Lynne Kennedy

Death by effectiveness: exercise as medicine caught in the efficacy trap!

that many studies examining the treatment effectiveness of exercise in the real world adopt laboratory style methods and controls that would be impractical and uneconomic in real-world interventions. Data resulting from such studies merely add to the efficacy data set. We argue that despite metaphorically drowning in evidence of efficacy and implementation effectiveness, SEM is yet to provide sufficient evidence of treatment effectiveness. Furthermore, while it is a mistake to confuse efficacy with effectiveness, 9 in lobbying for exercise as a public health tool, we often do just that.

Eating for 1, Healthy and Active for 2; feasibility of delivering novel, compact training for midwives to build knowledge and confidence in giving nutrition, physical activity and weight management advice during pregnancy

BackgroundWomen in Wales are more likely to be obese in pregnancy than in any other United Kingdom (UK) country. Midwives are ideally placed to explore nutrition, physical activity and weight management concerns however qualitative studies indicate they lack confidence in raising the sensitive issue of weight. Acknowledging this and the reality of finite time and resources, this study aimed to deliver compact training on nutrition, physical activity and weight management during pregnancy to increase the knowledge and confidence of midwives in this subject.MethodsA compact training package for midwives was developed comprising of evidence based nutrition, physical activity and weight management guidance for pregnancy. Training was promoted via midwifery leads and delivered within the Health Board. Questionnaires based on statements from national public health guidance were used to assess changes in self-reported knowledge and confidence pre and post training. Descriptive statistics were applied and 95% confidence intervals were calculated.Results43 midwives registered for training, 32 (74%) attended and completed the questionnaires. Although, pre training knowledge and confidence varied between participants, statistically significant improvements in self-reported knowledge and confidence were observed post training. 97% indicated knowledge of pregnancy specific food and nutrition messages as ‘better’ (95% CI 85 to 100), as opposed to 3% stating ‘stayed the same’ – 60% stated ‘much better’. 83% indicated confidence to explain the risks of raised BMI in pregnancy was either ‘much’ or ‘somewhat better’ (95% CI 66 to 93), as opposed to 17% stating ‘stayed the same’. 89% indicated confidence to discuss eating habits and physical activity was ‘much’ or ‘somewhat better’ (95% CI 73 to 97) as opposed to 11% stating ‘stayed the same’. Emergent themes highlighted that training was positively received and relevant to midwifery practice.ConclusionsThis study provides early indications that a compact nutrition, physical activity and weight management training package improves midwives self-reported knowledge and confidence. Cascading training across the midwifery service in the Health Board and conducting further studies to elicit longer term impact on midwifery practice and patient outcomes are recommended.

The Application of Salutogenesis in Communities and Neighborhoods

There is growing consensus that the places where people live and the various social processes, relationships, and psychosocial concepts associated with strong healthy communities and neighborhoods make an important contribution to health. Where you live makes a considerable difference; people living in more affluent communities, for example, are more likely to experience better self-reported health and well-being. This is particularly evident in current theoretical and policy debates concerning the salutogenic and so-called strength or assets-based approach to health; healthy communities have various social and physical resources available, which if they can recognize, share and utilize, can result in stronger SOC, increasing their ability to cope and thrive. Within health promotion we actively encourage communities to organize themselves for better health and well-being. The concept of “community” is both complex and subjective and difficult to define. So we start by conceptualizing the definitions, dimensions, and meanings of community—beyond a physical location—underpinning this chapter. There are several ideas linking the community or neighborhood as a setting, including community as a place to live, connectedness (social capital) and social action (the development of a strong SOC). The evidence is variable in quality and furthermore, few studies explicitly apply the theory of salutogenesis when they study health and well-being in the community context. The body of this chapter is devoted therefore to summarizing the available research about salutogenic and asset-based community interventions, drawing upon examples from empirical work. In doing so, we will highlight debates emerging around the concepts of a salutogenic framework and health assets in relation to community and neighborhood. As such, we are specifically interested in examining the resources (and/or assets) of communities and neighborhoods and the associated processes enabling these resources to be accessed for the benefit of the community’s health and well-being.