The global perspectives in the future of health promotion. Interventions in health promotion on adolescent physical activity. University of Eastern Finland, lecture 19th March 2020

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UEF // University of Eastern Finland
4312106 Globaalit näkökohdat terveyden
edistämisen tulevaisuudessa (The global
perspectives in the future of health
promotion)
Kwok Ng, PhD
Kwok.ng@uef.fi
University of Eastern Finland, Finland
University of Limerick, Ireland
@kwokwng
Interventions in health promotion on adolescent
physical activity
@kwokwng
http://s3-eu-west-1.amazonaws.com/wof-files/11996_Childhood_Obesity_Atlas_Report_ART_V2.pdf
Based on your current knowledge provide estimates of the prevalence
0% increase in
obesity by 2025
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Finland has one of the healthiest 11y olds, but
one of the least healthiest 15y olds
Shift in Overweight in Europe
27th/41 19th/41 9th/41
11y 13y 15y
@kwokwng
http://apps.who.int/iris/bitstream/handle/10665/272534/WHO-NMH-NVI-18.8-eng.pdf
Low- to Low-Middle-Income
Countries…
What about High-income-
countries, i.e. Finland/
Ireland?
$24.6 (Bertram, et al, 2018 10.1016/S0140-6736(18)30665-2)
@kwokwng
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Best Buys - Methods
Masters et al, 2017. doi:10.1136/jech-2016-208141
Health interventions; sexual health, smoking, diet, mental health, vaccines, walking.
@kwokwng
Summary
• There is a desperate need to address the NCDs, particularly for
adolescents.
• Through health promotion and legislative actions, the best
buys for combatting obesity include physical activity programs
• These apply throughout the world, with even stronger
financial returns in high income countries such as Finland and
Ireland
• In this lecture, we look at some considerations for
interventions that aim to address this
@kwokwng
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4. 18.3.20
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Multiple perspectives on health
promotion
Examples through the lens of disabilities
@kwokwng
UEF // University of Eastern Finland
The big elephant in the room
@kwokwng
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UEF // University of Eastern Finland
WHO - Family of Classifications
@kwokwng
https://www.who.int/classifications/en/
UEF // University of Eastern Finland
WHO International Classification of Functioning,
Disability and Health (ICF)
@kwokwng
Health Condition
(disorder or disease)
Body Function &
Structures
Activity Participation
Environmental
Factors
Personal Factors
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UEF // University of Eastern Finland
F-Words – Paediatrician perspective
https://www.canchild.ca/en/research-in-practice/f-words-in-childhood-disability
UEF // University of Eastern Finland
PAD model – empirical approach
Van der Ploeg, 2004. doi:10.2165/00007256-200434100-00002
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UEF // University of Eastern Finland
GSE INT
(X) FIT (Y) MVPA
0.30*** .02ns .81***
0.95***
.02*
1.93***
-.34***
Male (n=463) Total Effect: 1.27*** r2=.25
age
GSE INT
(X) FIT (Y) MVPA
0.29*** -.01ns .58***
1.01***
.06ns
2.42***
-.19**
Female (n=596)Total Effect: 1.17*** r2=.23
age
FIT – perceived fitness; GSE – Global Self-esteem; INT – PA intention; MVPA – Moderate-to-Vigorous Physical Activity
Ng et al 2014. doi:10.5507/ag.2014.019
Exploring Personal Factors
@kwokwng
UEF // University of Eastern Finland
ICF – Family perspective
@kwokwng
Health Condition
(disorder or disease)
Body Function &
Structures
Activity Participation
Environmental
Factors
Personal Factors
Kraus de Camargo, Simon, Ronen & Rosenbaum, 2018. ICF A hands on approach for clinicians and families
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UEF // University of Eastern Finland
Knowing in Part May Make a Fine Tale, but Wisdom
Comes From Seeing the Whole
UEF // University of Eastern Finland
Environmental
Enablers and
Barriers for
adapted
physical activity,
Sherrill, 2003
List the types of barriers and facilities for PA promotion from the family
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UEF // University of Eastern Finland
Environmental Barriers and Facilitators. Example
Bloemen et al, 2014 https://doi.org/10.111/dmcn.12624
UEF // University of Eastern Finland
Environmental
Enablers and
Barriers for
adapted
physical activity,
Sherrill, 2003
List major activities that link between different environments
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UEF // University of Eastern Finland
WHO Systems approach to Physical Activity Promotion
Interventions among Adolescents
@kwokwng
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Adolescent definition
Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, Patton GC. 2012.
Adolescence: a foundation for future health. The Lancet;379:1630-40.
doi:10.1016/S0140-6736(12)60072-5
@kwokwng
Conceptual framework for
adolescent health
Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, Patton GC. 2012.
Adolescence: a foundation for future health. The Lancet;379:1630-40.
doi:10.1016/S0140-6736(12)60072-5
@kwokwng
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Protective Factors through the
Lifecourse
Halfon & Hochstein. 2002. Life course health development: an integrated framework for
developing health, policy and research. Milbank Quarterly 2002; 80(3); 433-79
doi:10.111/1468-0009.00019
@kwokwng
UEF // University of Eastern Finland
Framework for intervention co-production and prototyping. a Stakeholders comprise those within or external to
the delivery setting (e.g. school-based: school teachers, head teacher, contact teacher, head of Personal, Social,
Health and Economic (PSHE) education, head of year, receptionist; national and local policy leads; parents/
guardians/ caregivers)
Hawkins, 2017. https://doi.org/10.1186/s12889-017-4695-8
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 Health Behaviour in School-aged Children study is an
international survey of adolescent health and health behaviour
in social and developmental context
 Every four years HBSC collects data on 11, 13, and 15 year olds’
health and well-being, social environments and health
behaviours.
 HBSC uses the findings at national and international levels to:
 gain new insight into young people’s health and well-being,
 understand the social determinants of health,
 and inform policy and practice to improve young people’s lives.
What is HBSC?
@kwokwng
 HBSC initiated in 1982 by three countries, shortly
afterwards adopted as a WHO collaborative study
 HBSC now includes 49 countries and regions across
Europe and North America.
 A collaborative project between national research
teams and in partnership with WHO
 Surveys conducted every 4 years using standard
international questionnaire in all countries
 latest survey in 2017/18
Health Behaviour in School-aged Children
(HBSC) study - Background
@kwokwng
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 The international standard questionnaire produced
for every survey cycle enables the collection of
common data across all participating countries and
thus enables the quantification of patterns of key
health behaviours, health indicators and contextual
variables.
 These data allow cross-national comparisons to be
made and, with successive surveys, trend data is
gathered and may be examined at both the national
and cross-national level.
A school-based survey
@kwokwng
How to measure adolescents’
socioeconomic status?
Any suggestions?
@kwokwng
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 Common metric of socioeconomic status
 Not dependent on reports of parental occupation,
education or income
 Simple items with low non-response make a scale
 Ideal for cross-national research
 Conceptually similar to common indexes of material
deprivation
Family affluence scale
@kwokwng
 Dynamic scale, items added or removed
 In 2017/18 scale comprises
 Number of cars in the family
 Unshared/shared bedroom
 Number of family holidays in past year
 Number of computers
 Number of bathrooms
 Dishwasher
 Gives a scale of 0 to 13 indicating low to high levels of family
affluence
Family affluence scale
@kwokwng
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Interpretation of FAS
Proportion of young
people taking soft
drinks daily in Armenia
is higher among those
from families with
higher affluence.
Prevalence of taking soft
drinks daily is lower
among young people
from higher-affluence
families in Scotland.
@kwokwng
 Health inequalities can be defined as differences in health
status or in the distribution of health determinants
between different population groups
 Social inequalities in health are traditionally measured by
examining differences in socioeconomic status (SES)
 Other dimensions than SES:
 gender
 ethnicity
 age
 place of residence
 disability
Dimensions of inequalities
@kwokwng
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Examples of the development of
the Irish Active School Flag
@kwokwng
UEF // University of Eastern Finland
Irish Second level Active School Flag
@kwokwng
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UEF // University of Eastern Finland
Step-by-step guide for behaviour change interventions
1. Define
problem in
behaviour
2. Select
(which?)
3. Specify
(precisely
what?)
4.
Understand
(why?)
5.
Intervention
functions
6. Behaviour
Change
Techniques
7. Mode of
delivery
8. Policy
categories
Target behaviour Design Intervention Deliver intervention
TDF
COM-B
UEF // University of Eastern Finland
ASF Report- Recommendations
✓Designated class for ASF committee
✓ASF Committee Structure
✓Appointment of ASF Committee-application
✓Completion of tasks timeline
✓Support and Feedback
✓Active School Week
✓Links with community
✓Survey
✓Regular ASF updates-staff and students
✓Length of Process
✓Training for ASF committee
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UEF // University of Eastern Finland
@kwokwng
Pilot Focus
groups
SLR
Focus Groups
pilot ASF
schools
(April/May)
Engagement with ASF working group
Inform design of updated pilot
programme
ASF Report
Feasibility
Study
(2018/2019)
Questions and close
Kwok.ng@uef.fi
Kwok.ng@ul.ie
@kwokwng
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