Category: Low Income/developing Countries

Research Priorities for Adolescent Health in Low Resource Countries: A Consultation with Experts

8/19/2016

The results of a Delphi consultation with 142 experts (out of 450) is reported in the July 2016 issue of the Journal of Adolescent Health. " These experts were invited to propose research questions related to descriptive epidemiology, interventions (discovery, development/testing, and delivery/implementation), and health policy/systems; and (3) asked the experts to prioritize the research questions based on five criteria: clarity, answerability, importance or impact, implementation, and equity. Overall, the types of the top 10 research questions in each of the eight health areas included descriptive epidemiology (26%), interventions: discovery (11%), development/testing (25%), delivery (33%), and policy, health and social systems (5%). Across health areas, the top questions highlighted integration of health services, vulnerable populations, and different health platforms (such as primary care, schools, families/parents, and interactive media). The top-ranked question for adolescent health: policy, health and social systems related to platforms to reach the most vulnerable adolescents. Priority topics/questions were identified in these eight areas: Communicable diseases prevention and management, Injuries and violence, Mental health, Noncommunicable diseases management, Nutrition, Physical activity, Substance use, Adolescent health: policy, health and social systems. Read More >>
(This item is among the 5-10 highlights posted for ISHN members each week from the ISHN Member information service. Click on the web link to join this service and to support ISHN)

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Medicalization of Global Health & NCD Plan

2/19/2015

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(From the ISHN Member information service) It is always nice to find someone that agrees with you. It is also disconcerting to find that they made the point before you. Our analysis of the WHO 2013-20 action plan on NCD noted that it, and the health ministries around the world, were retreating from a population, health promotion approach to a narrow, medical strategy. Our ongoing review of journals found a similar, earlier argument in the 2014 issue of Global health Action. The author, writing in a series on the medicalization of global health, comments on the "medicalization of NCD efforts". She says "The 2011 UN Summit, WHO 25×25 targets, and support of major medical and advocacy organisations have propelled prominence of NCDs on the global health agenda. NCDs are by definition ‘diseases’ so already medicalized. But their social drivers and impacts are acknowledged, which demand a broad, whole-of-society approach. However, while both individual- and population-level targets are identified in the current NCD action plans, most recommended strategies tend towards the individualistic approach and do not address root causes of the NCD problem. These so-called population strategies risk being reduced to expectations of individual and behavioural change, which may have limited success and impact and deflect attention away from government policies or regulation of industry. Industry involvement in NCD agenda-setting props up a medicalized approach to NCDs: food and drink companies favour focus on individual choice and responsibility, and pharmaceutical and device companies favour calls for expanded access to medicines and treatment coverage. Current NCD framing creates expanded roles for physicians, healthcare workers, medicines and medical monitoring. The challenge and opportunity lie in defining priorities and developing strategies that go beyond a narrow medicalized framing of the NCD problem and its solutions". Read more>>

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Superb Application of Ecological Approach in Mexico

8/29/2014

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(From the ISHN Member information service) In our extensive monitoring of the research, we find that the now-popular "ecological approach" is more often actually applied in the "analysis" stage, identifying the complex, multiple and multi-level influences on behaviour and practice, rather than being actually used in the "action" stage, where the approach is used to organize and deliver a planned variety of interventions to affect the multiple influences. We are pleased to read the article in the August 2014 issue of International Journal of Behavioral Nutrition & Physical Activity, which reports on a superb application of the ecological approach in 15 elementary schools in Mexico. The authors report that "Thirty-two distinct intervention strategies were implemented in one setting (i.e., school) to engage four different target-groups (students, parents, school representatives, government) across two domains (Nutrition and Physical Activity). Overall, 47.5% of the strategies targeted the school infrastructure and/or personnel; 37.5% of strategies targeted a key political actor, the Public Education Secretariat while fewer strategies targeted parents (12.5%) and children (3%). More strategies were implemented in the Nutrition domain (69%) than Physical Activity (31%). The most frequently used SCT construct within both intervention domains was Reciprocal Determinism (e.g., where changes to the environment influence changes in behavior and these behavioral changes influence further changes to the environment); no significant differences were observed in the use of SCT constructs across domains. Findings provide insight into a promising combination of strategies and theoretical constructs that can be used to implement a school-based obesity prevention program. Strategies emphasized school-level infrastructure/personnel change and strong political engagement." The complete text of the article is available. A full report on the project is also available here.

A detailed description of the impact of intervention during its two year implementation is provided here. (Note: the results after two years are modest, with small changes in eating habits and some types of physical activity reported. In our view, this reflects the reality that complex, multi-intervention programs need several years in order to be embedded in the school culture as well as to interact with the local neighbourhood and parents/families. Larger, community, media and societal influences are also important. The study did not report any changes to obesity levels. This is consistent with other studies, not only of school programs, that obesity is a problem that is far more challenging than what can be affected by a single setting within the community. For schools, we should adjust our expectations of the impact of even well-delivered multiple interventions such that students are truly supported by healthy factors while in school and that they graduate with the knowledge, skills, selected attitudes, beliefs and intentions that can be reasonably expected. If an entire society is obsengenic, then we should recognize the limits of the school's influence.

The authors capture our above assessment of current efforts to implement ecological approaches as follows: " The premise underlying ecological programming is that a multilevel program is likely to be more effective than an individually focused program because it affords the opportunity to encounter the same behavioral prompts (e.g., to be more physically active) from a variety of sources (parents, teachers, coaches) in a variety of settings (home, school, community) [13]-[16]. Therefore, an intervention program that contains diverse strategies to engage several different stakeholders across a range of settings might address the health behavior in a more comprehensive way and thus yield better results than a simpler program (i.e., fewer targets, less settings). Despite its intuitive appeal and an increase in the use of ecological principles for programming to prevent childhood obesity in developed countries [17], optimal (i.e., effective, easy to implement at low cost) combinations of intervention activities to promote healthy lifestyles have yet to be identified. In addition to determining optimal combinations of intervention activities, health promotion practitioners striving to integrate ecological principles into their programs must also strive to develop programs that are theoretically informed. Challenges to theoretical integration include practitioner difficulties in operationalizing and assessing theoretical constructs [18]. The purpose of this study was to assess the integration of ecological principles and theoretical constructs in a school-based obesity prevention program that was successful in creating a supportive environment for healthy behaviors."

The conclusion to the paper notes that "The aim of this paper was to assess the integration of ecological principles and theoretical constructs involved in a successful school-based obesity prevention program in Mexico City. We sought to unpack the intervention program along intervention domains in order to develop a map of the successful intervention program. If we compare our ecological map with recommendations in the literature [15],[17],[20], we can ascertain that this intervention program was a genuine ecological effort within a single setting since it delivered a diversity of intervention strategies involving multiple targets (POL, ORG, INT, IND), across both intervention domains. The ecological mapping showed that several different targets (PE teachers, school teachers, food vendors, parents, children and the school environment) were engaged, and that these efforts are consistent with those recommended to promote behavior change and to prevent obesity in children [7],[9],[23],[37]-[39]. Overall, our findings are consistent with existing evidence that policy intervention strategies can impact different ecological levels of influence [42]. This may be especially the case for hierarchical institutions such as school systems, where decisions are made at more than one level."

The reflections offered by the researchers are also interesting. "To our knowledge, this is the first research to document the integration of ecological principles and theoretical constructs in a school-based obesity prevention program in Mexico. The deconstruction of a successful intervention program that has documented environmental and student behavior improvements provides novel information for the implementation of multifactorial interventions in school-based health promotion programs. Although there may be a variety of successful combinations of ecological strategies and theoretical constructs, our findings provide one version that can be used as a starting point to develop even more effective combinations. Within the school setting, this ecological combination of strategies emphasizes school and political targets. Moreover, the strategies in both the Nutrition and Physical Activity domains are most commonly underpinned by the theoretical construct of Reciprocal Determinism. In a context where the school environment is considered “obesogenic” and there is compelling evidence that this environment can shape children's eating and PA patterns, the current findings provide valuable insight about the types of strategies that can be leveraged to optimal effects. It is expected that these findings will be especially meaningful to inform obesity prevention programs in Mexico and in low-middle income countries where childhood obesity is an emerging problem." Read more>>

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The Evolution of School Feeding Programs: From Education to Economic Development

3/25/2014

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(An item from the ISHN Member information service) In 2013, up to $75 billion dollars was invested by the governments of 169 countries into school feeding programmes. It is estimated that for every $1 spent feeding school children, $3 are generated for the local economy. On January 22, a special meeting of global leaders in school feeding met in the UK parliament to discuss how governments are increasingly using school feeding programmes as a means to both improve educational outcomes and at the same time improve agricultural economies. The real impact that a successful HGSF programme can have was provided by keynote speaker, H.E Raul Argebesola, Governor of Osun State in Nigeria who said that since the launch of his State’s school meals programme (known as O’Meals) which feeds over 250,000 children every school day, enrolment has increased by 24%. The O’Meals programme provides employment to over 3,000 women and purchases food from over 1000 local farmers. Key resources published as part of this parliamentary event include: Rethinking school feeding executive summary, State of School Feeding Worldwide 2013 and a HGSF Working Paper Series #1
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Research Priorities for Adolescent Health in Low Resource Countries: A Consultation with Experts

Medicalization of Global Health & NCD Plan

Superb Application of Ecological Approach in Mexico

The Evolution of School Feeding Programs: From Education to Economic Development

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Research Priorities for Adolescent Health in Low Resource Countries: A Consultation with Experts

Medicalization of Global Health & NCD Plan

Superb Application of Ecological Approach in Mexico

The Evolution of School Feeding Programs: From Education to Economic Development

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Welcome to our
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