Design Secondary analysis of student responses to a task called ‘Being Healthy’ in New Zealand’s National Education Monitoring Project.

Setting Year 4 (8—9 year-old) and Year 8 (12—13 year-old) students who took part in New Zealand’s National Education Monitoring for Health and Physical Education in 2002.

Method Coding of student responses using NVivo qualitative analysis package.

Results Students reiterated messages widely promulgated in popular and professional mediums. Students predominantly conceived of health as a corporeal matter, citing eating, exercise and hygiene practices as the most important health promoting behaviours.

Conclusion Students could usefully be encouraged to adopt socially critical understandings of what health might entail and broader, more holistic conceptualizations of health beyond matters of the ‘body’ alone.

Design Video recordings of consultations between 113 final-year medical students and simulated patients were scored blind by two independent raters with the Motivational Interviewing Skill Code (MISC). Half of the students participated in a four-hour motivational interviewing workshop while the other half did not.

Results Differences between the two groups were statistically significant for five of six global MISC variables. All differences were in the expected direction, with higher scores in the group that had received MI training. There were also statistically significant group differences in the expected direction on several behavioural measures. The group that received MI training asked fewer closed questions and more open questions; they summarized, affirmed and emphasized patient control more often, and directed and confronted less often.

Conclusion Four hours of training has a measurable effect on medical students’ style and verbal behaviour in simulated patient consultations, but is not sufficient to become proficient in motivational interviewing.

Design Longitudinal, pre-intervention and intervention assessments occurred between 2004 and 2006.

Setting Recruitment of 10,433 people from ten sites located in areas of high health need across England.

Method Demographic data were collected by questionnaire, with seven-day, population-specific self-reports assessing pre-intervention and intervention MPA. Using guidelines for young people and adults, MPA MET-minutes/week were used to assign participants to four MPA categories (sedentary, lightly, moderately and highly active) at pre-intervention and intervention phases. Cross-tabulation established movement between three change categories (reversal, stability and progression).

Results From nine sites, 5324 people engaged in the evaluation, and a sub-sample of 998 provided demographic and 1022 self-report baseline and intervention data (i.e. completers) for a typical week’s physical activity participation. Of completers who were sedentary or lightly active at pre-intervention, 58.5 per cent achieved recommended physical activity guidelines. 80.9 per cent who were sedentary at pre-intervention reported as lightly, moderately or highly active at intervention. Conclusions Completers increased overall activity levels, including those sedentary and lightly active at pre-intervention who increased levels to recommended guidelines.

Design Data for the study were generated from one-to-one qualitative interviews which encouraged the participants to articulate the symbolic value of eating choices in their day-to-day experiences.

Participants Twenty five young people (12 male, 13 female) aged between 15 and 17 years from diverse socio-economic backgrounds living in different parts of the urban area of Nicosia were recruited using a snowballing technique.

Analysis The analysis focused on the division between ‘healthy’ and ‘fast’ foods.

Results This study discloses the way that a group of young Cypriots make sense of, and articulate, ‘fast’ and ‘healthy’ foods as consumer eating choices. The analysis demonstrates how ‘fast’ and ‘healthy’ eating choices entail a symbolic value which the participants claimed had significance and meaning in young people’s lifestyles. Eating fast foods was primarily seen as a medium for expressing a youthful self and/or lifestyle image, while choosing healthy food was viewed as being in opposition to the normal image of being young.

Conclusions and implications This article challenges the one-dimensional approach of the ‘nutrition value of foods’ approach for convincing young people to choose healthy foods and strongly suggests the need to provide them with opportunities to become aware of and critical about the symbolic value of eating choices.

Design Qualitative study.

Setting Perth, Western Australia.

Methods Sixteen adults aged 65 to 74 years were interviewed in their own homes using a semi-structured interview schedule. Data were analysed using a descriptive qualitative methodology.

Results Participants believed that physical activity provided health benefits and reflected positively on physical activity experiences when they were younger, with many expressing a desire to engage in less age-appropriate activities. The major barrier to physical activity was pain. Participants described both positive and negative examples related to society’s support of physical activity.

Conclusions A number of issues were raised. These included: the need for more specific information on the benefits of physical activity; the role of pain management in physical activity; the concept that involvement in physical activity in younger years leads to involvement when older; and the expressed desire of older people to engage in less age-appropriate physical activities.

Design Qualitative research methods were used based on a grounded theory approach, to provide insights into older adults’ experiences following a fall, of both rehabilitation and home exercise.

Setting Community dwellings.

Method Nine participants who had been through falls rehabilitation and who were over 60 years old were recruited through health professionals. Participants had attended one of three different rehabilitation centres, or were under the care of the Specialist Case Manager for Elderly, Frail and Falls who sees clients with more complex needs.

Results Thekeyfactorcausingolderpeopletocarryouttheirhomeexercise programme is a determination to regain independence following illness and a fall. However, social interaction has a key role to play in this strive for independence through supporting the continuation of home exercise. Interview data reveal that relationships with professionals, families and friends (the existence of social networks) during and after the rehabilitation process can impact on uptake and continuation of exercise.

Conclusion A grounded theory approach to research with older people can be a useful tool for informing health promotion workers and other health professionals in practice. This study helps us to acknowledge that from an older adult’s perspective, independence is highly valued, and encourages us to consider how we can then adopt this as a motivator for participation in healthy, active ageing. When working with older people, professionals need to adopt a holistic approach to their health, using a person-centred approach to promote positive, active ageing.

Design This was a cross-sectional case study that involved an in-depth examination of the food choice process and knowledge of a child in the pre-operations stage and a child in the concrete operations stage as defined by Piaget.

Setting This study took place in New York City.

Methods The five general questions on health and nutrition which were posed to each child were: Why do we need to eat? What makes some foods healthy or unhealthy? Can some foods be healthy and unhealthy at the same time? Where do certain foods come from? Why is it important to eat in moderation? The responses to these questions were analyzed from both cognitive and health education perspectives. In addition to being asked questions about nutrition, each in-depth interview included an activity in which the children were given a stack of pictures of foods and were asked to classify them as being healthy or unhealthy.

Results Thelevelofknowledgeandthoughtprocessaboutfoodofachild in the pre-operations stage and a child in the concrete operations stage exhibit several significant differences that are characteristic of Piaget’s stages of cognitive development. Specifically, the depth of knowledge, the use of symbolic thinking, and the abilities to think bi-directionally and systematically, and to view issues from multiple perspectives vary between the two stages.

Conclusion Many of the predictions about how the children would react to certain questions given their age appear to be consistent with the early writings of Piaget. The main implications of these findings could help health educators who focus on nutrition to tailor their educational programmes according to the cognitive abilities defined by Piaget, and reinforced by our findings.

Design A cross-sectional survey.

Setting College students at a major Midwestern university.

Methods Students were recruited to complete a self-administered questionnaire that included information on sun-sensitivity, knowledge and tanning attitudes and behaviours. Survey sampling statistical techniques that account for clustering among the 163 students recruited were used.

Results We found a high level of skin cancer prevention knowledge; however, knowledge was not related to a reduction in the importance of tanning. In many cases, higher levels of knowledge corresponded to a greater emphasis on the importance of tanning. Sunscreen use was low among this population. Those who placed an importance on tanning more often indicated that they believed that ‘sunless tanning creams are safer than the sun’.

Conclusions This population’s belief that they look healthier and feel better with a tan strongly influences the desire to tan. Therefore, future cancer information campaigns or other prevention efforts should directly address the desire to tan by encouraging the use of sunless tanning products as an alternative method of tanning.

Design An exploratory cross-sectional design using in-depth interviews and focus group discussions was used.

Setting Two case study NGOs that heavily rely on volunteers as health educators were selected in a rural district in eastern Uganda.

Method Focus group discussions and observation of health education sessions were conducted, as well as in-depth interviews with volunteers and staff of the selected NGOs.

Results The NGOs were enthusiastic about the role of volunteers in health education and regarded them positively. However, the process of recruitment was informal. Orientation of the volunteers was insufficient and rather unsystematic. A minimal focus was placed on methods of conducting health education during the training of the volunteers, suggesting a failure to view health education as a professional field. This left the practice of health education at the mercy of the volunteers' own less reflective self-designed pedagogical approach.

Conclusion While there is a high enthusiasm for the potential role of volunteers, by both the NGOs and the community, their preparation for health education so far does not measure up to the demands of the tasks they are to perform. The limited emphasis on skills in planning, organizing and methods of health education leaves the practice of health education haphazard and indicates failure to view the area as a professional field.

Design Baseline data from a three-year longitudinal study.

Setting A purposive sample of 307 school children aged 7 to 15 years were recruited from three schools representing various socio-economic status (SES).

Method An interviewer-administered questionnaire was used to obtain information from children on their general dietary habits, perceptions on meaning of healthy eating, healthy and unhealthy foods and perceived health consequences of consuming unhealthy foods. Content analysis of the data was performed.

Results Children's views on the meaning of healthy eating centred around seven concepts. In older children, those with mothers with higher educational levels and normal/underweight children, perception of meaning of healthy eating was largely based on diet composition. Listings of healthy foods varied based on age group, gender and mother's educational level, while that of unhealthy foods was related to age group and SES. This knowledge, however, did not translate into eating choices, with no differences in intake of fried foods/snacks, aerated drinks, fast foods, sweets and chocolates evident across age groups, gender, SES and mother's educational level. Children from families with a history of chronic disease had an increased awareness (p < 0.001) of links between unhealthy eating and chronic disease, although intakes did not differ from those children without a family history of chronic disease. Conclusion A concerted effort is required to translate the knowledge of children into positive behaviour change towards healthy eating.

Design A six-week smoking cessation programme was delivered to 12—23 year olds in various youth venues, using weekly records of attendance and compulsory questionnaires delivered by the group facilitator at week one and week six.

Setting Twenty-two groups were delivered in 14 youth settings across Cardiff. These settings were categorized into three types: schools/ colleges; youth centres; and specialist youth provisions.

Method Data collected from 179 young people at week one and 84 young people at week six were used to measure changes in weekly smoking behaviour, weekly expenditure on cigarettes, knowledge about smoking and smoking cessation, attitudes toward smoking, motivation to quit/ cut down, and attrition. These were compared across the three different setting types. Youth Health Development Officers rated the three setting types on five factors (ease of access/communication with venue; suitability for sessions/acceptability to young people; supportiveness of environment for making a quit attempt; recruitment of young people; and data collection and evaluation) to reflect their practical experiences of delivering the six-week smoking cessation programme across the different youth settings.

Results Schools/colleges and specialist youth provision had the highest levels of attendance, and positive change in attitude toward quitting was greatest in specialist youth settings (79 per cent of attendees were more determined to quit).

Conclusion Overall, when both practical delivery issues and young peoples' outcome measures were considered, specialist youth provisions were the most effective settings for delivery of this programme. Delivery of smoking awareness as part of a wider health curriculum for groups of excluded young people is also recommended.

Study design Dental patients (n = 279) who had either been exposed to dental treatments or had no prior dental exposure, attending four selected dental clinics in Accra were randomly sampled. They were interviewed with the Modified Dental Anxiety Scale (MDAS) used to evaluate dental anxiety, and the Dental Fear Survey (DFS) used to measure dental fear among the respondents.

Results A high level of dental anxiety was found in 13.6 per cent of the study sample, while 47.3 per cent were fearful of various dental treatments. Female patients recorded a higher DFS score than males (22.84 ± 9.87 and 19.7 ± 8.15 respectively). The MDAS showed a significant difference between the sexes (X² = 6.912, p = 0.032). The DFS showed a significant difference (F = 2.56, p = 0.039) existing within the age group, with the younger age group showing the highest DFS value. There was no significant difference between the mean scores of the MDAS and the DFS of the study group with regard to educational level. Previous dental experience did not have any impact on fear or anxiety levels (p > 0.05)

Conclusions Dental anxiety and fear has been found to be high amongst dental patients in Ghana. Females are more likely to report higher dental anxiety and fear scores than males. Dental surgeons and the whole dental team should be made aware of this situation and the appropriate treatment plan created for an anxious or fearful patient.

Design Qualitative focus group study.

Setting Two Early Head Start programme sites in a Midwestern state which serve low income families.

Method Twenty-seven low-income African American mothers took part in two focus groups which were conducted by a facilitator, according to a semi-structured topic guide. Focus group data were supplemented with demographic family data.

Results Four major themes emerged: (1) maternal perceptions of healthy toddlers, (2) maternal food choices for toddlers, (3) maternal expectations about toddler autonomy and self-regulation of feeding, and (4) mealtime context and interaction.

Conclusions and implications Data provided examples of maternal expectations and experiences, suggesting the development of healthy feeding patterns among some toddlers and provided evidence of less healthy feeding patterns in others. Evidence of less healthy feeding patterns included limiting toddler autonomy and food regulation, and misinterpretation of normative toddler behaviours. Because parenting practices and perceptions have been reported to contribute to social and environmental influences of obesity, this research could aid development of culturally sensitive nutrition education interventions.

Design Four focus groups were run involving 36 COPD patients, facilitated by two researchers. Tape recordings were transcribed and emergent grouped themes identified.

Setting Four locations across the UK.

Results Of the three service areas considered, two (NIV and early discharge) were unknown to the majority of patients despite their strong evidence base and national recommendations for implementation. Where patients were familiar with a service they made consistent and useful recommendations for improving care. Those recently hospitalized reported insufficient information provision for them to make personal informed choices about key management interventions.

Conclusion Patients have important views on services with which they are familiar and if consulted can significantly contribute to their development. This report has identified a lack of knowledge amongst the majority of patients consulted about recent key NHS medical and service developments. At a group level this impairs the contributions that patients may make to forming service profiles. At an individual level, lack of prior knowledge places patients in a vulnerable position when admitted to hospital and asked to make informed decisions about their care.

Setting One large urban public secondary school, local authorities and external partners.

Methods A single case study, adopting an ethnographic approach, sought to record and explore the reality of partnerships at school level. Multilevel sampling was employed to extract one secondary school as a site for `good practice'. Individual interviews, focus groups, observation and document analysis were used to build this case study of applied partnerships. Grounded theory coding and thematic analysis identified themes associated with the idea of partnerships through the corpus of textual data (verbal and written).

Results (a) The key professional in the coordinating mechanism (local authorities) lacked sufficient support. (b) Voluntary collaborations alleviate the gaps in human resources. (c) Parents' engagement was marginal. (d) Top-down imposed partnerships did not work effectively. (e) `Social' health promoters were dismissed in favour of `biomedical' partners.

Conclusions Overall an explicit trend of failure in the process of building partnerships was shown in terms of this case of SHE curriculum implementation. To explain this trend, it is necessary to engage in attempts to understand the culture and context of the case.

Design The ASSIST intervention involved influential Year 8 students being trained to encourage their peers, through informal conversations, to be smoke-free. Its effectiveness was evaluated by a pragmatic randomized controlled trial with an integral process evaluation to examine the context, implementation and receipt of the intervention.

Setting Thirty secondary schools in South Wales and the west of England.

Method A variety of methods, including interviews, questionnaires and observation, were used to obtain data from key participants. Qualitative data were analysed using the constant comparative method.

Results Whilst overall fidelity was high, some variations were observed. Despite this variation, the intervention was largely delivered successfully and appropriately across a range of schools. Lessons learned from ASSIST enabled us to develop a model to categorize variations in intervention delivery.

Conclusion The model developed can inform the design of health promotion interventions and identify the level of fidelity which should be expected outside of a trial. We believe that this model can contribute to good practice in the implementation of evidence-based health promotion in schools.

Design An exploratory case study design with two groups of students.

Setting and Method Thirty-eight students, enrolled in intermediate Spanish IV and advanced Spanish V language classes, completed the exercise as part of their class work.

Results The students' mean age was 16.3 years with a gender distribution of 32 females, 13 of whom were horseback riders, and six male non-riders. Only six of the 13 female riders reported wearing a helmet at least half the time, and four never wore a helmet. The Spanish V students (11 of whom were riders) scored significantly higher (p <0.05) on four of the five exercise items than the Spanish IV students (two of whom were riders). However, the groups did not differ and scored low (55.3 per cent) on an item that involved recognizing pre-event contributors to the injury event. Students with riding experience scored significantly higher than non-riders (p <0.05) in recognizing that donning a helmet prior to riding is the most effective way to prevent a head injury. Although students believed that wearing a helmet could prevent brain injuries, they did not think they were at risk.

Conclusion The exercise was successfully integrated into both classes. Discussing its vocabulary and sentence structure prior to its administration would improve its effectiveness.

Design This study used a qualitative descriptive paradigm. Participants were required to participate in a one-hour, tape-recorded, semi-structured interview. Data obtained were then coded and analysed using thematic analysis.

Method A convenience sample of six young women participated in the study. Participants were all in their early twenties, with most being 21 years of age. All were university students who were studying a range of courses.

Results The young women had very low levels of knowledge and understanding about breast cancer. Although they identified it was a serious illness, they were not aware of much else about the disease except for treatments. They could only identify two main risk factors, age and family history, and believed in common myths such as getting hit in the breast causing breast cancer. Overall, they did not feel that breast cancer was something that they needed to be concerned about, although they did perceive the need for more age appropriate breast health information to be made available to young women.

Conclusions All women need to be educated about breast cancer and to learn early intervention techniques such as breast self examination at an early age. Lack of knowledge about breast cancer and breast cancer risk may lead to inaccurate perceptions of the disease and a lack of utilization of early detection techniques. Low levels of knowledge and a lack of perceived risk coupled with the inundation of breast cancer information that focuses on older women reinforces the belief that young women are not at risk and do not need to be aware of breast cancer. Furthermore, these data strongly support the need for breast health and breast cancer education in young women.

Design A cross-sectional survey on Disparities in Quality of Health Care that disproportionately sampled minority groups but was designed to generalize to the US adult population.

Methods Bivariate and multivariate regression techniques are used. Logistic regression models estimate the effects of health status, access to and patient satisfaction with conventional care on utilization of CAM therapies whilst adjusting for socio-economic factors that impact health.

Results An estimated 34.4 per cent of US adults used at least one of four CAM therapies in the two years prior to the survey. Although CAM use was higher among those who perceived themselves to be in excellent or very good health relative to those in fair or poor health, the difference was not statistically significant after adjustments were made. The results, however, showed that those who lacked access to conventional care due to cost and those who had lower satisfaction with the quality of conventional care were more likely to use CAM.

Conclusions Estimates of CAM use in this sample are relatively low but consistent with large national surveys that over-sampled minorities. The article highlights the need to include quality of care when defining satisfaction with conventional health care and reinforces findings that cost of conventional care increases the use of CAM. Implications for the integration of CAM into the health care system are discussed.

Design A triangulation survey approach using questionnaires, in-depth interviews and focus groups was undertaken with a range of organizations and professionals currently providing sexual health services within the area.

Setting The southern area of Northern Ireland, which is rural in nature and has a higher percentage of young people under 20 years old compared to the rest of the region and a rising rate of sexually transmitted infections.

Method 48 organizations known or perceived to provide sexual health services to young people in the area were surveyed. In-depth interviews were held with 22 key informants who worked within social services and the youth sector, and four focus groups were held with nursing professionals who directly supported young people in relation to their sexual health.

Results The results highlighted specific training and development needs at a range of levels. These included basic sexual health skills training which was identified as a need for a wide variety of staff across all sectors. In addition, specific/specialist training in sexual health was identified as a need for key professionals who work with vulnerable groups of young people.

Objective To systematically review the literature for definitions of literacy and health literacy as related to patient access, use, and comprehension of cancer prevention and treatment education.

Methods Original research articles written from 1992 to 2006 inclusive with the terms health literacy and/or literacy in the title, abstract or key words and explicitly linked to cancer information were found by searching MEDLINE, PsycINFO, CSA Sociological Abstracts, Social Sciences Citation Index, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).

Results A final sample of 78 studies was included in this review. Fortyfive articles mentioned literacy, seven were on health literacy, and 26 discussed both literacy and health literacy. Only 15 articles (19.2 per cent) defined literacy and/or health literacy.

Conclusion This systematic review indicates that definitions of literacy and health literacy are not being used consistently in the cancer education literature. Best practice definitions of literacy and health literacy are important, especially when screening individuals for their understanding of cancer prevention and treatment information.

Design This study involved a quasi-experimental design and students (N = 116) were assigned to an intervention group (n = 50) or a comparison group (n = 66) for a period of eight weeks.

Setting Three secondary schools (grades 7—12) in New South Wales (NSW), Australia were involved in the study.

Method At baseline and immediately following the intervention, students wore pedometers for four consecutive days and completed questionnaires assessing potential determinants of physical activity. At baseline, participants were classified using existing step recommendations, as low-active (girls < 11,000, boys < 13,000) or active (girls ≥ 11,000, boys ≥ 13,000) and the effects of the intervention on potential determinants were assessed using these subgroups. Subgroups were compared at baseline using independent samples t-tests and intervention effects were compared at post-test using linear regression (controlling for baseline measures).

Results Although the intervention had a statistically significant effect on physical activity among individuals classified as low-active at baseline, the intervention did not impact upon potential determinants of physical activity.

Conclusion Short-term changes in physical activity identified in the LEAF intervention were not mediated by changes in hypothesized determinants.