Health Promotion Practice

Among public health and health care practitioners, there is growing understanding that individuals make choices about their health not in a vacuum but based on the social, physical, and economic environments surrounding them and the resources available to them. Furthermore, we know that we, as a society, have designed these environments and resource allocation processes and that those in turn can produce better or worse health outcomes. In recognition of this, some practitioners are turning toward systems thinking as a way of understanding the many sectors and factors that influence health, and as a strategy for influencing broad and sustained health interventions. In October 2018, Prevention Institute released System of Prevention, a book that uses graphic design to illustrate Prevention Institute’s framework for a systems approach to population health that can achieve health equity. The book draws upon learning in the primary prevention arena and presents it in an innovative format designed to be accessible to the many sectors outside of public health that collectively shape the social and community determinants of health. It aims to spark dialogue and catalyze collaboration among the sectors and stakeholders that can together work for a healthy and equitable future for all communities.

Addressing and preventing the major health issues affecting American adolescents requires collaborative and authentic youth participation. Our current time reflects a pendulum shift toward authentic youth voice and democratic participation in school wellness and reform. In this application article, we outline and describe a youth–adult partnership curriculum to engage youth as change agents in their school community through youth-led research activities with publicly available and locally derived data from the Youth Risk Behavior Surveillance Survey. Getting to “Y”: Youth Bring Meaning to the Youth Risk Behavior Survey (GTY) is a positive youth development/youth participatory action research initiative, whereby students analyze their school health data and use those data as a starting point to create change in their school community. Focus groups were conducted with GTY youth and adult alumni in spring 2018. Results from the focus group data reinforce the GTY core assumptions and speak to the importance of structured opportunities for youth agency. GTY is a scalable, developmentally appropriate, resource-efficient, and empirically based curriculum that provides structured opportunities for youth-led research utilizing local Youth Risk Behavior Surveillance Survey data as a youth–adult partnership model to increase youth agency and engagement with school/community health needs.

Health advocacy is a central responsibility for health educators and public health practitioners, as documented clearly in our professional competencies. Professional organizations such as the Society for Public Health Education and the American Public Health Association undertake frequent advocacy initiatives and strive to engage their members in advocacy strategies on a regular basis. Despite this understanding and advocacy training requirements in academic preparation programs for public health professionals, students and emerging professionals often lack advocacy experience. In this article, we provide descriptions of multiple effective health advocacy strategies spread across the time intensity spectrum, in order of least time intensive to most. Advocates may select the best strategy based on the needs of their target audience, the amount of time and energy they have for the task, and the level of confidence they have in practicing the strategy itself.

Over the past 20 years, teenage birth rates in the United States have declined substantially but continue to persist among certain populations. During this time period, a series of rigorously tested teen pregnancy prevention (TPP) programs were developed, and a number of evidence-based interventions (EBIs) emerged. In April 2017, researchers reviewed EBIs in TPP and examined each program’s socioecological levels of intervention, measurements approaches, and other ecological aspects. Findings indicate that the majority of TPP EBIs are aimed at the individual and/or interpersonal level of intervention. Furthermore, the programs were evaluated using the individual as the unit of analysis, regardless of what level the EBI targets. These findings represent serious gaps, specifically a lack of system-, environmental-, and policy-level EBIs. Future TP approaches should target multiple levels of social ecology, ensure measurements appropriately capture changes within these levels, and shift to a focus on a longer term population health improvement.

We currently see an interdisciplinary shift toward a “participatory turn” in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.

Media coverage of mental health and other social issues often relies on episodic narratives that suggest individualistic causes and solutions, while reinforcing negative stereotypes. Community narratives can provide empowering alternatives, serving as media advocacy tools used to shape the policy debate on a social issue. This article provides health promotion researchers and practitioners with guidance on how to develop and disseminate community narratives to broaden awareness of social issues and build support for particular programs and policy solutions. To exemplify the community narrative development process and highlight important considerations, this article examines a narrative from a mental health consumer-run organization. In the narrative, people with mental health problems help one another while operating a nonprofit organization, thereby countering stigmatizing media portrayals of people with mental illness as dangerous and incompetent. The community narrative frame supports the use of consumer-run organizations, which are not well-known and receive little funding despite evidence of effectiveness. The article concludes by reviewing challenges to disseminating community narratives, such as creating a product of interest to media outlets, and potential solutions, such as engaging media representatives through community health partnerships and using social media to draw attention to the narratives.

Originating from one of the poorest areas in Mexico, Mixtecs are one of the largest indigenous groups of workers in California. Providing health education to this group is challenging because many do not speak English or Spanish, and indigenous languages are mainly oral, not written. We explored the feasibility of conveying health information through the radio and in promotora-led workshops. The study included an evaluation of the workshops through surveys before the workshop and 4 to 6 months later in a subsample of 96 indigenous women. The number of radio listeners averaged more than 2,000 per month, and 500 community members attended a workshop. Among women who completed pre- and postworkshop assessments (N = 75), there was a statistically significant increase in knowledge of how to get a wellness visit, where to get a free mammogram, and mammography screening guidelines. Women who ever had a mammogram or wellness visit at baseline were significantly more likely to report receipt of this service during the follow-up period than women who never had this service. Educational workshops and radio are promising and culturally appropriate strategies to provide health information in this community. However, many women need additional assistance to navigate access to health care.

We sought to examine parent vaccine information sources and to understand vaccine beliefs and concerns of a representative sample of Oregon parents from an area where low vaccination levels occur. We hoped to understand how these beliefs affect pediatric vaccine uptake and to inform efforts to shift vaccine-hesitant habits toward a norm of full vaccination. Oregon still permits nonmedical exemptions. We passively recruited parents of children ages 0 to 13 years, then divided them into focus groups by stance—whether vaccine-accepting or -hesitant. Because of recruitment challenges, we supplemented focus group data from 33 participants with six individual parent interviews. In focus groups and interviews, we probed for vaccine information sources perceived as credible as well as perceptions about vaccines and their utility, benefit, and safety, using constructs of the health belief model. The information sources included medical providers, family, and peers or social networks. We found that vaccine beliefs are not dichotomous but fall along a continuum from full acceptance to full opposition. Most parents who participated inclined toward flexible vaccination scheduling. Another new finding was that most participants, regardless of vaccine stance, acknowledged the tension between social responsibility and individual choice regarding vaccination; vaccine-accepters supported social responsibility and vaccine-hesitant participants stressed individual choice. In addition, parents across the spectrum expressed skepticism about the reliability of social media.

Background. Little is known about vaccine intention behavior among patients recovering from a medically attended acute respiratory infection. Methods. Adults ≥ 18 years old with an acute respiratory infection in the 2014-2015, 2015-2016, and 2016-2017 influenza seasons were tested for influenza and completed surveys. Across seasons, unvaccinated participants were grouped into those who intended to receive the influenza vaccine in the following season (vaccine intention) and those who did not (no vaccine intention). In 2016-2017, participants were asked the reasons for their vaccination behavior. Results. Of the 837 unvaccinated participants, 308 (37%) intended to be vaccinated the next season. The groups did not differ in demographic or overall health factors. In logistic regression, non-Whites, those reporting wheezing or nasal congestion, and those receiving an antiviral prescription were more likely to be in the vaccine intention group. That group was significantly more likely to cite perceived behavioral control reasons for not being vaccinated (forgot), while the no vaccine intention group was significantly (p < .001) more likely to report knowledge/attitudinal reasons (side effects). Conclusion. Because influenza vaccine is given annually, adults must make a conscious decision to receive the vaccine each year. Understanding the factors related to vaccination behavior and intent can help shape interventions to improve influenza vaccination rates. A medical visit at the time of an acute respiratory illness, especially one in which the provider suspects influenza, as evidenced by an antiviral prescription, is an ideal opportunity to recommend influenza vaccine in the next season, to prevent a similar experience.

This study compiled and detailed recommendations from Maryland Local Overdose Fatality Review Teams (LOFRTs) to provide state and local health departments with innovative strategies to address the worsening opioid epidemic and overdose-related deaths. LOFRTs consist of jurisdictional multiagency, multidisciplinary teams that share data to critically examine drug overdose cases. Goals include identification of risk factors and intervention opportunities to inform overdose prevention programs and policy. The authors qualitatively analyzed reports from Maryland LOFRTs case reviews to categorize outcomes and assess using frequency analyses. A total of 9 macro-level categories emerged from the review of approximately 361 recommendations from LOFRTs. Most recommendations related to Prevention Education, Integrated Care, and Harm Reduction strategies. Overdose fatality review is an effective means of understanding the opioid epidemic, strengthening coordinated interventions, and informing local and state health department overdose prevention strategic planning. Teams have a unique vantage point from which to view systems-level gaps and policy issues because of their collaborative nature and the quality of data provided by agencies that directly served decedents.

Background. The obesity epidemic has led to an increase in prediabetes in youth, causing a serious public health concern. Education on diabetes risk and initiation of lifestyle change are the primary treatment modalities. There are few existing age-appropriate health education tools to address diabetes prevention for high-risk youth. Aim. To develop an age-appropriate health education tool(s) to help youth better understand type 2 diabetes risk factors and the reversibility of risk. Method. Health education tool development took place in five phases: exploration, design, analysis, refinement, and process evaluation. Results. The project resulted in (1) booklet designed to increase knowledge of risk, (2) meme generator that mirrors the booklet graphics and allows youth to create their own meme based on their pancreas’ current mood, (3) environmental posters for clinic, and (4) brief self-assessment that acts as a conversation starter for the health educators. Conclusion. Patients reported high likability and satisfaction with the health education tools, with the majority of patients giving the materials an “A” rating. The process evaluation indicated a high level of fidelity and related measures regarding how the health education tools were intended to be used and how they were actually used in the clinic setting.

Screening for hepatitis B (HBV) among high-risk young adults can help prevent its transmission and lead to earlier treatment and better long-term health outcomes. Yet few interventions have focused on increasing HBV awareness among young adults. Social media (SM) may be an effective method for disseminating information and engaging young adults about HBV. In this pilot study, qualitative and quantitative methods were applied to collect information on current use and perceptions toward SM through semistructured interviews and focus groups with young Chinese and Vietnamese adults and community leaders from local organizations in Philadelphia. Additionally, survey items were collected during the interviews and focus groups to provide quantitative data. Results from the interviews provided evidence that young adults and local organizations are already using SM and are open to using it to share general health information that is specific to their community. The focus groups suggested that using group pages or chats could be most appropriate for reaching young adults and that credible sources should be used to deliver messages that are tailored to the audience. The findings from this study will support the development of an SM intervention aimed at increasing HBV awareness.

Introduction. This study investigated participants’ acceptance of a short messaging service (SMS) intervention designed to support asthma management, including suggestions regarding program delivery and message content. Methods. Individual and group interviews were conducted with patients from a safety-net health care system in Denver, Colorado. Eligible participants were English or Spanish speakers between the ages of 13 and 40 years, with diagnosed persistent asthma. All individual and group interviews were digitally recorded, transcribed, translated from Spanish to English (where applicable), and analyzed for thematic content by experienced analysts using established qualitative content techniques. The qualitative software package ATLAS.ti was used for data analysis and management. Results. This study included a total of 43 participants. In general, participants were receptive toward the SMS program and supported the use of tailored and interactive messages. Adolescents supported the idea of enhancing care by sending messages to a support person, such as a parent or guardian. However, adults were less receptive toward this idea. Participants also preferred directive educational messages and cues to action, while general messages reminding them of their asthma diagnosis were viewed less favorably. Implications. The results from this study will inform a randomized control trial evaluating the efficacy of the SMS intervention.

Older adolescent African American and Latina females have disproportionately high rates of unintended pregnancies and sexually transmitted infections (STIs). This article describes the development of a new video intervention for this population, modeled on Safe in the City (SITC), an evidence-based STI prevention video. Plan A was created from 2015 to 2016, using a systematic process similar to SITC. This included forming a project team with reproductive health experts, hiring a video production company and screenwriter, conducting a clinic staff survey (n = 8), and soliciting priority population input using three focus groups (n = 41) followed by a review panel (n = 9). The expert input, clinic staff survey, focus groups, and review panel informed the content and format of Plan A. The 23-minute video includes three interconnected stories with relatable characters and two animated sequences. Topics covered include condoms, long-acting reversible contraception, emergency contraception, STI prevention and testing, and patient–provider communication. SITC provided a model to create a new entertainment–education intervention for a different audience and to address pregnancy prevention as well as STIs. Sustained priority population involvement, input from stakeholders, and a highly iterative process were vital to developing Plan A, which is currently being evaluated in a randomized controlled trial.

Understanding how safety net programs adapt to systemic health care changes is pivotal for creating feasible recommendations for policy implementation. This study characterizes perspectives of Lead Agency (LA) coordinators of the Illinois Breast and Cervical Cancer Program (IBCCP) in response to sociopolitical changes at state and national levels. Our cross-sectional study included 29 semistructured telephone interviews between December 2015 and January 2016. Respondents indicated some changes in the priority population served, changes in referrals and clinical services, and, a continued commitment to IBCCP. Our findings suggest that IBCCP and other safety net programs will need to be flexible to meet the ongoing needs of historically vulnerable populations in a complex, shifting environment. Implications for public health practice and policy include the need to ensure that program personnel are aware of evidence-based strategies to reach different priority populations and are kept abreast of organizational and system changes that may affect referral patterns as well as the need to educate health care providers working with safety net programs about changes in the delivery and coordination of services.

Epidemiological data suggest that Native Hawaiian, Pacific Islander, and Asian American (NHPIA) adolescent females in Hawai‘i are at elevated risk for sexually transmitted infections (STIs). These data also indicate that teen girls in Hawai‘i are more likely to engage in high-risk sexual behaviors than boys. Despite this compelling evidence, there is a paucity of published research on effective STI prevention protocols that target NHPIA female adolescents. In light of this need, the purpose of this study was to adapt an evidence-based, group-level STI behavioral prevention intervention targeting local NHPIA adolescent girls in Hawai‘i for implementation by community-based organizations (CBOs). This article describes the adaptation of an evidence-based STI prevention intervention in partnership with a CBO, using a locally modified ADAPT-ITT model as a basis for the adaptation process. This research consisted of two phases: (1) development of an initial test version of an adapted intervention and (2) the development of the final version of the adapted intervention, Girl Power Hawai‘i. The results provide the empirical and foundational research necessary for a tailored intervention that can be readily implemented by CBOs for local teen girls in Hawai‘i.

The Patient Protection and Affordable Care Act of 2010 mandated nonprofit hospitals to complete community health needs assessments (CHNAs) every 3 years to identify priority health needs for the community they serve. The CHNA must include input from the community in the determination of health needs. Large variation exists across CHNAs on methods used in the integration of quantitative and qualitative data both in the determination and prioritization of health needs and those needs chosen by the hospital for community benefit funding. An important part of the CHNA is the prioritization of the needs identified, as it can influence hospital community benefit funding decisions. This article describes a method for clearly integrating qualitative and quantitative data in the CHNA process offering a best practice strategy for conducting CHNAs. The method uses an approach based on flexible, objective decision points that can be used to both generate a list of significant health needs and a prioritization of those needs based on community input, influencing funding priorities of the hospital. The method provides a standard approach useful across multiple hospital CHNAs in both rural and urban settings, and in collaborative-based CHNAs (local public health departments and hospitals) as well.