Quality indicators for health promotion programmes

Methods for systematically following up and auditing health promotion have been in demand for a considerable period of time. Quality assurance as an auditing method has opened up new opportunities in this area. On the basis of Donabedian's 'triad' of structure, process and outcome, the theoretical preconditions for and implementation of a number of successful health promotion programmes/ projects have been analysed with regard to their common characteristics. These characteristics have been generalized and then transformed into indicators of a successful health promotion programme/project. To ensure the practical applicability of the quality indicators, they were operationalized in what we call a 'question pro-forma'. Any negative response to a question on the pro-forma indicates quality defects in a programme, and any positive response the opposite. The 'template' can be employed for both the planning and auditing for quality assurance on health promotion programmes and projects. The question pro-forma has been tested successfully on a number of programmes and projects. The results from one study are shown in the article.     

The ATS-Sardegna Campaign for cardiovascular disease prevention and health promotion

The ATS-Sardegna Campaign is a community-oriented initiative for cardiovascular disease prevention and health promotion, spreading throughout the whole island of Sardinia. The campaign was planned and is being carried out by the Centre of Cagliari, which pertains to the Italian Group for the Study of Metabolic Diseases and Atherosclerosis. The campaign is financed by the Sardinian Department of Public Health. The programme adopted both a population strategy and an individual (high-risk) strategy, and takes advantage of the experience gained by the Cagliari Centre as an Operative Unit of the Italian National Research Council. The population strategy is based on repeated educational messages in local daily newspapers and on TV networks, and through the distribution, free of charge, to all Sardinian households of an illustrated booklet that is written in a similar fashion as a car maintenance hand-book. The individual strategy relies upon general practitioners with full collaboration from the Sardinian Medical Associations, in order to involve the doctors in the promotion of preventive medicine. The ATS-Sardegna Campaign is designed in such a way as to ensure the transferability of its protocol to other Italian regions, and so to act as the first stage of a national programme.

     

Relationship between an interview-based health promotion program and cardiovascular risk factors at Japanese companies

The present study investigated the relationship between an interview-based health promotion program and cardiovascular risk factors at manufacturing companies. Excluding insufficient data and the workers who took medication prescribed by a physician in 1993, the subjects were six hundred and twenty-nine 18-55-yr-old employees who had been working at two manufacturing companies in Kyushu from 1993 to 1997. The intervention company introduced an interview-based health promotion program from 1993. The program consisted of health measuring, group education, and health interviewing all employees to help with their behavioral change. We subdivided the subjects into younger (18-34-yr-old) and older (35-55-yr-old) groups. We defined changing degree (Delta) with (the following data in 1997) minus (the initial data in 1993). With agreement of the subject companies, we compared the Delta of each item, including body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum total cholesterol (T-cho), serum aspartate aminotransaminase (AST), serum alanine aminotransferase (ALT), and serum gammaglutamyl transpeptidase (GGTP), in the intervention with that in the reference. BMI and SBP decreased significantly after the program in the under 35-yr-old intervention group. On the other hand, T-cho, AST, ALT, and GGTP decreased and HDL increased significantly after the program in the over 34-yr-old intervention group. Our results showed that the worksite health promotion had the potential to improve cardiovascular risk factors of Japanese employees.     

The promotion of health and integrated prevention of risk factors for cardiovascular diseases

Cardiovascular diseases are currently the most common causes of morbimortality worldwide. In the context of disease prevention, actions creating favorable health environments and promoting healthy choices prove fundamental. Intervention programs with a community basis have been introduced in different countries since the beginning of the 1970s, aiming to modify cardiovascular risk factors and decrease morbidity and mortality due to cardiovascular diseases. In such experiences, the importance of public policies and cardiovascular risk vigilance systems needs to be stressed, permitting a more accurate assessment of the magnitude of the problem and the development of more cost-effective actions. The scope of this bibliographical study was to describe community-geared experiences in many countries in the campaign against cardiovascular diseases through health promotion and primary prevention of risk factors, as well as to identify in Brazil the vigilance actions of the risk factors of non-transmissible chronic diseases, stressing the strategic challenges facing the Family Health Program in tackling cardiovascular diseases.     

Effects of a tailored health promotion program to reduce cardiovascular disease risk factors among middle-aged and advanced-age bus drivers

A tailored health promotion program was developed and applied to reduce cardiovascular disease risk factors among middle-aged and advanced-age bus drivers. The participants were 248 bus drivers from 2 transportation companies, in whom the authors surveyed health behaviors (physical activity, diet, smoking habit, and alcohol consumption), health status (body mass index, systolic blood pressure, triglycerides, total cholesterol, high-density lipoprotein, and low-density lipoprotein), and job stress. The tailored health promotion program consisted of exercise, diet, temperance, and smoking cessation education; the program was developed to reduce cardiovascular disease risk factors and was administered for 6 months. After the program, health behaviors, such as physical activity, dietary habits, smoking habits, and alcohol consumption, and health status indicators, such as blood pressure, had significantly improved (P < .05). The authors did not find an association between job stress and health behavior and status. This suggests that a tailored health promotion program for middle-aged and advanced-age bus drivers was effective.     

Assessing organizational support for school health promotion

The Western Australian School Health Project (WASH Project)is an intervention that encourages schools to develop comprehensivehealth promotion programs. The WASH Project works with self-selectedschool communities and uses community development strategiesto support participating schools in identifying and respondingto health concerns relevant to their students. The study reportedhere was designed to assess the impact of the WASH Project interventionon changes to a school's structural commitment to comprehensivelypromote health. School structural factors include both managementfactors, which identify a schools commitment to health promotion,and health promotion factors, which help to identify the breadthof a school's health promotion program. The study employed aquasi-experimental research design with pre-test, post-testand a control group. In this instance the WASH Project has demonstratedan ability to involve the school in health promotion to theextent that it is willing to provide both monetary and humanresources to the development of school health promotion, andto adopt policy to reinforce this change. These structural improvementsindicate that relatively modest external interventions, suchas the WASH Project, can influence the way a school operatesto increase adoption and development of comprehensive healthpromotion programs.     

Identifying primary care patients at risk for future diabetes and cardiovascular disease using electronic health records

Background  

Prevention of diabetes and coronary heart disease (CHD) is possible but identification of at-risk patients for targeting interventions is a challenge in primary care.     

Health seeking behaviours among Chinese-Australian women: implications for health promotion programmes

Preventive medicine is an important element of the Australian health care system. An essential aspect of the biomedical model of health care is screening for the early detection of disease in otherwise asymptomatic people. There is ample evidence that acceptance levels of western medicine vary and that a variety of health epistemologies and health practices coexist. To examine the extent to which Chinese-Australian women integrate western medicine practices in their health seeking behaviour, a qualitative study was conducted, which involved in-depth interviews in Cantonese with 20 women. Although adherence to western health beliefs and practices varied, in general these Chinese-Australian women sought medical help only after they felt unwell. Commonly, they first tried traditional remedies for minor diseases. Many saw no reason to participate in screening when they were asymptomatic. Direct communication with health care providers who speak the same language appears to be important to many Chinese-Australian women when seeking health care services. It is recommended that ethnic health workers should participate in screening programmes and other health promotion activities.     

Dietary intake of children at high risk for cardiovascular disease

Cardiovascular disease and obesity begin in childhood, and dietary interventions to prevent them should be initiated then. We hypothesized that children who were at high risk for cardiovascular disease based on family history would have diets that were different than those of children from low-risk families. Two hundred ninety-seven children were screened for family history of early cardiovascular disease; had height, weight, and finger-stick total cholesterol measured; and filled out food frequency questionnaires. Sixty-eight (23%) children were at risk for cardiovascular disease. Cholesterol was significantly higher compared with those not at risk (4.71+/-0.93 mmol/L vs 4.35+/-0.92 mmol/L, P=.005). Intakes of energy, fat, fiber, and cholesterol were similar between groups. Children at high risk for cardiovascular disease were no more likely to meet guidelines for heart-healthy diets than were children at low risk. Families need guidance to change dietary patterns to prevent future disease.     

Methods to persuade higher management to invest in health promotion programmes in the workplace

This study was conducted to find effective methods to persuadehigher management to invest in workplace health promotion (WHP)programmes. The study included 639 occupational health professionalsselected from the directory of the Japan Society for OccupationalHealth. A questionnaire survey was mailed to health professionalsthroughout Japan in 1992, and all respondents were asked toidentify themselves. We received 242 replies, which constituteda response rate of 38%. Eighty-one per cent of the respondentshad attempted to persuade higher management to implement a WHPprogramme. Health professionals frequently presented their caseto higher management through a safety and health committee (SHC),and advice provided at the SHC was perceived to be the mosteffective method by occupational nurses (ONs) and safety andhealth supervisors (SHSs). This method was rated second by occupationalphysicians (OPs), who thought recommendations from OPs stipulatedby the Industrial Safety and Health Law to be most effective.Statistics on medical examinations constituted the data mostfrequently used to persuade higher management, followed by reportson worksite inspections and health care plans. Nearly 90% ofOPs and 80% of ONs and SHSs felt that the above methods werefairly successful.     

Factors related to misperception of physical activity in The Netherlands and implications for health promotion programmes

With respect to health risk behaviours, many people are unaware of their own risk behaviour and regard their behaviour as more healthy than it really is. This article studied differences between people with and without misperception of their physical activity with respect to several reference points: the social comparison style of people (upward, equal and downward); the body self-image with regard to their weight [body mass index (BMI) and self-rated weight]; and linkages of physical activity with different outcome expectancies (health, appearance, weight, feeling fit, relaxation and stress relief). Results from 516 respondents (response 52%; 56% women) with a mean age of 53.7 years found that respondents who incorrectly think that their physical activity is adequate (overestimators) tend to rate their physical activity more often in comparison to others. Furthermore, overestimators and people who correctly think they exercise enough more often use downward comparison, while underestimators and people who know they exercise too little mostly use upward comparison. People who, rightly or not, think their weight is adequate or who have a lower BMI, more often assume that their physical activity is sufficient or high. People who, rightly or not, think that their physical activity is adequate more often score higher on other reasons to be physically active besides health. Increasing the accuracy of people's self-perceptions of physical activity may be important to incorporate into strategies to promote physical activity in populations at risk of inactivity.