Changes in Australian community perceptions of non-communicable disease prevention: a greater role for government?

BACKGROUND: Monitoring trends in community opinion can identify critical opportunities to implement upstream health policies or interventions. Our study examines change and demographic modifiers of change in community perceptions of government intervention for prevention of lifestyle-related chronic disease across two time points in Australia. METHODS: Data were drawn from the 2016 (n = 2052) and 2018 (n = 2601) waves of a nationally representative cross-sectional telephone survey, 'AUSPOPS'. Survey questions gauged perceptions of government intervention for health in general, peoples'/organizations' role in maintaining health (e.g., parents, government) and support for specific health interventions (e.g., taxing soft drink). Bivariate and multivariate regression models tested for change between the two surveys, adjusted for demographic characteristics. Models with interactions between survey wave and demographic variables tested for differential change. One-tailed variance ratio tests examined whether opinions had become more polarized in 2018 compared with 2016. RESULTS: The large, significant increase observed in the perceived size of the role that government has in maintaining people's health was uniform across demographic subpopulations. The role for employers and private health insurers was also perceived to be larger in 2018 compared with 2016, but the degree of change varied by gender, age and/or socioeconomic status. Support for some government interventions (e.g., taxing soft drinks) increased among specific demographic subgroups whilst exhibiting no overall change. Opinion was more polarized on general attitudes to government intervention for population health in 2018 compared to 2016, despite little change in central tendency. CONCLUSIONS: Opportunities may exist to implement government health-promoting policies (e.g., taxing soft drinks), although advocacy may be needed to address the concerns of less supportive subpopulations. Attitudes on government intervention in general may be becoming more polarized; future research examining the association of such changes with exposure to different information sources could inform communication strategies for future health policy change

Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods.

Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia-Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs

Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment

Outdoor recreational spaces have the potential to increase physical activity. This study used a quasi-experimental evaluation design to determine how a playground renovation impacts usage and physical activity of children and whether the visitations correlate with children’s physical activity levels and parental impressions of the playground. Observational data and intercept interviews were collected simultaneously on park use and park-based activity among playground visitors at pre- and postrenovation at an intervention and a comparison park during three 2-hour periods each day over two weeks. No detectable difference in use between parks was observed at followup. In the intervention park, attendance increased among boys, but decreased among girls although this (nonsignificant) decline was less marked than in the comparison park. Following renovation, there was no detectable difference between parks in the number of children engaged in MVPA (interaction between park and time: P=0.73). At the intervention park, there was a significant decline in girls engaging in MVPA at followup (P=0.04). Usage was correlated with parental/carer perceptions of playground features but not with physical activity levels. Renovations have limited the potential to increase physical activity until factors influencing usage and physical activity behavior are better understood

Participant profile and impacts of an Aboriginal healthy lifestyle and weight loss challenge over four years 2012-2015

OBJECTIVE: To explore participation, consistency of demographic and health profiles, and short-term impacts across six Aboriginal Knockout Health Challenge (KHC) team-based weight loss competitions, 2012 to 2015. METHODS: Data comprised one competition each from 2012 and 2013 and two per year in 2014 and 2015. We compared baseline and change (pre- to post-competition) in weight, fruit and vegetable consumption, physical activity and waist circumference (baseline only) across competitions using mixed models. RESULTS: Numbers of teams and participants increased from 2012 to 2015 from 13 and 324 to 33 and 830, respectively. A total of 3,625 participants registered, representing 2,645 unique people (25.4% repeat participation). Participants were mainly female and >90% were classified obese at baseline. Baseline weight and weight lost (between 1.9% and 2.5%) were significantly lower in subsequent competitions compared with the first. Improvements in fruit and vegetable consumption and physical activity were comparable across competitions. CONCLUSION: The KHC has increasing and sustained appeal among Aboriginal communities, attracting those at risk from lifestyle-associated chronic disease and effectively reducing weight and promoting healthy lifestyles in the short term. Implications for public health: Community-led programs generated by, and responsive to, Aboriginal Australians' needs can demonstrate consistent community reach and sustained program-level lifestyle improvements

Using natural experiments to improve public health evidence: a review of context and utility for obesity prevention.

Background Natural experiments are increasingly valued as a way to assess the health impact of health and non-health interventions when planned controlled experimental research designs may be infeasible or inappropriate to implement. This study sought to investigate the value of natural experiments by exploring how they have been used in practice. The study focused on obesity prevention research as one complex programme area for applying natural experiment studies. Methods A literature search sought obesity prevention research from January 1997 to December 2017 and identified 46 population health studies that self-described as a natural experiment. Results The majority of studies identified were published in the last 5 years, illustrating a more recent adoption of such opportunities. The majority of studies were evaluations of the impact of policies (n = 19), such as assessing changes to food labelling, food advertising or taxation on diet and obesity outcomes, or were built environment interventions (n = 17), such as the impact of built infrastructure on physical activity or access to healthy food. Research designs included quasi-experimental, pre-experimental and non-experimental methods. Few studies applied rigorous research designs to establish stronger causal inference, such as multiple pre/post measures, time series designs or comparison of change against an unexposed group. In general, researchers employed techniques to enhance the study utility but often were limited in the use of more rigorous study designs by ethical considerations and/or the particular context of the intervention. Conclusion Greater recognition of the utility and versatility of natural experiments in generating evidence for complex health issues like obesity prevention is needed. This review suggests that natural experiments may be underutilised as an approach for providing evidence of the effects of interventions, particularly for evaluating health outcomes of interventions when unexpected opportunities to gather evidence arise

Are perceptions of government intervention for prevention different by gender and age? Results from the AUStralian Perceptions Of Prevention Survey (AUSPOPS).

OBJECTIVES: Understanding public opinion and community attitudes is needed to help the implementation of chronic disease prevention policies that are acceptable to the population. The AUStralian Perceptions Of Prevention Survey ('AUSPOPS') is a national survey designed to provide evidence on the views of Australians regarding government intervention for prevention. However there is limited evidence whether age and gender have modifying effects on attitudes about prevention. METHODS: Using results from the 2018 AUSPOPS dataset, this study examines whether the effect of age on attitudes about prevention is modified by the effect of gender. Survey questions included views about statements for government intervention and whether government had gone far enough for thirteen different preventive interventions. RESULTS: 2601 Australian residents aged 18 years or older participated in the survey (response rate 16.7%). Results showed strong support for prevention framed as a shared responsibility between governments and individuals. Interventions where >50% of respondents felt the government had not gone far enough in prevention were restricting unhealthy food advertising for children and setting salt limits on processed food. There were significant age by gender interactions in a small number (n = 4) of questions examining support for government intervention for prevention, suggesting young men were least in favour of more action by government. CONCLUSIONS: There is general support in the Australian community for government intervention for prevention. Policymakers could capitalize on this sentiment by prioritizing policies with high levels of support across all groups, and target population subgroups on issues where acceptability appears to be heterogenous

A systematic search and review of adult-targeted overweight and obesity prevention mass media campaigns and their evaluation: 2000–2017

Mass media campaigns are a commonly used strategy in public health. However, no review has assessed whether the design and evaluation of overweight and obesity campaigns meets best practice recommendations. This study aimed to fill this gap. We systematically searched five databases for peer-reviewed articles describing adult-targeted obesity mass media campaigns published between 2000 and 2017, complemented by reference list searches and contact with authors and agencies responsible for the campaigns. We extracted data on campaign design, implementation, and evaluation from eligible publications and conducted a qualitative review of 29 publications reporting on 14 campaigns. We found a need for formative research with target audiences to ensure campaigns focus on the most salient issues. Further, we noted that most campaigns targeted individual behaviors, despite calls for campaigns to also focus upstream and to address social determinants of obesity. Television was the dominant communication channel but, with the rapid advance of digital media, evaluation of other channels, such as social media, is increasingly important. Finally, although evaluation methods varied in quality, the evidence suggests that campaigns can have an impact on intermediate outcomes, such as knowledge and attitudes. However, evidence is still limited as to whether campaigns can influence behavior change

Is Active Design changing the workplace? - A natural pre-post experiment looking at health behaviour and workplace perceptions

BACKGROUND: Active Design is a relatively new concept and evaluation on its effects on healthy behaviour is lacking. OBJECTIVE: To investigate Active Design influence on workplace physical activity, sedentary behaviour, musculoskeletal complaints, and perceptions of the workplace and productivity. METHODS: Participants (n = 118 adults) moving from 14 workplaces into a new building completed an online questionnaire pre- and post-move. The questions related to health behaviours (physical activity, sitting time and sleep); musculoskeletal issues; perceptions of the office environment; productivity; and engagement. RESULTS: After the move, 68% of participants were located in an open plan building (21% before the move). In the new workplace participants tended to sit less during their work time (72% – 66%; p \u3c 0.05) and stand more (15% – 19%; p \u3c 0.05) while walking remained unchanged. Participants reported less lower-back pain. The new work environment was perceived as more motivating and providing better light, air quality and temperature, but less storage space. Participants reported looking forward to going to work more than before. No difference was reported in productivity related measures. CONCLUSIONS: Moving to a new Active Design building can have some physical health-promoting effects on occupants. Satisfaction with environmental characteristics tended to improve in the new building though perceptions of productivity measures were variable

Evaluation of Get Healthy at Work, a state-wide workplace health promotion program in Australia.

Background Workplace health programs (WHPs) may improve adult health but very little evidence exists on multi-level WHPs implemented at-scale and so the relationship between program implementation factors and outcomes of WHPs are poorly understood. This study evaluated Get Healthy at Work (GHaW), a state-wide government-funded WHP in Australia. Methods A mixed-method design included a longitudinal quasi-experimental survey of businesses registered with GHaW and a comparison group of businesses surveyed over a 12-month period. Semi-structured interviews and focus groups with key contacts and employees of selected intervention group businesses and the service providers of the program were conducted to assess program adoption and adaptation. Results Positive business-level changes in workplace culture were observed over time among GHaW businesses compared with the control group. Multilevel regression modelling revealed perceptions that employees were generally healthy (p = 0.045 timeXgroup effect) and that the workplace promoted healthy behaviours (p = 0.004 timeXgroup effect) improved significantly while the control group reported no change in work culture perceptions. Changes in perceptions about work productivity were not observed; however only one third of businesses registered for the program had adopted GHaW during the evaluation period. Qualitative results revealed a number of factors contributing to program adoption: which depended on program delivery (e.g., logistics, technology and communication channels), design features of the program, and organisational factors (primarily business size and previous experience of WHPs). Conclusions Evaluation of program factors is important to improve program delivery and uptake and to ensure greater scalability. GHaW has the potential to improve workplace health culture, which may lead to better health promoting work environments. These results imply that government can play a central role in enabling prioritisation and incentivising health promotion in the workplace