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Distribuição por Sexo , Reino Unido , Adulto Jovem
9.
Soc Sci Med ; 238: 112489, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31437768

RESUMO

Organised walking groups are increasingly widespread in the UK and elsewhere and have been shown to have many benefits for participants. They tend to attract more women than men, but little is known about how and why walking groups 'recruit' women. This is of particular importance given observed inequalities in physical activity participation by gender, in favour of men. To explore women's participation in walking groups, we conducted ethnographic fieldwork (in May-August 2017) with women members of five different walking groups in deprived areas of north-east England. Participant observation and informal 'go along' interviewing were conducted on 25 group walks, and 20 semi-structured interviews were undertaken. Fieldnotes and interview transcripts were analysed thematically. This paper presents five portraits to show how the identified themes played out in women's lives. For many of the women, the act of moving and socialising together in outdoor environments was highly valued. We show how walking groups found a place within the lives of women, becoming spaces of sharing, healing and enjoyment and acting as a positive resource or "lifeline", often around time-spaces of change (biographical disruptions). We contribute new understandings of how walking groups work by showing how women's reasons for participating were intimately intertwined with their life circumstances and relationships, thus furthering the ongoing theoretical shift from investigating health 'behaviours' to health 'practices'. We conclude that walking groups work well for some people at particular times in their lives, especially (but not only) for older women and, more generally, that life transitions offer an opportunity for interventions to enhance health if they work within the lives of prospective participants.

10.
Health Place ; 58: 102161, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31301599

RESUMO

Environmental changes aimed at encouraging walking or cycling may promote activity and improve health, but evidence suggests small or inconsistent effects in practice. Understanding how an intervention works might help explain the effects observed and provide guidance about generalisability. We therefore aimed to review the literature on the effects of this type of intervention and to understand how and why these may or may not be effective. We searched eight electronic databases for existing systematic reviews and mined these for evaluative studies of physical environmental changes and assessed changes in walking, cycling or physical activity. We then searched for related sources including quantitative or qualitative studies, policy documents or reports. We extracted information on the evidence for effects ('estimation'), contexts and mechanisms ('explanation') and assessed credibility, and synthesised material narratively. We identified 13 evaluations of interventions specifically targeting walking and cycling and used 46 related sources. 70% (n = 9 evaluations) scored 3 or less on the credibility criteria for effectiveness. 6 reported significant positive effects, but higher quality evaluations were more likely to report positive effects. Only two studies provided rich evidence of mechanisms. We identified three common resources that interventions provide to promote walking and cycling: (i) improving accessibility and connectivity; (ii) improving traffic and personal safety; and (iii) improving the experience of walking and cycling. The most effective interventions appeared to target accessibility and safety in both supportive and unsupportive contexts. Although the evidence base was relatively limited, we were able to understand the role of context in the success of interventions. Researchers and policy makers should consider the context and mechanisms which might operate before evaluating and implementing interventions.

11.
Res Synth Methods ; 10(3): 452-464, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31125493

RESUMO

Approaches to synthesizing qualitative data have, to date, largely focused on integrating the findings from published reports. However, developments in text mining software offer the potential for efficient analysis of large pooled primary qualitative datasets. This case study aimed to (a) provide a step-by-step guide to using one software application, Leximancer, and (b) interrogate opportunities and limitations of the software for qualitative data synthesis. We applied Leximancer v4.5 to a pool of five qualitative, UK-based studies on transportation such as walking, cycling, and driving, and displayed the findings of the automated content analysis as intertopic distance maps. Leximancer enabled us to "zoom out" to familiarize ourselves with, and gain a broad perspective of, the pooled data. It indicated which studies clustered around dominant topics such as "people." The software also enabled us to "zoom in" to narrow the perspective to specific subgroups and lines of enquiry. For example, "people" featured in men's and women's narratives but were talked about differently, with men mentioning "kids" and "old," whereas women mentioned "things" and "stuff." The approach provided us with a fresh lens for the initial inductive step in the analysis process and could guide further exploration. The limitations of using Leximancer were the substantial data preparation time involved and the contextual knowledge required from the researcher to turn lines of inquiry into meaningful insights. In summary, Leximancer is a useful tool for contributing to qualitative data synthesis, facilitating comprehensive and transparent data coding but can only inform, not replace, researcher-led interpretive work.


Assuntos
Mineração de Dados/métodos , Ciência de Dados/métodos , Reconhecimento Automatizado de Padrão , Pesquisa Qualitativa , Algoritmos , Confiabilidade dos Dados , Bases de Dados Factuais , Feminino , Humanos , Aprendizado de Máquina , Masculino , Distribuição Normal , Software , Reino Unido
12.
Soc Sci Med ; 220: 150-158, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30445340

RESUMO

BACKGROUND: Cancer is a leading cause of premature death in women worldwide, and is associated with socio-economic disadvantage. Yet many interventions designed to reduce risk and improve health fail to reach the most marginalised with the greatest needs. Our study focused on socially marginalised women at two women's centres that provide support and training to women in the judicial system or who have experienced domestic abuse. METHODS: This qualitative study was framed within a sociological rather than behavioural perspective involving thirty participants in individual interviews and focus groups. It sought to understand perceptions of, and vulnerability to, cancer; decision making (including screening); cancer symptom awareness; and views on health promoting activities within the context of the women's social circumstances. FINDINGS: Women's experiences of social adversity profoundly shaped their practices, aspirations and attitudes towards risk, health and healthcare. We found that behaviours such as unhealthy eating and smoking need to be understood in the context of inherently risky lives. They were a coping mechanism whilst living in extreme adverse circumstances, navigating complex everyday lives and structural failings. Long term experiences of neglect, harm and violence, often by people they should be able to trust, led to low self-esteem and influenced their perceptions of risk and self-care. This was reinforced by negative experiences of navigating state services and a lack of control and agency over their own lives. CONCLUSION: Women in this study were at high risk of cancer, but it would be better to understand these risk factors as markers of distress and duress. Without appreciating the wider determinants of health and systemic disadvantage of marginalised groups, and addressing these with a structural rather than an individual response, we risk increasing cancer inequities by failing those who are in the greatest need.


Assuntos
Atitude Frente a Saúde , Tomada de Decisões , Equidade em Saúde , Neoplasias/psicologia , Marginalização Social/psicologia , Feminino , Grupos Focais , Promoção da Saúde , Humanos , Entrevistas como Assunto , Programas de Rastreamento , Neoplasias/diagnóstico , Pesquisa Qualitativa , Fatores de Risco , Fatores Socioeconômicos
13.
Artigo em Inglês | PAHO-IRIS | ID: phr-49689

RESUMO

[ABSTRACT]. Objective. To explore what is known on community-based food production initiatives (CFPIs) in Small Island Developing States, particularly the health, social, economic, and environmental impacts of and on CFPIs. Methods. This was a systematic scoping review using 14 electronic databases to identify articles published from 1997 to 2016 on the topic of CFPIs in Small Island Developing States. From 8 215 articles found, 153 were eligible and abstracted. Analysis focused on geographic location, typology, methodology, study design, theoretical frameworks, and impacts. Results. Most research was conducted in the Pacific or Caribbean (49% and 43% of studies, respectively) and primarily focused on fishing and crop farming (40%, 34%). Findings indicate a predominance of research focusing on the environmental impact of marine and coastal resources on CFPIs, and very limited evidence of CFPI impact on human health, particularly nutrition and diet-related outcomes. There was a lack of explicit theoretical frameworks to explain the impacts of CFPIs. Conclusions. Evidence of impacts of CPFIs in Small Island Developing States is limited and the approaches taken are inconsistent. This review demonstrates the need and provides a basis for developing a coherent body of methods to examine the impacts of CFPIs and provide evidence to guide policy, especially as it relates to health.


[RESUMEN]. Objetivo. Explorar las iniciativas de producción de alimentos basadas en la comunidad (CFPI, por sus siglas en inglés) en los pequeños Estados insulares en desarrollo, en particular su impacto sanitario, social, económico y ambiental. Métodos. Se realizó una revisión sistemática exploratoria usando 14 bases de datos electrónicas para identificar artículos publicados entre 1997 y 2016 sobre las CFPI en los pequeños Estados insulares en desarrollo. De 8 215 artículos encontrados, 153 fueron elegibles y resumidos. El análisis se centró en la ubicación geográfica, el tipo de iniciativa, la metodología, el diseño del estudio, el marco teórico y el impacto. Resultados. La mayoría de las investigaciones se realizaron en el Pacífico o el Caribe (49% y 43% de los estudios, respectivamente) y se centraron principalmente en la pesca y el cultivo (40%, 34%). Los hallazgos indican un predominio de investigaciones centradas en el impacto ambiental de los recursos marinos y costeros en las CFPI, y una evidencia muy limitada del impacto de las CFPI en la salud humana, en particular en resultados relacionados con la nutrición y la dieta. Faltan marcos teóricos explícitos para explicar el impacto de las CFPI. Conclusiones. La evidencia del impacto de las CPFI en los pequeños Estados insulares en desarrollo es limitada y los enfoques adoptados son inconsistentes. Esta revisión demuestra la necesidad de efectuar estudios y proporciona una base para desarrollar métodos coherentes para examinar el impacto de las CFPI y proporcionar evidencia para guiar las políticas, especialmente las relacionadas con la salud.


[RESUMO]. Objetivo. Explorar iniciativas de produção alimentar baseada na comunidade (CFPI) em pequenos Estados insulares em desenvolvimento, particularmente seu impacto na saúde, social, econômico e ambiental. Métodos. Uma revisão sistemática exploratória foi realizada utilizando 14 bases de dados eletrônicas para identificar artigos publicados entre 1997 e 2016 sobre CFPI em pequenos Estados insulares em desenvolvimento. Dos 8 215 artigos encontrados, 153 foram elegíveis e resumidos. A análise centrou-se na localização geográfica, no tipo de iniciativa, na metodologia, no desenho do estudo, no referencial teórico e no impacto. Resultados. A maior parte da pesquisa foi realizada no Pacífico ou no Caribe (49% e 43% dos estudos, respectivamente) e se concentrou principalmente na pesca e na agricultura (40%, 34%). Os resultados indicam uma predominância de pesquisas focadas no impacto ambiental dos recursos marinhos e costeiros na CFPI, e evidências muito limitadas do impacto das CFPI na saúde humana, particularmente nos resultados relacionados à nutrição e dieta. Não existem quadros teóricos explícitos para explicar o impacto das CFPI. Conclusões. A evidência do impacto das CPFI em pequenos Estados insulares em desenvolvimento é limitada e as abordagens adotadas são inconsistentes. Esta revisão demonstra a necessidade de estudos e fornece uma base para o desenvolvimento de métodos coerentes para examinar o impacto das CFPI e fornecer evidências para orientar políticas, especialmente aquelas relacionadas à saúde.


Assuntos
Segurança Alimentar e Nutricional , Produção de Alimentos , Cultivos Agrícolas , Criação de Animais Domésticos , Indústria Pesqueira , Doenças não Transmissíveis , Meio Ambiente e Saúde Pública , Ilhas do Pacífico , Região do Caribe , Cultivos Agrícolas , Criação de Animais Domésticos , Indústria Pesqueira , Doenças não Transmissíveis , Ilhas do Pacífico , Região do Caribe , Indústria Pesqueira , Segurança Alimentar e Nutricional , Produção de Alimentos , Meio Ambiente e Saúde Pública , Segurança Alimentar e Nutricional , Produção de Alimentos , Criação de Animais Domésticos , Doenças não Transmissíveis , Meio Ambiente e Saúde Pública , Ilhas do Pacífico , Região do Caribe
14.
Artigo em Inglês | PAHO-IRIS | ID: phr-49573

RESUMO

[ABSTRACT]. Objective. To identify, assess, and compare existing policies on noncommunicable diseases (NCDs) in the Caribbean, gaps in policy responses, and the factors influencing successful policy development and implementation following the Port of Spain Declaration of 2007. Specifically, to examine policies that target the upstream determinants of two NCD risk factors—unhealthy diets and physical inactivity. Methods. A total of 76 semi-structured interviews with 80 relevant stakeholders in government, the private sector, and civil society were complemented by policy document analysis. Interviews were analyzed pragmatically, framed by the CARICOM government commitments, the WHO NCD Action Plan, a Multiple Streams framework approach, and realist evaluation ideas. Results. The most widely-reported policy successes involved health promotion activities (e.g., school meal programs) that leveraged multisectoral collaboration among government ministries, such as Health, Education, and Agriculture. Large policy gaps still exist around creating legislative, physical, and social environments to support healthy eating and physical activity at the population level. Multisectoral NCD commissions successfully reached across sectors, but had limited influence on policy development. Different policy levels emerged with national-level policies considered a lengthy process, while “On-the-ground” programming was considered faster to implement than national policies. External barriers included a reliance on food imports enabled by international trade agreements limited availability, quality, and affordability of healthy foods. International pushback limited legislation to reduce food imports and the absence of an international/regional framework, similar to the Framework Convention on Tobacco Control, further impedes efforts. Conclusions. Regional collaboration and political support across sectors are essential to accelerating the pace of action to support healthy eating and active living environments. Policy “blueprints” could accelerate the process of development. Regional “NCD champions” could spearhead such responses and approaches.


[RESUMEN]. Objetivo. Identificar, evaluar y comparar las políticas existentes sobre enfermedades no transmisibles (ENT) en el Caribe, las brechas en las respuestas políticas y los factores que influyeron en el desarrollo y la implementación de políticas exitosos luego de la Declaración de Puerto de España en 2007. Específicamente, examinar las políticas que se enfocan en dos factores de riesgo de ENT: las dietas no saludables y la inactividad física. Métodos. Se efectuaron 76 entrevistas semiestructuradas a 80 interesados relevantes pertenecientes al gobierno, el sector privado y la sociedad civil, y la información obtenida se complementó con un análisis de los documentos sobre las políticas. Las entrevistas se analizaron pragmáticamente en el marco de los compromisos de los gobiernos del CARICOM, el Plan de Acción sobre las ENT de la Organización Mundial de la Salud, un enfoque del marco de Flujos Múltiples e ideas de evaluación realistas. Resultados. Los resultados positivos de las políticas más reportados incluyeron las actividades de promoción de la salud (por ej., los programas de comidas escolares) que consiguieron la colaboración multisectorial de diferentes instituciones gubernamentales tales como los ministerios de salud, educación y agricultura. Todavía existen grandes brechas políticas relacionadas con la creación de entornos legislativos, físicos y sociales que apoyen la alimentación saludable y la actividad física a nivel de la población. Las comisiones multisectoriales dedicadas a las ENT presentaron un alcance adecuado en todos los sectores, pero tuvieron una influencia limitada en el desarrollo de políticas. Se observaron diferentes niveles de políticas y las de nivel nacional fueron procesos prolongados; los programas “en el terreno” fueron más rápidos de implementar. Las barreras externas incluyeron la dependencia de las importaciones de alimentos permitidas por los acuerdos comerciales internacionales, que limitan la disponibilidad, la calidad y la asequibilidad de los alimentos saludables. La limitada legislación a nivel internacional para reducir las importaciones de alimentos y la ausencia de un marco internacional o regional, similar al Convenio Marco para el Control del Tabaco, dificulta aún más los esfuerzos. Conclusiones. La colaboración regional y el apoyo político en todos los sectores son esenciales para acelerar el ritmo de acción en apoyo de una alimentación saludable y entornos que favorezcan una vida activa. Los “proyectos” de políticas podrían acelerar el proceso de desarrollo. Los “campeones regionales contra las ENT” podría liderar las estrategias y respuestas.


[RESUMO]. Objetivo. Identificar, avaliar e comparar as políticas existentes sobre doenças não transmissíveis (DNT) no Caribe, as lacunas nas respostas e fatores que influenciam o desenvolvimento e implementação de políticas bem sucedidas depois da Declaração de Porto Espanha em 2007. Especificamente, examinar as políticas que apontam para dois fatores de risco de DNT: dietas não saudáveis e inatividade física. Métodos. Um total de 76 entrevistas semi-estruturadas com 80 participantes diretos, pertencentes ao governo, ao setor privado e à sociedade civil, foram complementados com a análise de documentos sobre as políticas estabelecidas. As entrevistas foram analisadas pragmaticamente, enquadradas nos compromissos dos governos do CARICOM, no Plano de Ação das DNTs da Organização Mundial da Saúde, numa abordagem do quadro de fluxos múltiplos e em ideias de avaliação realistas. Resultados. Os resultados positivos das políticas mais divulgados incluíram atividades de promoção da saúde (por exemplo, programas de alimentação escolar) que tiveram colaboração multissetorial de diferentes instituições governamentais, como os ministérios da saúde, educação e agricultura. Ainda existem grandes lacunas políticas em torno da criação de ambientes legislativos, físicos e sociais para apoiar a alimentação saudável e a atividade física no nível populacional. As comissões multissetoriais de ENT alcançaram com sucesso todos os setores, mas tiveram influência limitada no desenvolvimento de políticas. Diferentes níveis de políticas foram observados e aqueles em nível nacional foram processos prolongados; os programas “no terreno” foram mais rápidos para implementar. As barreiras externas incluíram a dependência de importações de alimentos permitidas por acordos comerciais internacionais que limitam a disponibilidade, qualidade e acessibilidade de alimentos saudáveis. A legislação internacionalmente limitada para reduzir as importações de alimentos e a ausência de um quadro internacional o regional, semelhante à Convenção-Quadro para o Controle do Tabaco, torna os esforços ainda mais difíceis. Conclusões. A colaboração regional e o apoio político em todos os setores são essenciais para acelerar o ritmo de ação em apoio à alimentação saudável e a ambientes de vida ativa. Os “esquemas” de políticas podem acelerar o processo de desenvolvimento. Os “campeões regionais de ENT” poderiam liderar as estratégias e respostas.


Assuntos
Doenças não Transmissíveis , Formulação de Políticas , Política de Saúde , Exercício Físico , Ciências da Nutrição , Região do Caribe , Doenças não Transmissíveis , Política de Saúde , Exercício Físico , Região do Caribe , Exercício Físico , Formulação de Políticas , Ciências da Nutrição , Doenças não Transmissíveis , Política de Saúde , Formulação de Políticas , Ciências da Nutrição , Região do Caribe
15.
Health Expect ; 21(5): 919-926, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29624803

RESUMO

BACKGROUND: Physical activity levels decline in later life despite the known benefits for physical, cognitive and mental health. Older people find it difficult to meet activity targets; therefore, more realistic and meaningful strategies are needed. We aimed to develop a typology of older people's motivations and lifelong habits of being active as a starting point to co-designing active ageing strategies in a workshop. METHODS: We conducted semi-structured interviews with 27 participants aged 65-80 in Norfolk, UK, and participant observation with 17 of them. At a workshop with 13 study participants and 6 government and civil society representatives, we invited reflections on preliminary findings. RESULTS: Three types were developed. "Exercisers" had engaged in sport and exercise throughout their life but experienced physical ill health and limitations as barriers. "Out-and-about-ers" pursued social engagement and a variety of interests but experienced biographical disruption through retirement and loss of companions that limited social activities in later life. A final type characterized people who preferred "sedentary/solitary" activities. A workshop elicited suggestions for new strategies relating to these types that addressed people's specific motivations. An example was to combine social engagement and physical activity in "dog-parent"-walking schemes to link people through shared responsibility for a dog. CONCLUSIONS: We suggest that these potential strategies map more closely onto the everyday life-worlds in which public health might seek to intervene than common physical activity interventions. Most notably, this means a more differentiated understanding of barriers, and acknowledging that intellectual, social or solitary pursuits can include incidental physical activity.


Assuntos
Envelhecimento/psicologia , Exercício Físico/psicologia , Motivação , Caminhada , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , Estilo de Vida , Masculino , Pesquisa Qualitativa , Reino Unido
16.
Qual Health Res ; 28(8): 1320-1329, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29562834

RESUMO

As part of a process evaluation, we explored in semi-structured interviews the experiences of 19 mothers who had taken part in a trial to reduce infant formula-milk intake and promote healthy weight gain, and reflections of three facilitators who delivered the intervention and control group protocols. Mothers appreciated the nonjudgmental support provided during the trial, after experiencing stigma and receiving limited advice on how, how much, and how often formula-milk should be given. The information mothers had previously found, printed on formula-milk tins, or provided by family, friends, and health professionals was often perceived as contradictory; the trial guidance also conflicted with social norms relating infant health positively with weight gain. For those recruited into the trial with older infants, who had already exceeded the recommendations, reducing formula-milk amounts was difficult. The findings highlight the difficulties of addressing a highly stigmatized, complex social practice with an individual, behavioral intervention approach.


Assuntos
Educação em Saúde/organização & administração , Fórmulas Infantis , Mães/psicologia , Ganho de Peso/fisiologia , Adulto , Comportamento Alimentar , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Normas Sociais
17.
Rev Panam Salud Publica ; 42: e174, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31093202

RESUMO

Objective: To identify, assess, and compare existing policies on noncommunicable diseases (NCDs) in the Caribbean, gaps in policy responses, and the factors influencing successful policy development and implementation following the Port of Spain Declaration of 2007. Specifically, to examine policies that target the upstream determinants of two NCD risk factors-unhealthy diets and physical inactivity. Methods: A total of 76 semi-structured interviews with 80 relevant stakeholders in government, the private sector, and civil society were complemented by policy document analysis. Interviews were analyzed pragmatically, framed by the CARICOM government commitments, the WHO NCD Action Plan, a Multiple Streams framework approach, and realist evaluation ideas. Results: The most widely-reported policy successes involved health promotion activities (e.g., school meal programs) that leveraged multisectoral collaboration among government ministries, such as Health, Education, and Agriculture. Large policy gaps still exist around creating legislative, physical, and social environments to support healthy eating and physical activity at the population level. Multisectoral NCD commissions successfully reached across sectors, but had limited influence on policy development. Different policy levels emerged with national-level policies considered a lengthy process, while "On-the-ground" programming was considered faster to implement than national policies. External barriers included a reliance on food imports enabled by international trade agreements limited availability, quality, and affordability of healthy foods. International pushback limited legislation to reduce food imports and the absence of an international/regional framework, similar to the Framework Convention on Tobacco Control, further impedes efforts. Conclusions: Regional collaboration and political support across sectors are essential to accelerating the pace of action to support healthy eating and active living environments. Policy "blueprints" could accelerate the process of development. Regional "NCD champions" could spearhead such responses and approaches.

18.
Rev Panam Salud Publica ; 42: e176, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-31093204

RESUMO

Objective: To explore what is known on community-based food production initiatives (CFPIs) in Small Island Developing States, particularly the health, social, economic, and environmental impacts of and on CFPIs. Methods: This was a systematic scoping review using 14 electronic databases to identify articles published from 1997 to 2016 on the topic of CFPIs in Small Island Developing States. From 8 215 articles found, 153 were eligible and abstracted. Analysis focused on geographic location, typology, methodology, study design, theoretical frameworks, and impacts. Results: Most research was conducted in the Pacific or Caribbean (49% and 43% of studies, respectively) and primarily focused on fishing and crop farming (40%, 34%). Findings indicate a predominance of research focusing on the environmental impact of marine and coastal resources on CFPIs, and very limited evidence of CFPI impact on human health, particularly nutrition and diet-related outcomes. There was a lack of explicit theoretical frameworks to explain the impacts of CFPIs. Conclusions: Evidence of impacts of CPFIs in Small Island Developing States is limited and the approaches taken are inconsistent. This review demonstrates the need and provides a basis for developing a coherent body of methods to examine the impacts of CFPIs and provide evidence to guide policy, especially as it relates to health.

19.
Artigo em Inglês | LILACS | ID: biblio-978861

RESUMO

ABSTRACT Objective. To identify, assess, and compare existing policies on noncommunicable diseases (NCDs) in the Caribbean, gaps in policy responses, and the factors influencing successful policy development and implementation following the Port of Spain Declaration of 2007. Specifically, to examine policies that target the upstream determinants of two NCD risk factors—unhealthy diets and physical inactivity. Methods. A total of 76 semi-structured interviews with 80 relevant stakeholders in government, the private sector, and civil society were complemented by policy document analysis. Interviews were analyzed pragmatically, framed by the CARICOM government commitments, the WHO NCD Action Plan, a Multiple Streams framework approach, and realist evaluation ideas. Results. The most widely-reported policy successes involved health promotion activities (e.g., school meal programs) that leveraged multisectoral collaboration among government ministries, such as Health, Education, and Agriculture. Large policy gaps still exist around creating legislative, physical, and social environments to support healthy eating and physical activity at the population level. Multisectoral NCD commissions successfully reached across sectors, but had limited influence on policy development. Different policy levels emerged with national-level policies considered a lengthy process, while "On-the-ground" programming was considered faster to implement than national policies. External barriers included a reliance on food imports enabled by international trade agreements limited availability, quality, and affordability of healthy foods. International pushback limited legislation to reduce food imports and the absence of an international/regional framework, similar to the Framework Convention on Tobacco Control, further impedes efforts. Conclusions. Regional collaboration and political support across sectors are essential to accelerating the pace of action to support healthy eating and active living environments. Policy "blueprints" could accelerate the process of development. Regional "NCD champions" could spearhead such responses and approaches.


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RESUMO Objetivo. Identificar, avaliar e comparar as políticas existentes sobre doenças não transmissíveis (DNT) no Caribe, as lacunas nas respostas e fatores que influenciam o desenvolvimento e implementação de políticas bem sucedidas depois da Declaração de Porto Espanha em 2007. Especificamente, examinar as políticas que apontam para dois fatores de risco de DNT: dietas não saudáveis e inatividade física. Métodos. Um total de 76 entrevistas semi-estruturadas com 80 participantes diretos, pertencentes ao governo, ao setor privado e à sociedade civil, foram complementados com a análise de documentos sobre as políticas estabelecidas. As entrevistas foram analisadas pragmaticamente, enquadradas nos compromissos dos governos do CARICOM, no Plano de Ação das DNTs da Organização Mundial da Saúde, numa abordagem do quadro de fluxos múltiplos e em ideias de avaliação realistas. Resultados. Os resultados positivos das políticas mais divulgados incluíram atividades de promoção da saúde (por exemplo, programas de alimentação escolar) que tiveram colaboração multissetorial de diferentes instituições governamentais, como os ministérios da saúde, educação e agricultura. Ainda existem grandes lacunas políticas em torno da criação de ambientes legislativos, físicos e sociais para apoiar a alimentação saudável e a atividade física no nível populacional. As comissões multissetoriais de ENT alcançaram com sucesso todos os setores, mas tiveram influência limitada no desenvolvimento de políticas. Diferentes níveis de políticas foram observados e aqueles em nível nacional foram processos prolongados; os programas "no terreno" foram mais rápidos para implementar. As barreiras externas incluíram a dependência de importações de alimentos permitidas por acordos comerciais internacionais que limitam a disponibilidade, qualidade e acessibilidade de alimentos saudáveis. A legislação internacionalmente limitada para reduzir as importações de alimentos e a ausência de um quadro internacional o regional, semelhante à Convenção-Quadro para o Controle do Tabaco, torna os esforços ainda mais difíceis. Conclusões. A colaboração regional e o apoio político em todos os setores são essenciais para acelerar o ritmo de ação em apoio à alimentação saudável e a ambientes de vida ativa. Os "esquemas" de políticas podem acelerar o processo de desenvolvimento. Os "campeões regionais de ENT" poderiam liderar as estratégias e respostas.


Assuntos
Formulação de Políticas , Exercício Físico , Ciências da Nutrição , Doenças não Transmissíveis , Política de Saúde , Região do Caribe
20.
Int J Behav Nutr Phys Act ; 14(1): 156, 2017 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-29141646

RESUMO

BACKGROUND: Changing the physical environment is one way to promote physical activity and improve health, but evidence on intervention effectiveness is mixed. The theoretical perspectives and conceptual issues discussed or used in evaluative studies and related literature may contribute to these inconsistencies. We aimed to advance the intervention research agenda by systematically searching for and synthesising the literature pertaining to these wider conceptual issues. METHODS: We searched for editorials, commentaries, reviews, or primary qualitative or quantitative studies in multiple disciplines by electronic searches of key databases (MEDLINE and MEDLINE In-Process, Web of Science, Cochrane Reviews, ProQuest for dissertations, Health Evidence, EPPI-Centre, TRID and NICE) and snowballing. We extracted theoretical and conceptual material and used thematic analysis in an in-depth, configurative narrative approach to synthesis. RESULTS: Our initial searches identified 2760 potential sources from fields including public health, sociology, behavioural science and transport, of which 104 were included. By first separating out and then drawing together this material, we produced a synthesis that identified five high-level conceptual themes: one concerning outcomes (physical activity as a behaviour and a socially embedded practice), one concerning exposures (environmental interventions as structural changes) and three concerning how interventions bring about their effects (the importance of social and physical context; (un) observable mechanisms linking interventions and changes in physical activity; and interventions as events in complex systems). These themes are inter-related but have rarely been considered together in the disparate literatures. Drawing on these insights, we present a more generalisable way of thinking about how environmental interventions work which could be used in future evaluation studies. CONCLUSIONS: Environmental and policy interventions are socially embedded and operate within a system. Evaluators should acknowledge this, and the philosophical perspective taken in their evaluation. Across disciplinary fields, future studies should seek to understand how interventions work through considering these systems, the context in which interventions take place, and the (un) observable mechanisms that may operate. This will help ensure that findings can be more easily interpreted and widely applied by policymakers. We hope that highlighting these conceptual issues will help others to interpret and improve upon a somewhat contested evidence base.


Assuntos
Planejamento Ambiental , Exercício Físico , Comportamentos Relacionados com a Saúde , Humanos
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