Health Education Journal

Schools are well recognised as critical contexts for the promotion of mental health and well-being and offer the potential to reach a large number of children at an early age, at a time when they are developing important attitudes and behaviours that may influence their future health. Ensuing from a number of large-scale epidemiological studies which have found that young Irish people are significantly struggling with their mental health and well-being, the Government of Ireland has committed to prioritising mental health promotion in schools through a multicomponent, preventive, whole school approach.

To obtain a detailed and integrated account of the implementation of a whole school approach to mental health and well-being promotion in the Irish primary school context.

A qualitative case study approach was undertaken employing in depth semi-structured interviews, document analysis and field notes. Thematic analysis was applied to all interview data and emerging themes were mapped on to the Theoretical Domains Framework (TDF) domains.

Three Irish primary schools.

Facilitators and barriers that emerged from the data related primarily to the schools’ economic and political context, organisational context, and internal and external partnerships and relationships.

This study has demonstrated that the implementation process in ‘real-world’ practice settings, such as schools, is dynamic, complex and exists within a multi-level system and requires careful consideration of the numerous ecological factors that can influence implementation.

Engaging in healthy behaviour while studying at university is a defining factor in terms of its impact on a person’s later health in life. Therefore, university students are a priority when it comes to health education interventions. This article describes the development and implementation of a web-based health programme intervention to enable students to acquire knowledge and strategies to allow them to make decisions that favour their health by adopting healthy and positive behaviours.

The design of the Health On You programme was based on the PRECEDE-PROCEED model and used an online platform designed to facilitate self-learning using interactive teaching strategies. The programme included six modules focusing on the following topics – Drinking responsibly; Living free of smoke; Saying no to illicit drugs and to self-medication; Balanced, Healthy and Sustainable Diet; Moving Yourself; and Preventing Sexually Transmitted Infections.

Data collection took place in a public university in northern Portugal.

In 2021, a cross-sectional study was carried out with a convenience sample of 37 students attending a Portuguese university to assess the implementation process.

Overall assessment of the programme was fairly positive – 5.00 (with 5 being the highest mark), as well as for each of its developed modules (mean scores, 4.66–5.00).

The Health On You programme appeared to be an innovative web-based health intervention due to the broad-based approach it adopted, both in terms of the topics tackled and the variety of teaching and learning strategies used to address each of the modules.

The incidence of type 2 diabetes in UK Black African and Caribbean communities is up to three times higher than in the general population, and engagement with self-management advice is poorer. This study explores the perspective of those living with diabetes to understand how the cultural salience of advice could be improved.

Participants were recruited via community venues, faith institutions and primary care. Eight focus groups were conducted with 41 individuals (Black African n = 23, Black Caribbean n = 18). Grounded theory methods were used for analysis.

Although motivated to manage the condition, individuals experienced a misalignment between elements of the care provision and cultural norms. Explanatory models of diabetes differed from the biomedical model reducing trust in treatment protocols. A lack of cultural salience reduced the accessibility of advice. Furthermore, elements of self-management advice were seen to conflict directly with some cultural traditions and practices. Individuals had to reconcile the two perspectives in order to proceed with self-management, often prioritising cultural norms and advice from informal sources over healthcare advice. Building personal relationships with the healthcare team improved trust and engagement.

Findings suggest the needs in these communities were not being fully met. The healthcare interaction was pivotal in improving trust and engagement and reducing misinformation. However, appropriately informed community support also offers the potential to mitigate misalignment and to improve equity of access.

Ageing populations are a global phenomenon resulting from increasing life expectancy and decreasing fertility rates. Thus, investigation into the factors affecting the quality of life (QOL) of the elderly has become important. This study aimed to assess the association between active ageing and health literacy, and QOL in a sample of elderly people in Northeast Thailand.

Cross-sectional data were collected from 1,226 persons aged 60 years and above from Northeast Thailand. A general linear mixed model (GLMM) was used to determine the association between active ageing, health literacy and sociodemographic factors and the outcome variable, good QOL, as determined using the WHOQOL-BREF.

Overall, 42.09% of participants had a good QOL. After adjusting for the effects of the other covariates, a multivariable analysis indicated that a high level of active ageing (adj. odds ratio [OR] = 4.51; 95% confidence interval [CI]: 3.27–6.23), adequate health literacy (adj. OR = 2.53; 95% CI: 1.79–3.59), age < 70 years (adj. OR = 4.09; 95% CI: 3.03–5.50), having completed secondary school or higher education (adj. OR = 2.43; 95% CI: 1.57–3.76), and having a monthly household income ⩾ 15,000 baht (adj. OR = 3.01; 95% CI: 1.73–5.22) were significantly associated with good QOL in the sample.

The QOL of the elderly must be prioritised. Active ageing and health literacy should be promoted as part of socioeconomic and health policies. Negative attitudes and ‘ageism’ towards the elderly should be reduced among populations of all ages. Health communication for members of a demographic with limited health literacy should be enhanced, and employment of the elderly encouraged.

Regular exercise and healthy eating are important contributors to a person’s overall health and well-being. To enhance community health, Keck School of Medicine of the University of Southern California medical students have been leading in-person nutrition, cooking and exercise classes for community members at the Los Angeles County Wellness Center. In September 2020, due to the COVID-19 pandemic, students pivoted to teaching through a virtual platform. In this study, we evaluated community participants’ experiences attending virtual, bilingual nutrition, cooking and exercise classes; the efficacy of virtual classes in providing education; participants’ preference for virtual versus in-person classes; and potential advantages and disadvantages of the virtual versus in-person formats.

Cross-sectional study design.

Following 22 virtual classes between September 2020 and April 2021, participants completed an online Qualtrics survey.

Quantitative data were descriptively analysed within Qualtrics using the Sign test. Qualitative free response data were analysed by coding responses for common themes using an inductive approach.

There were 326 responses from 130 unique participants. Satisfaction was high for nutrition and exercise classes (99%), and 98% of participants reported they would make healthy nutrition and exercise behaviour changes. Participants preferred online classes compared to in-person classes (p = .0008). Barriers to attending in-person classes included lack of childcare, transport issues and COVID-19 risk.

Virtual classes were well-received and effective. Virtual classes circumvented some of the barriers to in-person class attendance, and many participants preferred virtual classes to in-person classes.

The aim of this study was to evaluate primary and secondary school teachers’ attitudes and perceptions regarding the usefulness and effectiveness of Health Education Nutrition Programmes (HENPs) in Greece.

Qualitative study using semi-structured interviews.

In total, 18 teachers (7 men, 11 women), aged 36–55 years, working in primary (n = 8) and secondary education (n = 10) were recruited via purposive sampling from three counties in Greece and were interviewed via through an online platform. Thematic analysis was used to interpret the data.

Four main themes were identified: teachers’ awareness of HENPs; the role of the external environment in shaping students’ dietary habits; the value of experiential learning; and barriers and facilitators to the implementation of HENPs. Most teachers considered HENPs important and effective in improving children’s eating habits through experiential learning; however, training and support were very limited. The family has a crucial role in shaping children’s eating habits, which highlights the need for collaboration between school and family. The main barriers for the implementation of HENPs were lack of time and resources.

Teachers perceive HENPs as effective tools to improve children’s dietary behaviour. However, they need support/training from experts to deliver them successfully at school. Expert guidance to train the teachers and family involvement are needed to increase the effectiveness of the HENPs used in Greek primary and secondary schools.

Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers.

Complex intervention development based on a five-step multi-methods process.

Tertiary individual prevention of work-related skin disease in Germany.

Intervention development comprised the following steps: literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients’ needs, development of a programme theory, and intervention development and concept validation.

We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals.

A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way.

Sports clubs’ investment in health promotion (HP) has so far been limited, and efforts to understand where gaps exist in implementation are few and far between. This mixed-method study analysed managers’, coaches’ and sports participants’ perceptions of HP in a single sports club.

A mixed-method cross sectional design was used.

The goal was to assess HP perceptions at the macro (club), meso (managers) and micro (coaches) levels with respect to four key health determinants.

Quantitative data were collected from 237 participants using e-PROSCeSS questionnaires. Qualitative data collection included two meetings with managers and a focus group with sports club participants. Data analysis took place by means of a hybrid thematic analysis informed by the health promoting sports club (HPSC) model.

Similar answer patterns among managers, coaches and sports club participants illustrated that social and environmental determinants scored higher than organisational and economic determinants, which was consistent with qualitative findings. Only one significant difference was found between managers and sports club participants – for organisational determinants at the macro level. In others words, all club actors agreed that sports clubs needed to invest in HP policy and funding, and not only acknowledge that HP is an integral outcome of sports participation. Gender differences in HP perceptions were identified, while being a volunteer compared to a non-volunteer did not make any significant difference.

Study findings raise questions about how best to implement and evaluate sports club HP, especially in relation to policies and resources. This is essential to understand the interactions between macro, meso and micro level health determinants and the temporal implications of implementing a HPSC’s approach.

This study aimed to assess the quality and readability of web-based information on familial hypercholesterolaemia.

Internet searches using the terms ‘familial hypercholesterolemia’, ‘hypercholesterolemia’, ‘inherited high cholesterol’, ‘hereditary high cholesterol’ and ‘inherited high LDL’ were conducted with the Google, Yahoo! and Bing search engines using default settings during August 2021. The first 50 web links that appeared using each search engine were evaluated using the Flesch Reading Ease Score (FRES) and DISCERN instrument for readability and the quality of the website. The LIDA tool was used to assess reliability and usability.

In all, 750 websites were accessed and 38 websites were included in the analysis. The majority of the websites (29, 76.3%) were owned by non-governmental institutions. Twelve (30.8%) websites were certified by the Health On the Net Foundation (HON) code of conduct. Only 17 websites (44.7%) had a stated author. Twenty-nine (76.3%) websites had a stated date of publication. Only 16 (42.1%) provided references for the statements made. Infographics were used in 17 (44.7%) websites. The median FRES was 47.15 (range: 22.3–91.8), which is equivalent to college-level readability. The median LIDA usability and reliability score was 38.00 (range: 25–46) and 15.00 (range: 7–24), respectively. The median DISCERN score was 45.00 (range: 17–76). The DISCERN score was significantly associated with the FRES (0.047) and whether the website was governmental or not (0.028).

According to this study, the readability, reliability, usability and quality of the majority of websites were inadequate. Due to the rapid growth in the use of the Internet, steps need to be taken to standardise and regulate patient education websites for this and perhaps other health conditions.

Schools that have partnerships with health services have shown improvements in attendance and academic performance. This study examined the effects of intersectoral educational training (IET) between the health and education sectors on students’ learning outcomes, emotional experiences and subjective task values.

In this experimental field study, students in the control group were taught about health by a regular team of teachers, the experimental group was taught by a teacher–general practitioner team. Qualitative and quantitative data were collected at three different points of time.

The study was conducted with students aged between 13 and 14 years in three classes at a secondary school in Baden-Wuerttemberg.

Data were collected on demographic variables as well as learning outcomes assessed by a multiple choice test. For the assessment of emotional experiences, the validated Achievement Emotions Questionnaire was used and for subjective task values a modified Motivated Strategies for Learning Questionnaire was employed. Quantitatively, descriptive statistics were calculated and correlation analyses were conducted to explore the association of positive emotions and task value with knowledge after the intervention and follow-up.

Over time, 69 of 76 participants (91%) completed all three surveys. Both groups showed significant and sustainable knowledge increases, but there were no significant differences between the groups in knowledge increase, positive emotions and task values.

Health education in public secondary schools seems useful for increasing students’ health knowledge both in the short- and longer-term. However, future research will need to examine the potential effects of IET approaches on students’ cognitive and motivational experience.