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1.
Implement Sci ; 14(1): 81, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412894

RESUMO

BACKGROUND: The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration. METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation. RESULTS: The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test). CONCLUSIONS: In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.


Assuntos
Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde/organização & administração , Centers for Disease Control and Prevention (U.S.) , Guias como Assunto , Promoção da Saúde/economia , Humanos , Ciência da Implementação , Estilo de Vida , Avaliação de Programas e Projetos de Saúde , Estados Unidos
4.
Aust N Z J Public Health ; 43(4): 328-333, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31268219

RESUMO

OBJECTIVE: To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015. METHODS: Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models. RESULTS: Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions. CONCLUSION: The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements.


Assuntos
Exercício , Promoção da Saúde/organização & administração , Estilo de Vida Saudável , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Sobrepeso/etnologia , Perda de Peso , Adulto , Pesquisa Participativa Baseada na Comunidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Obesidade/prevenção & controle , Grupo com Ancestrais Oceânicos/psicologia , Sobrepeso/prevenção & controle , Programas de Redução de Peso , Adulto Jovem
5.
Lancet ; 394(10194): 261-272, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31327370

RESUMO

Oral diseases are a major global public health problem affecting over 3·5 billion people. However, dentistry has so far been unable to tackle this problem. A fundamentally different approach is now needed. In this second of two papers in a Series on oral health, we present a critique of dentistry, highlighting its key limitations and the urgent need for system reform. In high-income countries, the current treatment-dominated, increasingly high-technology, interventionist, and specialised approach is not tackling the underlying causes of disease and is not addressing inequalities in oral health. In low-income and middle-income countries (LMICs), the limitations of so-called westernised dentistry are at their most acute; dentistry is often unavailable, unaffordable, and inappropriate for the majority of these populations, but particularly the rural poor. Rather than being isolated and separated from the mainstream health-care system, dentistry needs to be more integrated, in particular with primary care services. The global drive for universal health coverage provides an ideal opportunity for this integration. Dental care systems should focus more on promoting and maintaining oral health and achieving greater oral health equity. Sugar, alcohol, and tobacco consumption, and their underlying social and commercial determinants, are common risk factors shared with a range of other non-communicable diseases (NCDs). Coherent and comprehensive regulation and legislation are needed to tackle these shared risk factors. In this Series paper, we focus on the need to reduce sugar consumption and describe how this can be achieved through the adoption of a range of upstream policies designed to combat the corporate strategies used by the global sugar industry to promote sugar consumption and profits. At present, the sugar industry is influencing dental research, oral health policy, and professional organisations through its well developed corporate strategies. The development of clearer and more transparent conflict of interest policies and procedures to limit and clarify the influence of the sugar industry on research, policy, and practice is needed. Combating the commercial determinants of oral diseases and other NCDs should be a major policy priority.


Assuntos
Assistência Odontológica/organização & administração , Reforma dos Serviços de Saúde/organização & administração , Doenças da Boca/terapia , Saúde Bucal , Sacarose na Dieta/efeitos adversos , Indústria Alimentícia , Saúde Global , Promoção da Saúde/organização & administração , Humanos , Doenças da Boca/etiologia , Odontologia Preventiva/organização & administração , Saúde Pública
6.
Am Surg ; 85(6): 579-586, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31267897

RESUMO

We aim to investigate the prevalence of posttraumatic stress disorder (PTSD), physician burnout (PBO), and work-life balance (WLB) among surgical residents, fellows, and attendings to illustrate the trends in surgeon wellness. A cross-sectional national survey of surgical residents, fellows, and attendings was conducted screening for PTSD, PBO, and WLB. The prevalence of screening positive for PTSD was more than two times that of the general population at all levels of experience, and more than half have an unhealthy WLB. The prevalence of PTSD, PBO, and unhealthy WLB declined with increasing level of experience (P < 0.001). One deviation in this trend was a lower prevalence of PBO among surgical fellows compared with residents and attendings (P < 0.001). Surgeon wellness improved with increasing level of experience. The incorporation of wellness programs into surgical residencies is essential to the professional development of young surgeons to cultivate healthy lasting habits for a well-balanced career and life.


Assuntos
Esgotamento Profissional/epidemiologia , Promoção da Saúde/organização & administração , Satisfação no Emprego , Satisfação Pessoal , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Cirurgiões/psicologia , Adulto , Esgotamento Profissional/psicologia , Estudos Transversais , Bolsas de Estudo/tendências , Feminino , Humanos , Internato e Residência/tendências , Masculino , Corpo Clínico Hospitalar/tendências , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Cirurgiões/educação , Estados Unidos , Adulto Jovem
10.
Implement Sci ; 14(1): 64, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215450

RESUMO

BACKGROUND: In addition to their more traditional clinical role, midwives are expected to perform various health promotion practice behaviours (HePPBes) such as informing pregnant women about the benefits of physical activity during pregnancy and asking women about their alcohol consumption. There is evidence to suggest several barriers exist to performing HePPBes. The aim of the study was to investigate the barriers and facilitators midwives perceive to undertaking HePPBes. METHODS: The research compromised of two studies. Study 1: midwives based in a community setting (N = 11) took part in semi-structured interviews underpinned by the theoretical domains framework (TDF). Interviews were analysed using a direct content analysis approach to identify important barriers or facilitators to undertaking HePPBes. Study 2: midwives (N = 505) completed an online questionnaire assessing views on their HePPBes including free text responses (n = 61) which were coded into TDF domains. Study 2 confirmed and supplemented the barriers and facilitators identified in study 1. RESULTS: Midwives' perceived a multitude of barriers and facilitators to carrying out HePPBes. Key barriers were requirements to perform an increasing amount of HePPBes on top of existing clinical work load, midwives' cognitive resources, the quality of relationships with pregnant women, a lack of continuity of care and difficulty accessing appropriate training. Key facilitators included midwives' motivation to support pregnant women to address their health. Study 1 highlighted strategies that midwives use to overcome the barriers they face in carrying out their HePPBes. CONCLUSIONS: Despite high levels of motivation to carry out their health promotion practice, midwives perceive numerous barriers to carrying out these tasks in a timely and effective manner. Interventions that support midwives by addressing key barriers and facilitators to help pregnant women address their health behaviours are urgently needed.


Assuntos
Consumo de Bebidas Alcoólicas , Exercício , Promoção da Saúde/organização & administração , Tocologia , Cuidado Pré-Natal/organização & administração , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Escócia , Inquéritos e Questionários
11.
BMC Public Health ; 19(1): 782, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221117

RESUMO

BACKGROUND: The purpose of this study was to determine physical activity (PA) preferences associated with increases in moderate-to-vigorous physical activity (MVPA) and decrease in sedentary time in Mexican American (MA) women participating in a Promotora (community health worker)-led intervention on the U.S.-Mexico border. METHODS: Enlace ('to link' in Spanish) was a randomized clinical trial to increase PA in low-income, MA women living in South Texas on the U.S.-Mexico border. A total of 620 participants were recruited into the study. The primary outcome was increase in moderate to vigorous physical activity (MVPA) using the Actigraph GT3X 16 Mb accelerometer. A modified version of the Community Health Activities Model Program for Seniors Physical Activity (CHAMPS) instrument was used to predict MVPA. Adjusted and unadjusted logistic regression models predicted change in MVPA by change in CHAMPS activities. ANOVA analysis determined the variance explained in change in MVPA by change in time engaged in activity. Individual effect sizes were then calculated for significant activity type change on MVPA increase. RESULTS: There were significant increases in all CHAMPS activities except aerobic machines and errand walking. An increase in leisure walking (O.R. = 2.76, p = .046), errand (O.R. = 3.53, p = .051), and brisk walking (O.R. = 4.74, p = .011), dance (O.R. = 8.22, p = .003), aerobics class (O.R. = 32.7, p = .001), and light housework (O.R. = 6.75, p = .000), were associated with a decrease in sedentary time. Significant effect sizes for MVPA were observed for jogging (1.2, p = .050), general exercise (1.6, p = .024), and other exercise not specified (2.6, p = .003). Significant effect sizes for sedentary time were detected for leisure time (.031, p = .036), errands (.017, p = .022), brisk walking (.022, p = .003), dance (.042, p = .005), and aerobics class (.013, p = .009). DISCUSSION: Participants who engaged in walking and aerobic activities through this intervention significantly increased their engagement in MVPA and decreased their sedentary time. These findings are novel, since preferences have not been examined in relation to MVPA or sedentary time in MA women. CONCLUSION: PA preferences need to be considered when aiming to promote activities that reduce sedentary time and increase PA participation among marginalized groups, such as MA women. TRIAL REGISTRATION: NCT02046343 .


Assuntos
Exercício/psicologia , Promoção da Saúde/organização & administração , Americanos Mexicanos/psicologia , Pobreza/etnologia , Adulto , Feminino , Humanos , Americanos Mexicanos/estatística & dados numéricos , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Comportamento Sedentário/etnologia , Texas
12.
BMC Public Health ; 19(1): 801, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226957

RESUMO

BACKGROUND: Unimproved water, sanitation, and hygiene (WASH) behaviors are key drivers of infectious disease transmission and influencers of mental well-being. While WASH is seen as a critical enabler of health, important knowledge gaps related to the content and delivery of effective, holistic WASH programming exist. Corresponding impacts of WASH on mental well-being are also underexplored. There is a need for more robust implementation research that yields information regarding whether and how community-based, demand-side interventions facilitate progressive and sustained adoption of improved sanitation and hygiene behaviors and downstream health impacts. The purpose of this protocol is to detail the rationale and design of a cluster-randomized trial evaluating the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia. METHODS: Together with partners, we developed a theoretically-informed, evidence-based behavioral intervention called Andilaye. We randomly selected and assigned 50 sub-districts (kebeles) from three purposively selected districts (woredas); half to receive the Andilaye intervention, and half the standard of care sanitation and hygiene programming (i.e., community-led total sanitation and hygiene [CLTSH]). During baseline, midline, and endline, we will collect data on an array of behavioral factors, potential moderators (e.g., water and sanitation insecurity, collective efficacy), and our primary study outcomes: sanitation and hygiene behaviors and mental well-being. We will perform a process evaluation to assess intervention fidelity and related attributes. DISCUSSION: While CLTSH has fostered sanitation and hygiene improvements in Ethiopia, evidence of behavioral slippage, or regression to unimproved practices in communities previously declared open defecation free exists. Other limitations of CLTSH, such as its focus on disgust, poor triggering, and over-saturation of Health Extension Workers have been documented. We employed rigorous formative research and practically applied social and behavioral theory to develop Andilaye, a scalable intervention designed to address these issues and complement existing service delivery within Ethiopia's Health Extension Program. Evidence from this trial may help address knowledge gaps related to scalable alternatives to CLTSH and inform sanitation and hygiene programming and policy in Ethiopia and beyond. TRIAL REGISTRATION: This trial was registered with clinicaltrials.gov ( NCT03075436 ) on March 9, 2017.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/organização & administração , Higiene/normas , Saúde Mental/estatística & dados numéricos , População Rural , Saneamento/normas , População Suburbana , Adulto , Criança , Pré-Escolar , Etiópia , Feminino , Humanos , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Projetos de Pesquisa , População Rural/estatística & dados numéricos , População Suburbana/estatística & dados numéricos
13.
BMC Public Health ; 19(1): 791, 2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31226977

RESUMO

BACKGROUND: Ghana is among African countries not likely to achieve the Sustainable Development Goal (SDG) three (3) target of reducing maternal mortality to 70 per 100,000 live births by the year 2030 if maternal and child health services utilization are not improved. Community engagement in health is therefore advocated to help address this challenge. This study evaluated the impact of a community engagement intervention on maternal and child health services utilization in Ghana. METHODS: This study was a cluster randomised trial among primary healthcare facilities (n = 64) in the Greater Accra and Western regions in Ghana. Multivariate multiple regression analysis and paired-ttest were used to determine impact of the community engagement intervention on maternal and child health indicators at baseline and follow-up. RESULTS: Intervention health facilities recorded significant improvements over control facilities in terms of average spontaneous vaginal deliveries per month per health facility (baseline mean = 15, follow-up mean = 30, p = 0.0013); child immunizations (baseline mean = 270, follow-up mean = 455, p = 0.0642) and female condoms distribution (baseline mean = 0, follow-up mean = 2, p = 0.0628). Other improved indicators in intervention facilities were average number of Human Immunodeficiency Virus (HIV) tests for non-pregnant women (baseline mean = 55, follow-up 104, p = 0.0213); HIV tests for pregnant women (baseline mean = 40, follow-up mean = 119, p = 0.0067) and malaria tests (baseline mean = 43, follow-up mean = 380, p = 0.0174). Control facilities however performed better than intervention facilities in terms of general laboratory tests, voluntary counselling and testing, treatment of sexually transmitted infections, male child circumcisions and other minor surgical procedures. CONCLUSION: Community engagement in health has the potential of improving utilization of maternal and child health services. There is the need for multi-stakeholder dialogues on complementing existing quality improvement interventions with community engagement strategies.


Assuntos
Participação da Comunidade , Promoção da Saúde/organização & administração , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Seguimentos , Gana , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Avaliação de Programas e Projetos de Saúde
14.
BMC Public Health ; 19(1): 835, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248396

RESUMO

BACKGROUND: Commissioning and monitoring of community-based interventions is a challenge due to the complex nature of the environment and the lack of any explicit cut-offs to guide decision making. At what point, for example, is participant enrolment to interventions, course completion or satisfaction deemed to be acceptable or sufficient for continued funding? We aimed to identify and quantify key progression criteria for fourteen early years interventions by (1) agreeing the top three criteria for monitoring of successful implementation and progress; and (2) agreeing boundaries to categorise interventions as 'meeting anticipated target' (green); 'falling short of targets' (amber) and 'targets not being met' (red). METHODS: We ran three workshops in partnership with the UK's Big Lottery Fund commissioned programme 'Better Start Bradford' (implementing more than 20 interventions to improve the health, wellbeing and development of children aged 0-3) to support decision making by agreeing progression criteria for the interventions being delivered. Workshops included 72 participants, representing a range of professional groups including intervention delivery teams, commissioners, intervention-monitoring teams, academics and community representatives. After discussion and activities, final decisions were submitted using electronic voting devices. All participants were invited to reconsider their responses via a post-workshop questionnaire. RESULTS: Three key progression criteria were assigned to each of the 14 interventions. Overall, criteria that participants most commonly voted for were recruitment, implementation and reach, but these differed according to each intervention. Cut-off values used to indicate when an intervention moved to 'red' varied by criteria; the lowest being for recruitment, where participants agreed that meeting less than 65% of the targeted recruitment would be deemed as 'red' (falling short of target). CONCLUSIONS: Our methodology for monitoring the progression of interventions has resulted in a clear pathway which will support commissioners and intervention teams in local decision making within the Better Start Bradford programme and beyond. This work can support others wishing to implement a formal system for monitoring the progression of public health interventions.


Assuntos
Saúde da Criança , Tomada de Decisões Gerenciais , Promoção da Saúde/organização & administração , Administração em Saúde Pública , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Inquéritos e Questionários , Reino Unido
15.
Implement Sci ; 14(1): 68, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238955

RESUMO

BACKGROUND: Excessive weight gain among young adult women age 18-45 years is an alarming and overlooked trend that must be addressed to reverse the epidemics of obesity and chronic disease. During this vulnerable period, women tend to gain disproportionally large amounts of weight compared to men and to other life periods. Healthy Eating and Active Living Taught at Home (HEALTH) is a lifestyle modification intervention developed in partnership with Parents as Teachers (PAT), a national home visiting, community-based organization with significant reach in this population. HEALTH prevented weight gain, promoted sustained weight loss, and reduced waist circumference. PAT provides parent-child education and services free of charge to nearly 170,000 families through up to 25 free home visits per year until the child enters kindergarten. METHODS: This study extends effectiveness findings with a pragmatic cluster randomized controlled trial to evaluate dissemination and implementation (D&I) of HEALTH across three levels (mother, parent educator, PAT site). The trial will evaluate the effect of HEALTH and the HEALTH training curriculum (implementation strategy) on weight among mothers with overweight and obesity across the USA (N = 252 HEALTH; N = 252 usual care). Parent educators from 28 existing PAT sites (14 HEALTH, 14 usual care) will receive the HEALTH training curriculum through PAT National Center, using PAT's existing training infrastructure, as a continuing education opportunity. An extensive evaluation, guided by RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance), will determine implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and adaptation) at the parent educator level. The Conceptual Framework for Implementation Research will characterize determinants that influence HEALTH D&I at three levels: mother, parent educator, and PAT site to enhance external validity (reach and maintenance). DISCUSSION: Embedding intervention content within existing delivery channels can help expand the reach of evidence-based interventions. Interventions, which have been adapted, can still be effective even if the effect is reduced and can still achieve population impact by reaching a broader set of the population. The current study will build on this to test not only the effectiveness of HEALTH in real-world PAT implementation nationwide, but also elements critical to D&I, implementation outcomes, and the context for implementation. TRIAL REGISTRATION: https://ClinicalTrials.gov , NCT03758638 . Registered 29 November 2018.


Assuntos
Promoção da Saúde/organização & administração , Estilo de Vida Saudável , Mães , Obesidade/prevenção & controle , Sobrepeso/prevenção & controle , Adolescente , Adulto , Análise por Conglomerados , Feminino , Humanos , Modelos Teóricos , Desenvolvimento de Programas , Qualidade de Vida , Projetos de Pesquisa , Estados Unidos , Ganho de Peso
16.
BMC Health Serv Res ; 19(1): 347, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151451

RESUMO

BACKGROUND: In life time, nearly each person succumbs to some sort of chronic disease and many develop complicated chronic diseases. It is critical to focus on preventive services with a relatively high health impact and favorable cost effectiveness. During routine health facility visits, it is advisable to evaluate both symptomatic and asymptomatic patients for their needs of health promotion and disease prevention services. This necessitates the development of an integrated health service (IHS) approach that incorporates health promotion, disease prevention and curative services. METHODS: There were two phases for the study. The first phase explored the degree of promotive and preventive health care delivery at the health centers and hospitals. Phase two, utilizing the Delphi strategy, centered on looking for agreement on the finding from phase 1 and on IHS approach. Delphi questions were created based on the results of phase 1, and the reply choices were tied to a five point Likert scale. Consensus was considered come to when 75% of the experts concurred on an issue. From that point, advance clarification and agreement was looked for by implies of a second-round assessment for scores between 50 and 75%. Agreement on proposed IHS model, application of case finding and Periodic Health Examination (PHE) approaches were also sought. This study focuses on finding from phase 2. RESULT: Of the twenty experts, 90% (n = 18) agreed that the IHS framework shows the causal relationship of diseases and included plausible intervention approaches. Experts reached consensus (90%;n = 18) that case finding testing,screening patients for conditions other than the medical care they sought at a particular time, can be performed at health facilities. All experts (100%; n = 20) recommended conducting periodic health examinations in selected diseases for patients who are apparently not sick. CONCLUSION: The Integrated Health Service (IHS) framework was agreed by experts to be a plausible method in describing the causal relationship of chronic non-communicable, communicable, and nutrition-related diseases. The framework can play a vital role by preventing the acquiring, progression, suffering or dying from diseases through restraining the vicious cycle of chronic diseases.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Doenças não Transmissíveis/prevenção & controle , Adulto , Consenso , Análise Custo-Benefício , Etiópia , Feminino , Promoção da Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/organização & administração
17.
BMC Public Health ; 19(1): 774, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208375

RESUMO

BACKGROUND: Regular physical activity (PA) has been recommended for the management of HIV and AIDS. The purpose of this study was to develop a contextualised intervention for promoting PA among women living with HIV and AIDS (WLWHA) of low socioeconomic status (SES). A secondary aim of the study was to optimise the PA intervention using behavioural theory/ frameworks derived from preliminary studies and the literature. METHODS: The Behaviour Change Wheel (BCW) for designing behaviour change interventions was used. This method was further supplemented by evidence from the literature, systematic literature review (SLR), a concurrent mixed methods study and two cross-sectional studies. The SLR aided in determining the theoretical frameworks to inform the intervention, the specific PA behaviours to be targeted by the intervention, the intervention functions, the intervention policy category and the mode of delivery of the intervention. The concurrent mixed methods study was used to identify key factors that needed to change in order for participants to engage in regular PA. The first cross-sectional study was used to determine the gender to be targeted by the study. The second cross-sectional study was used to determine the domain and intensity of PA to target in the intervention. RESULTS: A face-to-face context-sensitive PA intervention employing 14 behavioural change techniques was designed. The PA intervention (a) utilised the Transtheoretical model of behaviour change and the Social Cognitive theory as the underpinning theoretical frameworks (b) included convenient PAs, such as walking, doing simple home-based exercises, engaging in activities of daily living or doing simple exercises at the community centre (c) used education, reward, training in PA, modelling exercise activities and enablement to increase the opportunity to engage in PA as intervention functions (d) used service provision as policy priorities, and (e) used a direct face-to-face mode of delivery. CONCLUSIONS: The PA intervention emphasises behavioural techniques for increasing PA participation, such as goal-setting, self-monitoring, strategies for overcoming PA barriers, social support and rewards. The intervention employs strategies that highlight low-cost local PA resources and opportunities to help HIV infected women of low SES to participate in PA. The BCW provides a useful and comprehensive framework for the development of evidence and theory-based PA interventions for PLWHA of low SES. The BCW can thus be used in the development of interventions that 'talk' to policy by bridging the health inequality gap.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Exercício/psicologia , Infecções por HIV/terapia , Promoção da Saúde/organização & administração , Pobreza , Síndrome de Imunodeficiência Adquirida/epidemiologia , Estudos Transversais , Prática Clínica Baseada em Evidências , Feminino , Infecções por HIV/epidemiologia , Promoção da Saúde/métodos , Humanos , Revisão Sistemática como Assunto
18.
Arch. prev. riesgos labor. (Ed. impr.) ; 22(2): 72-75, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181178

RESUMO

Objetivos: Evaluar los cambios en la actividad física de los participantes de un programa de actividad física (Mueve-T) implantado en el medio laboral. Métodos: En marzo del 2014, se iniciaron las actividades del programa Mueve-T con los objetivos de sensibilizar a los trabajadores en la práctica de la actividad física y conseguir una mejora en el nivel de actividad. Para evaluar su efectividad se utilizó el Cuestionario IPAQ (International Physical Activity Questionnaire) antes de iniciarse el programa (2014) y a los dos años (2016). Se realiza la comparación entre años ajustando un modelo logístico de medidas repetidas de dos poblaciones de trabajadores de distintos centros de trabajo de la misma empresa con respuesta ordinal politómica para IPAQ (nivel bajo o inactivo, moderado y alto), para toda la población y estratificado por sexo, centro de trabajo y puesto de trabajo. Resultados: Se incluyen los 314 trabajadores que respondieron el cuestionario en los dos años. En 2014 un 35,35% de los encuestados reportaron un nivel bajo de actividad, un 39,50% moderado y un 25,15 un nivel alto. En 2016 un 36,30% reportaron nivel bajo de actividad, un 39,80% nivel moderado y un 23, 90% un nivel alto. El análisis de respuesta entre años no ha mostrado evidencia de cambio entre años (p=ns). No se han encontrado diferencias por sexo, pero sí una menor actividad en determinados centros y puestos de trabajo. Conclusiones: Si valoramos los resultados del programa y su efectividad con el cuestionario IPAQ, observamos que estadísticamente no muestran cambio en actividad física estadísticamente significativo; pero si hay cambios en el nivel de actividad manteniéndose y aumentando en un grupo de trabajadores, a su vez consideran el programa efectivo y desean continuar con las actividades. Para obtener un aumento del nivel de actividad física se precisaría de un periodo más largo de evaluación


Objective: To analyze the effectiveness of a company-based physical activity program using the International Physical Activity Questionnaire (IPAQ) questionnaire. Methods: In March 2014 we implemented a company-based physical activity program (Mueve-T, by its Spanish acronym) with the objective of increasing awareness of physical activity among employees, and measuring improvements in activity level. To evaluate the effectiveness of the program, we administered the IPAQ Questionnaire, before the program began in 2014 and two years later, in 2016. Descriptive summary statistics included frequencies, percentages and bar charts. To compare pre- and post-intervention results, we used a logistic repeated measures model, adjusted for two populations, with an ordinal polytomous response for IPAQ (low or inactive, moderate and high), applied to the overall study population and further examined by sex, workplace and job. Results: A total of 746 participants responded in 2014 and 563 in 2016. Only 314 respondents completed both surveys. In 2014, 35.4% of the respondents reported a low level of activity, moderate was 39.5% and highwas, 25.2%. In 2016, 36.3% reported a low level of activity, moderate was 39.8% and a high level was indicated by 23.9%. Overall, there were no significant differences in physical activity levels between the pre- and post-intervention period, among those who participated in both surveys. Likewise, there were no significant differences when this result was examined by sex, although employees sales or commercial tasks has lower levels of physical activity as compared to other centers or jobs. Conclusions: The results did not find this intervention program to be effective in increasing levels of physical activity. The differences found among the sales and commercial task employees could have been due to differences in the effect on awareness achieved by companywide information dissemination (e.g., newsletters, talks, intranet notes, etc.) as compared to specific individual activities (e.g., (yoga classes, zumba, cycling, walks, etc.). A longer evaluation period is needed to confirm these findings


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Atividade Motora , Promoção da Saúde/organização & administração , Eficácia/estatística & dados numéricos , Avaliação de Eficácia-Efetividade de Intervenções , Doenças Cardiovasculares/prevenção & controle , Saúde do Trabalhador/estatística & dados numéricos , Promoção da Saúde/tendências , Local de Trabalho/psicologia
19.
Glob Health Action ; 12(1): 1609313, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116096

RESUMO

Background: Community-based approaches have been identified as an effective strategy to address the growing burden of noncommunicable diseases (NCDs) worldwide. However, little is known about community as a concept among people living in socioeconomically disadvantaged settings and stakeholders' interactions and engagement in NCDs prevention and management. Objective: The aim of this study was to understand; (1) the meaning of community among people living in socioeconomically disadvantaged suburbs in Region Stockholm and (2) how communities interact and engage with stakeholders at local and regional levels for the prevention and management of type 2 diabetes (T2D). Methods: This qualitative study was conducted in three municipalities in Region Stockholm with a high proportion of migrants. Multiple data collection methods were used, including observations of community activities; interviews with community members, representatives of public authorities and NGOs; and group interviews with healthcare providers. Data were analyzed using content analysis. Results: Community was perceived as living in close proximity with shared beliefs, values and resources. Although they recognized its social and cultural diversity, community members focused more on the commonalities of living in their neighborhood and less on their differences in country of birth and languages spoken. Several mismatches between awareness of community needs and the available skills and resources among stakeholders for T2D prevention were identified. Stakeholders expressed awareness of T2D risk and interest in addressing it in a culturally appropriate manner. Conclusion: Interaction between the communities and stakeholders was limited, as was engagement in T2D prevention and management. This highlights barriers in the collaboration between community, healthcare institutions and other stakeholders which consequently affect the implementation of preventive interventions. Innovative ways to link the community to the healthcare sector and other local government institutions are needed to build the capacity of health systems for T2D prevention in socioeconomically disadvantaged communities.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/prevenção & controle , Promoção da Saúde/organização & administração , Colaboração Intersetorial , Populações Vulneráveis/psicologia , Populações Vulneráveis/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Socioeconômicos , Suécia
20.
Glob Health Action ; 12(1): 1610253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31120345

RESUMO

Background: Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care. Objective: This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam. Methods: Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology. Results: There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam's National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%. Conclusions: Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.


Assuntos
Assistência à Saúde/organização & administração , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Hipertensão/terapia , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vietnã
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