Benjamin John Smith

Vitamin D supplementation to reduce depression in adults: Meta-analysis of randomized controlled trials

OBJECTIVES The aim of this study was to estimate the weighted mean effect of vitamin D supplementation in reducing depressive symptoms among individuals aged ≥18 y diagnosed with depression or depressive symptoms. METHODS A meta-analysis of randomized controlled trials (RCTs) in which vitamin D supplementation was used to reduce depression or depressive symptoms was conducted. Databases MEDLINE, EMBASE, psych INFO, CINAHL plus, and the Cochrane library were searched from inception to August 2013 for all publications on vitamin D and depression regardless of language. The search was further updated to May 2014 to include newer studies being published. Studies involving individuals aged ≥18 y who were diagnosed with depressive disorder based on both the Diagnostic and Statistical Manual of Mental Disorders or other symptom checklist for depression were included. Meta-analysis was performed using random effects model due to differences between the individual RCTs. RESULTS The analysis included nine trials with a total of 4923 participants. No significant reduction in depression was seen after vitamin D supplementation (standardized mean difference = 0.28; 95% confidence interval, -0.14 to 0.69; P = 0.19); however, most of the studies focused on individuals with low levels of depression and sufficient serum vitamin D at baseline. The studies included used different vitamin D doses with a varying degree of intervention duration. CONCLUSIONS Future RCTs examining the effect of vitamin D supplementation among individuals who are both depressed and vitamin D deficient are needed.

Identifying important and feasible policies and actions for health at community sports clubs: A consensus-generating approach

OBJECTIVES Childrens high participation in organised sport in Australia makes sport an ideal setting for health promotion. This study aimed to generate consensus on priority health promotion objectives for community sports clubs, based on informed expert judgements. DESIGN Delphi survey using three structured questionnaires. METHODS Forty-six health promotion, nutrition, physical activity and sport management/delivery professionals were approached to participate in the survey. Questionnaires used an iterative process to determine aspects of sports clubs deemed necessary for developing healthy sporting environments for children. Initially, participants were provided with a list of potential standards for a range of health promotion areas and asked to rate standards based on their importance and feasibility, and any barriers to implementation. Subsequently, participants were provided with information that summarised ratings for each standard to indicate convergence of the group, and asked to review and potentially revise their responses where they diverged. In a third round, participants ranked confirmed standards by priority. RESULTS 26 professionals completed round 1, 21 completed round 2, and 18 completed round 3. The highest ranked standards related to responsible alcohol practices, availability of healthy food and drinks at sports canteens, smoke-free club facilities, restricting the sale and consumption of alcohol during junior sporting activities, and restricting unhealthy food and beverage company sponsorship. CONCLUSIONS Identifying and prioritising health promotion areas that are relevant to childrens sports clubs assists in focusing public health efforts and may guide future engagement of sports clubs. Approaches for providing informational and financial support to clubs to operationalise these standards are proposed.

Organizational change theory: implications for health promotion practice

Sophisticated understandings of organizational dynamics and processes of organizational change are crucial for the development and success of health promotion initiatives. Theory has a valuable contribution to make in understanding organizational change, for identifying influential factors that should be the focus of change efforts and for selecting the strategies that can be applied to promote change. This article reviews select organizational change models to identify the most pertinent insights for health promotion practitioners. Theoretically derived considerations for practitioners who seek to foster organizational change include the extent to which the initiative is modifiable to fit with the internal context; the amount of time that is allocated to truly institutionalize change; the ability of the agents of change to build short-term success deliberately into their implementation plan; whether or not the shared group experience of action for change is positive or negative and the degree to which agencies that are the intended recipients of change are resourced to focus on internal factors. In reviewing theories of organizational change, the article also addresses strategies for facilitating the adoption of key theoretical insights into the design and implementation of health promotion initiatives in diverse organizational settings. If nothing else, aligning health promotion with organizational change theory promises insights into what it is that health promoters do and the time that it can take to do it effectively.

The correlates of chronic disease-related health literacy and its components among men: a systematic review

BackgroundChronic diseases drive the burden of disease in many societies, particularly among men. Lifestyle behaviours are strongly associated with chronic disease development, and in a number of countries men tend to engage in more risky behaviours, and have lower health knowledge and attention to prevention, than women. This study investigated the correlates of men’s health literacy and its components about major lifestyle-related diseases, namely ischaemic heart disease and type 2 diabetes mellitus, to gain evidence to guide the development of policy and programs to improve men’s health.MethodsA systematic review was undertaken of observational studies that investigated men’s health literacy and its components related to ischaemic heart disease or type 2 diabetes mellitus, and their associated risk factors. The Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Embase and the Cochrane Library databases were searched for articles published since 2003. The strength of the evidence was rated using the GRADE approach.ResultsAfter screening and review of 504 articles, the search elicited nine studies for inclusion: only one study examined health literacy (nutrition literacy). The majority of included studies focused on only one component of health literacy, namely knowledge (n = 7) and personal skills (confidence) (n = 1). Twenty correlates were identified, primarily relating to the knowledge component, with the strength of the evidence for only one correlate, education, graded as being of moderate quality. The evidence for all other correlates was graded as being of low quality.ConclusionsThe limited body of research identified may have resulted from a lack of consensus about the definition of health literacy, and a concordant set of validated health literacy measures. Despite these limitations, broadening the search to include components of health literacy has identified that several factors are associated with men’s knowledge and awareness of ischaemic heart disease and type 2 diabetes mellitus that will assist in the development of men’s health promotion strategies. However, addressing the broader knowledge gaps and controversy in the health literacy field will deliver policy and program benefits to address these major contributors to the burden of disease among men.

Exploring the partnership networks of churches and church-affiliated organisations in health promotion

Health promotion professionals often work with community organisations and voluntary associations, including churches and church-affiliated organisations, to reduce health inequities within communities. How voluntary and church-affiliated organisations form intersectoral relationships and partnerships, and the challenges they face in doing so, has been well researched. However, there is a need to investigate further the extent to which local churches collaborate or form partnerships with other actors, such as government, peak bodies and welfare organisations. This paper reports a Victorian-based mapping exercise of partnerships and funding involving document analysis of the annual reports from 126 organisations and 35 interviews conducted with church-affiliated organisations and local churches. The discussion begins with the exploration of the nature of, and the reason why churches partner with other sectors. The paper also examines funding sources and partnership pathways that churches access to undertake the activities and programs they conduct. Interview themes highlight the value to churches of the sharing of expertise and resources, the provision of support to communities, a shared ethos of social justice and the empowerment of vulnerable populations. The findings about the extent to which local churches are involved in partnerships across society, and the extent of public and private funds they draw on to provide resources and assistance to local communities, indicate that churches are now a key player not just in welfare provision but also in health promotion activities. The findings contribute to the understanding of church activities in relation to health promotion and will assist organisations who may be potential partners to consider their collaborative efforts in the health promotion field.

Historical overview of church involvement in health and wellbeing in Australia: implications for health promotion partnerships

Health promotion practice requires partnerships with different sectors of society and at all levels of government to achieve health equity as the prerequisites for health include domains that exist outside of the health sphere. Therefore existing partnerships for health need to be strengthened and the potential for new partnerships must be considered in order to address health holistically. The literature base exploring the church as a partner and setting for health promotion is predominantly from the US and therefore there is a need for research exploring the opportunities and challenges of partnering with churches in the Australian context. This paper presents an historical overview of the involvement of churches and church affiliated organisations in health and welfare in Australia recognising that while some of the values, practices and beliefs of churches may have considerable synergies with health promotion, others may be sources of contention or difference.

Community understanding of the preventability of major health conditions as a measure of health literacy

Objective To examine health literacy in a rural community by measuring the understanding of the preventable nature of six major health conditions. Design Cross-sectional population survey. Setting New housing areas of Strathfieldsaye, Victoria. Participants A total of 197 adults aged 18 years or older. Main outcome measures Perceived preventability of skin cancer, lung cancer, cervical cancer, high blood pressure, heart attack and diabetes. Results Skin cancer was the only condition which most people perceived as being all or mostly preventable (50.3%). Lung cancer was perceived to be all or mostly preventable by 35.5% of respondents, high blood pressure by 34.0%, cervical cancer by 27.4%, diabetes by 25.4% and heart attack by only 14.7%. Conclusions This study shows that there is a lack of understanding of the preventability of these health conditions. Efforts need to be directed towards improving the publics knowledge of disease prevention and to ensure that health promotion programs reach populations with the most need.OBJECTIVE To examine health literacy in a rural community by measuring the understanding of the preventable nature of six major health conditions. DESIGN Cross-sectional population survey. SETTING New housing areas of Strathfieldsaye, Victoria. PARTICIPANTS A total of 197 adults aged 18 years or older. MAIN OUTCOME MEASURES Perceived preventability of skin cancer, lung cancer, cervical cancer, high blood pressure, heart attack and diabetes. RESULTS Skin cancer was the only condition which most people perceived as being all or mostly preventable (50.3%). Lung cancer was perceived to be all or mostly preventable by 35.5% of respondents, high blood pressure by 34.0%, cervical cancer by 27.4%, diabetes by 25.4% and heart attack by only 14.7%. CONCLUSIONS This study shows that there is a lack of understanding of the preventability of these health conditions. Efforts need to be directed towards improving the publics knowledge of disease prevention and to ensure that health promotion programs reach populations with the most need.

Overcoming disparities in organized physical activity: findings from Australian community strategies

Organized physical activity through sport and recreational activities is beneficial for physical and psychosocial well-being and community connectedness. However, many who could gain significantly from this have lower participation, especially the socioeconomically disadvantaged, Indigenous people, culturally diverse communities and people with a disability. This study examined barriers to participation by these underserved groups and the success of strategies for overcoming these used in 22 community projects over 3 years in the VicHealth Participation in Community Sport and Recreation Program, in Victoria, Australia. Each year, in-depth interviews were undertaken with 50-60 activity providers and 30-40 project partners. Major barriers to participation were cost, lack of transport, cultural differences, the environment of sporting groups and inaccessible facilities for people with disabilities. Projects that overcame these selected one or two priority groups, put significant effort into communication and building partnerships with community organizations, provided training to staff and volunteers and created new or modified forms of activity. Strategies were put in place to reduce cost and provide transport, but these did not appear to be sustainable. Many organizations found engaging the underserved was more difficult than anticipated and require information and support about how to develop acceptable, accessible and flexible opportunities for disadvantaged groups. Cost and lack of transport are persistent barriers to participation that need to be addressed by the sport and recreation sector and policy-makers.

The MOVE study: a study protocol for a randomised controlled trial assessing interventions to maximise attendance at physical activity facilities

BackgroundPhysical activity is associated with a host of health benefits, yet many individuals do not perform sufficient physical activity to realise these benefits. One approach to rectifying this situation is through modifying the built environment to make it more conducive to physical activity, such as by building walking tracks or recreational physical activity facilities. Often, however, modifications to the built environment are not connected to efforts aimed at encouraging their use. The purpose of the Monitoring and Observing the Value of Exercise (MOVE) study is to evaluate the effectiveness of two interventions designed to encourage the ongoing use of a new, multi-purpose, community-based physical activity facility.Methods/designA two-year, randomised controlled trial with yearly survey points (baseline, 12 months follow-up, 24 months follow-up) will be conducted among 1,300 physically inactive adult participants aged 18–70 years. Participants will be randomly assigned to one of three groups: control, intervention 1 (attendance incentives), or intervention 2 (attendance incentives and tailored support following a model based on customer relationship management). Primary outcome measures will include facility usage, physical activity participation, mental and physical wellbeing, community connectedness, social capital, friendship, and social support. Secondary outcome measures will include stages of change for facility usage and social cognitive decision-making variables.DiscussionThis study will assess whether customer relationship management systems, a tool commonly used in commercial marketing settings, can encourage the ongoing use of a physical activity facility. Findings may also indicate the population segments among which the use of such systems are most effective, as well as their cost-effectiveness.Trial registrationAustralian New Zealand Clinical Trials Registry: ACTRN12615000012572 (registered 9 January 2015).