Bronwyn McGill

Improving health literacy in community populations: a review of progress.

Governments around the world have adopted national policies and programs to improve health literacy. This paper examines progress in the development of evidence to support these policies from interventions to improve health literacy among community populations. Our review found only a limited number of studies (n=7) that met the criteria for inclusion, with many more influenced by the concept of health literacy but not using it in the design and evaluation. Those included were diverse in setting, population and intended outcomes. All included educational strategies to develop functional health literacy, and a majority designed to improve interactive or critical health literacy skills. Several papers were excluded because they described a protocol for an intervention, but not results, indicating that our review may be early in a cycle of activity in community intervention research. The review methodology may not have captured all relevant studies, but it provides a clear message that the academic interest and attractive rhetoric surrounding health literacy needs to be tested more systematically through intervention experimentation in a wide range of populations using valid and reliable measurement tools. The distinctive influence of the concept of health literacy on the purpose and methodologies of health education and communication is not reflected in many reported interventions at present. Evidence to support the implementation of national policies and programs, and the intervention tools required by community practitioners are not emerging as quickly as needed. This should be addressed as a matter of priority by research funding agencies.

Overselling Sit-Stand Desks: News Coverage of Workplace Sitting Guidelines

ABSTRACT The first quantitative, specific recommendations for sitting time at work were released in June 2015. This paper examines the implications of news coverage received by this position statement. Media reports about statement published May, 31–June, 29, 2015 were analyzed according to five recommendations and three caveats extracted from the guidelines’ press release. Information about how physical activity was framed and mentions of conflicts of interest were recorded. Of 58 news reports, nine reported all five recommendations in the position paper. The topline recommendation (two hours daily of standing and light activity) was reported in all articles. Alleviating musculoskeletal discomfort by sitting less was not reported by 72% of reports. Physical activity was mentioned in 32 reports: 69% said physical activity did not attenuate the risks of prolonged sitting. No reports mentioned any potential conflicts of interest despite co-author links to sit-stand desk industry. These results demonstrate the need to balance public and market demands for public health guidance around sitting; and could encourage more accurate communication of research outcomes. The physical activity component of the “move more and sit less” message requires greater efforts to raise its public salience.

Preventive health coaching: is there room to be more prescriptive?

Abstract Objectives: Health coaching is gaining prominence in chronic diseases management, treatment adherence and more recently, in the area of preventive health. In Australia, the Get Healthy Information and Coaching Service (GHS) is a preventive health coaching service with demonstrated outcome effectiveness. The purpose of this study was to determine the effectiveness of the process of health coaching. Design: The study (n = 61) involved analysis of audio recordings of coaching calls at time points during the six-month coaching program. A coaching call review instrument was developed specifically to assess: goal setting, relationship building, information exchange and education, behavioral modification techniques, emotional management, and GHS content-specific information. Methods: Two reviewers were randomly assigned to review the calls. Descriptive analyses were performed on coaching domain variables and coaching behavior variables as collected by the instrument. Results: The results indicate that the GHS coaches incorporated goal setting, information exchange and education, and relationship building moderately in their coaching interactions. Behavior modification and emotional management were incorporated to a lesser extent. GHS reference material was rarely mentioned and there were significant differences based on when the coaching call occurred; such that realistic weight loss and reference to the GHS materials were more likely to be mentioned in weeks 0–4 (p < 0.05; and p < 0.001 respectively). Conclusions: There is an opportunity for preventive health coaching to be more prescriptive and directive through maximizing the accountability of goals, referencing evidence-based materials more often, providing more information and education, and managing the coaching process to stimulate action.

User Perceptions of the Make Healthy Normal campaign Facebook Page: A Mixed Methods Study

Facebook is used as part of public health communication efforts but little evidence is available on why people engage with health-related Facebook pages and what content appeals to them. This study aimed to investigate user perceptions of and experience with the Make Healthy Normal (MHN) Facebook page, part of a government campaign to address overweight and obesity in adults in New South Wales, Australia. This sequential mixed methods study comprised an online survey (n = 591) and six focus groups (n = 33) of Facebook users, including both fans (i.e., users who have “liked” the MHN page) and non-fans. We analyzed the online survey descriptively and employed inductive thematic analysis for the focus groups, integrating the two data sources at the stage of interpretation. Our results show that MHN and similar health pages are in demand but that there are a number of contextual and content-related factors that are critical in determining user engagement and over which page administrators have varying levels of influence. Contextual factors, including the drivers for user engagement and Facebook user practices, can be leveraged or managed to influence user engagement but they cannot be controlled. On the contrary, content factors, like the nature of posts, post presentation, and post subject, can be directly influenced by page administrators. Policymakers and practitioners can use these findings to inform the design and operation of their own Facebook pages and should look to conduct and disseminate robust evaluation of their pages to improve user satisfaction and engagement.

A review of UK media coverage of physical activity associated with the publication of special issues in a high-impact medical journal

OBJECTIVES The media is a substantial vehicle for conveying public health messages to the public. This study examined the extent to which the publication of special issues in a high-impact medical journal in 2012 and 2016 generated media interest in physical activity and health in the UK and explored the main issues that were reported. STUDY DESIGN This is a systematic narrative review of print media. METHODS Relevant print news articles were identified by searching Factiva and Google News. The timeframe of each search was 2 weeks, using the publication date of each special issue as the anchor point. Overall, 20 articles were included in the analysis for 2012 and 37 articles for 2016. RESULTS The news media coverage was encouraging for the profile of physical activity and health. In 2012 and 2016, common themes included the benefits of physical activity and the risks of being inactive, comparisons between mortality rates from physical inactivity and smoking and the recommended volume of physical activity to benefit health. CONCLUSIONS The profile given to an issue through prestigious scientific publication is one of the levers for community attention and policy change. Efforts are needed to further use the media for improving policy, practice and public awareness, which are antecedents to population health change.

A review of the impact of physical activity mass media campaigns on low compared to high socioeconomic groups

Physical inactivity is a major contributor to non-communicable disease and people of low socioeconomic status (SES) are more likely to be insufficiently active. Physical activity mass media campaigns aim to increase physical activity participation, but little is known about their impact on low SES groups. We reviewed the published literature from 1990 to June 2016 to identify reports of physical activity mass media campaigns. We documented evaluation/study design, target population, campaign outcomes assessed, SES measures used and analysed the results of the SES comparisons. A total of 23 papers were reviewed, reporting on 17 physical activity campaigns and 12 campaigns compared SES differences for 85 outcomes: 45 comparisons showed no difference between lowest and highest SES groups, 20 showed a better outcome for the lowest SES group and 20 showed a worse outcome. Some campaigns found inconsistent results, but seven found only equal and/or better results for low SES groups. Post-campaign physical activity behaviour most commonly showed no SES differences, but no other patterns were seen. Our review found that physical activity mass media campaigns have mostly equitable or better impacts for low SES groups, but to reduce inequalities these campaigns need to be maximally effective for low SES populations.

Weight-Related Goal Setting in a Telephone-Based Preventive Health-Coaching Program Demonstration of Effectiveness

Purpose: This study investigated whether participants in a 6-month telephone-based coaching program, who set physical activity, nutrition, and weight loss goals had better outcomes in these domains. Design: Quasi-experimental design. Setting: The Australian Get Healthy Information and Coaching Service (GHS), a free population-wide telephone health-coaching service that includes goal setting as a key component of its coaching program. Participants: Consenting GHS coaching participants who had completed coaching between February 2009 and December 2012 (n = 4108). Measures: At baseline, participants select a goal for the coaching program, and sociodemographic variables are collected. Self-reported weight, height, waist circumference, physical activity, and nutrition-related behaviors are assessed at baseline and 6 months. Analysis: Descriptive analysis was performed on key sociodemographic variables, and the relationship between goal type and change in health outcomes was assessed using a series of linear mixed models that modeled change from baseline to 6 months. Results: Participants who set goals in relation to weight management and physical activity achieved better results in these areas than those who set alternate goals, losing more than those who set alternate goals (1.5 kg and 0.9 cm in waist circumference) and increasing walking per week (40 minutes), respectively. There was no difference in food-related outcomes for those that set nutrition-related goals. Conclusion: Goal setting for weight management and increasing physical activity in the overweight and obese population, undertaken in a telephone-based coaching program, can be effective.