Nigel Sherriff

The gradient in health inequalities among families and children: A review of evaluation frameworks

Public health policies and interventions that seek to tackle the social gradient in health need to be more adequately evaluated. The GRADIENT Project sets out to recommend public health policy options which effectively tackle health inequalities and address the gradient in health determinants among families and children in Europe. This work is underpinned by the development of a dedicated evaluation framework-a scheme that elaborates steps in a process of assessment which can act as a useful guide for decision makers. This paper presents the results from a narrative review, based on realist review principles, of 34 evaluation frameworks. It uses a set of analytical criteria, drawn from the EUHPID health development model, the Ottawa Charter for Health Promotion, and the wider literature on health inequalities, to analyse these frameworks. The findings reveal that no one suitable evaluation framework exists to evaluate whether policies and/or interventions targeting children and families reduce the health gradient. It is suggested that this work will be useful in assessing the complex nature of public health interventions and their evaluation. It will be used to develop an evaluation framework to guide decision makers to begin to understand the key drivers at each stage of the policy development and implementation cycle.

Developing public health competencies through building a problem-based learning project

AimIn order to tackle the major challenges faced by public health over recent decades, there is a pressing need for an appropriately competent work force. Therefore, investment is required in the development of the necessary pedagogical strategies to deliver such competencies and thereby enable public health professionals to effectively perform their core functions. Drawing primarily upon on the work and experiences of the EC-funded PHETICE (Public Health Education and Training in the Context of an Enlarging Europe) and EUMAHP (European Masters in Health Promotion) projects, in this article an appropriate training method that integrates several public health models is introduced and discussed in order to deliver key public health competencies.MethodsA student-centred learning (SCL) approach is recommended, from both theoretical and practical perspectives, as a more effective way of delivering training to achieve these competencies than traditional pedagogical methods. An ecological and educational approach to planning in public health is demonstrated by using a problem-based Learning (PBL) approach to the acquisition of basic public health competencies.ConclusionsIn outlining the PBL approach, the authors go on to explain how it can enable learners to gain systematically the necessary competencies to carry out comprehensive planning and decision making based on a comprehensive assessment, using the practical skills of compromise, negotiation, teamwork, and leadership.

Bio-behavioural HIV and STI surveillance among men who have sex with men in Europe: the Sialon II protocols

BackgroundGlobally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach.Methods/DesignSialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for ‘hard-to-reach’ populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection.DiscussionThrough the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need.

A qualitative approach to intergroup relations: exploring the applicability of the social identity approach to ‘messy’ school contexts

The social identity approach (SIA) is one of the most influential theories of group processes and intergroup relations worldwide. However, we argue that the dominance of (post)positivist research methods in SIA work limits the extent to which it enables an understanding of the complexities of intergroup relations in schools. Drawing on qualitative data from two research studies, we highlight important questions and issues that are obscured by traditional psychological approaches to studying intergroup relations. In particular, we focus on the complex interplay among discourses about popularity within schools, constructions of gender identities, and intergroup relations. In doing so, we demonstrate the benefits that qualitative research may have for social psychological intergroup theories (and their applications) and, specifically, the SIA. We highlight how qualitative data can add considerable richness to understandings of intergroup relations and draw attention to inconsistencies and contradictions that otherwise may go unnoticed.

Health in the Urban Environment: A Qualitative Review of the Brighton and Hove WHO Healthy City Program

Phase IV of the WHO European Region’s Healthy Cities Program ended in December 2008. This article presents the findings from a recently completed review of Brighton and Hove’s Healthy City Program which aimed to scope whether added value had accrued from the city’s role as a WHO Healthy City during phase IV. In contrast to most other evaluations of healthy cities, this review adopted a qualitative approach representing an appraisal of the Brighton and Hove Healthy City Program from the internal viewpoint of its local stakeholders. In addition to documentary analysis and a facilitated workshop, a series of in-depth interviews (N = 27) were conducted with stakeholders from the Brighton and Hove Healthy City Partnership representing each of the sectors reflected in the Local Strategic Partnership (public, statutory, elected, community and voluntary, neighborhood and communities, business). The key findings of the review are presented in a way which reflects the three key areas of the review including (1) the healthy cities approach, (2) participation in phase IV of the WHO Healthy Cities Program, and (3) the Brighton and Hove Healthy City Partnership. These findings are discussed, and recommendations for action at local, national, and European levels are proposed. In particular, we argue that there is an urgent need to develop a suitable monitoring and evaluation system for the WHO Healthy Cities Program with appropriate indicators that are meaningful and relevant to local stakeholders. Moreover, it would be important for any such system to capitalize on the benefits that qualitative methodologies can offer alongside more traditional quantitative indicators.

Promoting resilience and emotional wellbeing of transgender young people: research at the intersections of gender and sexuality

ABSTRACT Within lesbian, gay, bisexual and transgender (LGBT) research there is increasing health-related scholarship on trans lives, with a growing awareness of the impact of health inequalities on trans well-being. The aim of the paper is to provide greater understanding of transgender young people’s views of what is needed to promote their emotional well-being and resilience by undertaking specific analysis of data collected as part of wider research with young people (n = 97). The study utilised participatory qualitative methods with a cross sectional design generating data via a focus group with trans youth (n = 5), followed by thematic analysis. Findings suggest that both individual and collective capacities or resources enable and sustain resilience and well-being for trans young people. The adversity trans youth face is present in school, the community and in healthcare, but they are able to find places where they feel safe and connected to others. Practitioners, teachers and school nurses are well positioned to facilitate structural change in alliance with trans youth to promote resilience. Research results were utilised to inform health improvement, commissioning and service delivery.

Socio-demographic Characteristics, Sexual and Test-Seeking Behaviours Amongst Men Who have Sex with Both Men and Women: Results from a Bio-behavioural Survey in 13 European Cities

Within the MSM population, men who have sex with both men and women (MSMW) are identified as a high-risk group both worldwide and in Europe. In a multi-centred bio-behavioural cross-sectional study, we aimed to assess the relationship(s) between socio-demographic factors, stigma, sexual behavioural patterns, test seeking behaviour and sero-status amongst MSMW. A multi-level analysis was conducted to identify factors associated with being MSMW versus Men who have Sex with Men Only (MSMO). A total of 4901 MSM were enrolled across the 13 study sites. Participants were categorised as MSMW in the 12.64% of the cases. Factors such as educational status, perceived homonegativity, testing facilities knowledge and HIV testing lifetime seem to be relevant factors when characterising the MSMW group. The results highlight the vulnerability of MSMW and the wide spectrum of risky behavioural and psycho-social patterns, particularly in terms of HIV testing, ‘outness’, and perceived stigma.ResumenLos Hombres que tienen Sexo con Hombres y Mujeres (HSHM) son un grupo de población de alto riesgo dentro de los HSH. Evaluar la relación entre factores socio-demográficos, estigma, patrones de conducta sexual y de búsqueda de la prueba y el estado serológico de los HSHM. Estudio bio-conductual multicéntrico transversal. Análisis multinivel para identificar factores asociados con ser HSHM respecto a los Hombres que Sólo tienen Sexo con Hombres. Se reclutaron 4.901 HSH en 13 ciudades, siendo un 12,64% HSHM. El nivel educativo, la homonegatividad percibida, el conocimiento de los lugares de realización de la prueba y la prueba del VIH alguna vez son factores relevantes para caracterizar los HSHM. Los resultados subrayan la vulnerabilidad de los HSHM y la diversidad de conductas y patrones psicosociales de riesgo, particularmente en términos de la prueba del VIH, visibilidad de la identidad sexual y estigma percibido.

Engaging ‘gay’ businesses in HIV prevention ‘Everywhere’: Findings from a qualitative study in eight European cities

Objective: ‘Gay’ businesses providing physical and virtual sex spaces for men who have sex with men (MSM) have been shown empirically to be useful sites for public health and health promotion interventions. While HIV incidence in Europe has been more or less stable in recent years, the number of infections attributed to MSM has continued to increase with new cases almost doubling in Western and Central Europe between 2000 and 2006. Set within the context of the Everywhere Project, the objective of this study was to explore the feasibility and acceptability to ‘gay’ businesses of developing and implementing a European model of HIV prevention focusing on MSM that provides common prevention standards across eight European countries. Design: A qualitative study Setting: ‘Gay’ businesses that bring men together and facilitate sex between them in ‘gay’ tourist destinations and other European capital cities. Method: Semi-structured qualitative interviews were conducted with 54 ‘gay’ business representatives from different European cities. Interviews were recorded, transcribed, translated, and analyzed using a ‘framework’ approach. Results: Many representatives of ‘gay’ businesses reported being willing to provide HIV prevention activities that target MSM in their venues and perceive this as part of improving their corporate image of being a socially responsible enterprise. However, concerns were voiced around issues such as fear of alienating customers, and inciting stigma and discrimination, safe-sex fatigue and lack of knowledge of prevention messages, as well as the need for appropriate condom and lubricant distribution networks. Businesses also reflected on the potential benefits and disadvantages of being involved in a scheme that provides a common and recognizable framework for HIV prevention across multiple European countries. Conclusions: Early conclusions from this exploratory research suggest that a European-wide model of HIV prevention is acceptable and feasible to those working in ‘gay’ businesses. Further investigations, however, are required to develop solutions in order to overcome identified social, cultural and practical barriers.

Transatlantic Student Exchange between Canada and Europe: Experiences from the CEIHPAL Project.

International student mobility amongst and between countries has become increasingly common and forms a central feature of the global higher education system. This paper examines the key learning experiences relating to the student mobility component of the Canadian-European Initiative for Health Promotion Advanced Learning (CEIHPAL) project. CEIHPAL was a unique and innovative project that fostered advanced intercontinental education and learning in health promotion from 2005–2008. With co-funding from the European Commission and the Canadian Government, the project facilitated institutional, student and faculty cooperation, by developing a high level of international communication. In particular, this paper focuses on the student mobility component and experiences of the CEIHPAL programme, a central part of the project activities. Feedback from both Canadian and European students themselves is used to document their participation in the programme, including the benefits derived from taking part as well as the problems and difficulties they encountered.

Prevalence of drug use during sex amongst MSM in Europe: Results from a multi-site bio-behavioural survey

BACKGROUND Substance use has been consistently reported to be more prevalent amongst Men who have Sex with Men (MSM) compared to the general population. Substance use, in particular polydrug use, has been found to be influenced by social and contextual factors and to increase the risk of unprotected intercourse among MSM. The objective of this analysis was to investigate the prevalence and predictors of drug use during a sexual encounter and to identify specific prevention needs. METHODS/DESIGN A multi-site bio-behavioural cross-sectional survey was implemented in 13 European cities, targeting MSM and using Time-Location Sampling and Respondent-Driven Sampling methods Multivariable multi-level logistic random-intercept model (random effect of study site) was estimated to identify factors associated with the use of alcohol, cannabis, party drugs, sexual performance enhancement drugs and chemsex drugs. RESULTS Overall, 1261 (30.0%) participants reported drug use, and 436 of 3706 (11.8%) reported the use of two or more drugs during their last sexual encounter. By drug class, 966 (23.0%) reported using sexual performance enhancement drugs, 353 (8.4%) - party drugs, and 142 (3.4%) the use of chemsex drugs. Respondents who reported drug use were more frequently diagnosed with HIV (10.5% vs. 3.9%) before and with other STIs during the 12 months prior to the study (16.7% vs. 9.2%). The use of all the analysed substances was significantly associated with sexual encounter with more than one partner. DISCUSSION Substance and polydrug use during sexual encounters occurred amongst sampled MSM across Europe although varying greatly between study sites. Different local social norms within MSM communities may be important contextual drivers of drug use, highlighting the need for innovative and multi-faceted prevention measures to reduce HIV/STI risk in the context of drug use.