SHE mapping report Lessons learnt from policies and practices of SHE member countries

The Schools for Health in Europe Network Foundation mapping (SHE mapping) survey is a cross-national study to map the level of implementation of health promotion in schools of the SHE member countries and how this implementation is carried out. SHE mapping collected international data on: the integration of the national Health Promoting School (HPS) policy into other national policies; how national policies frame school practices in the whole school approach of HPS; how national policies contribute to a healthy physical environment in the school setting; the contributions of national policies to a school’s social environment, favourable to health promotion; the guidelines, tools and resources for a school to become a HPS; the national process of monitoring / evaluation of HPS; health topics included in the national HPS policy; health promoting school label; sources of funding for national HPS; main expectations of the SHE national coordinators for their national HPS scheme; number of HPS in SHE member countries; HPS facilities; how inclusion of health promotion is done in the school curriculum; health topics worked regularly in HPS; learning methods / strategies in HPS; practices and suggestions for the SHE School Manual and its two accompanying tools; facilitating factors and barriers faced by HPS in the SHE member countries. Data were collected using the Survey Monkey. All SHE national and regional coordinators from the 37 SHE member countries were invited to complete a questionnaire, upon completion of a statement of informed consent. Data were received from 75.7% of countries, but after removal of the incomplete questionnaires and two SHE regional coordinators who responded in duplicate for their country, because it was not possible to gather information from regions as there were only three regional coordinators who answered, 64.9% of countries were analysed.Este trabalho é financiado por Fundos Nacionais através da FCT – Fundação para a Ciência e a Tecnologia no âmbito do projeto do CIEC (Centro de Investigação em Estudos da Criança da Universidade do Minho) com a referência UID/CED/00317/2019

Identifying how COVID-19-related misinformation reacts to the announcement of the UK national lockdown: An interrupted time-series study

COVID-19 is unique in that it is the first global pandemic occurring amidst a crowded information environment that has facilitated the proliferation of misinformation on social media. Dangerous misleading narratives have the potential to disrupt ‘official’ information sharing at major government announcements. Using an interrupted time-series design, we test the impact of the announcement of the first UK lockdown (8–8.30 p.m. 23 March 2020) on short-term trends of misinformation on Twitter. We utilise a novel dataset of all COVID-19-related social media posts on Twitter from the UK 48 hours before and 48 hours after the announcement (n = 2,531,888). We find that while the number of tweets increased immediately post announcement, there was no evidence of an increase in misinformation-related tweets. We found an increase in COVID-19-related bot activity post-announcement. Topic modelling of misinformation tweets revealed four distinct clusters: ‘government and policy’, ‘symptoms’, ‘pushing back against misinformation’ and ‘cures and treatments’

Vers une compréhension des modalités d’implantation des dispositifs d’éducation et de promotion de la santé : Conceptualisation du processus d’implantation, et analyse des facteurs intervenant dans l’effet des programmes

La mise en œuvre de programmes de santé publique complexes est particulièrement délicate en milieu scolaire. Des différences sont fréquemment observées entre ce qui était attendu du programme et ce qui en résulte en réalité. Ces différences sont dues à un certain nombre de facteurs contextuels, en lien avec les caractéristiques propres du milieu, de la communauté et des acteurs concernés. Développer des programmes de prévention efficaces, implique de prendre en compte l’impact de ces facteurs sur le processus d’implantation des projets. Par conséquent, il convient de s’intéresser à deux questions majeures : la première est celle de la transférabilité des programmes, dont les effets sont difficiles à prévoir dans une telle variabilité contextuelle. La seconde question concerne la généralisation à l’échelon régional ou national de la mise en œuvre de tels programmes de prévention en milieu scolaire qui, loin d’être une évidence, est également sujette à de nombreux déterminants variables en fonction des situations. Alors que l’implantation et la mise en œuvre des programmes est un champ largement investigué dans le soin comme dans le management, il s’agit d’un champ de recherche en expansion dans le domaine de la prévention, de l’éducation à la santé et de la promotion de la santé. Cette thèse propose de s’intéresser aux modalités d’implantation des programmes avec un objectif double : une visée épistémique par une réflexion théorique sur les concepts à mobiliser, puis une confrontation empirique de cette approche dans trois études ; une visée transformative s’appuyant sur des propositions d’opérationnalisation de notre approche. Chaque étude contribuera à explorer et expliciter un aspect de l’implantation : des processus générés, aux effets observés, en prenant en compte les facteurs déterminants en jeu. Les résultats de ce travail mettent l’accent sur le fait que les caractéristiques initiales des différents contextes ont un impact majeur sur le processus d’implantation, à différents niveaux de mise en œuvre. Les interactions entre les facteurs sont complexes, elles s’inscrivent dans des boucles d’action-rétroaction. L’introduction d’un programme dans un contexte peut agir comme un révélateur de certaines conditions favorables ou défavorables, un élément perturbateur imposant de nouvelles contraintes, ou, au contraire, un nouvel élan stimulant la motivation des équipes. Il apparaît que les programmes sont « instrumentalisés » par les acteurs pour servir leurs propres objectifs en fonction des conditions de départ. Il s’agit par conséquent de questionner le statut et le potentiel des programmes implantés au sein de contextes d’une extrême complexité. Nous ne prônons pas un changement de paradigme, mais plutôt un déplacement du curseur d’une focalisation sur l’amélioration de la fidélité avec laquelle les programmes sont mis en œuvre, vers un ancrage fort dans les différents contextes. Cette stratégie nous semble particulièrement adaptée à une démarche de réduction des inégalités sociales de santé. Dans cette perspective, nous proposons l’élaboration de « patterns » d’implantation sur la base d’une analyse détaillée des éléments déterminants préexistant dans les contextes considérés. Pour développer cette approche, il est nécessaire de poursuivre les recherches afin d’analyser les combinaisons de facteurs contextuels dans différents types d’écoles comme dans d’autres milieux.Implementing health-related interventions is challenging in school settings. Discrepancies, between expected and actual programme outcomes, are often reported. They are, at least partly, due to contextual factors in the setting, the community and the stakeholders involved. The impact of these factors sets two challenges for the development of successful health promotion programmes: first, transferability and generalization, as end effects are in reality difficult to predict; second, the scaling up of interventions cannot be taken for granted, as the determinants involved are numerous and variable, depending on situations. While implementation research is substantial in healthcare or management, it is an emerging and growing field in health promotion. This work proposes to produce knowledge on implementation in health promotion, with a twofold approach based on a theoretical reflection, and its confrontation with three empirical studies. Each study contributes to understand a different aspect of implementation, namely the processes involved, the outputs resulting from the process and the influential factors in play. Findings put forward that specific characteristics of the context, which exist prior to implementation, influence the implementation process greatly, on various levels and according to complex loops of interactions. The new programme introduced sometimes acts as a revealer, a constraint, or a motivator. It is used as a tool, a guideline or a vision, depending on initial conditions, expectations and potentiality of the context of implementation. This work also discusses the way in which school stakeholders tend to “instrumentalize” programmes and guidelines for their own purpose. Questioning the design, status and potentiality of programmes is essential. Rather than proposing a paradigm shift, our suggestion is to move towards implementation research and programme design that focus on interactions between contexts and programmes, to reduce health inequities. It is about moving the cursor from evidence-base and fidelity, to a focus on contextual influencing implementation. Implementation patterns, based on a detailed understanding of contextual factors, could serve as guiding directions to support the implementation process, in a transformational change perspective. More research is needed on combinations of contextual factors in different types of school, and other types of settings, to further develop the approach presented in this work

Implementation of a Health Promotion Programme: A 10 Year Retrospective Study

International audienceImplementing health promotion programmes in school settings(I.U.H.P.E. 2009; SHE network 2013; Safarjan et al. 2013; Simovska et al. 2011)is key to address health inequalities and improve children’s health and well-being. Nonetheless, the core business of schools is focused on educational outcomes, rather than the reduction of health problems. From an educational point of view, schools contribute to health by: i) creating the conditions for pupils’ achievement through improvement of the school environment; and ii) acquiring health competencies to empower young and future generations to make healthy decisions. Promoting health in schools means developing a policy at the school level, which remains difficult.As Don Nutbeam (2013) stated, despite “innovation, energy and enthusiasm, achieving successful implementation and sustaining the positive benefits for school students of school health programmes has proven to be challenging”. Achieving expected results in school settings is laborious and requires to understand discrepancies between expected and actual outcomes. Focusing on the implementation process itself is critical to inform potential further development of practice (Samdal & Rowling 2013).Such discrepancies are due to the embedded variability in contexts, which quite often differ from what had been foreseen during programme design, which to some extent, was undertaken out-of-context. When considering the variability embedded in contexts, it seems paradoxical to wish for and strive for programme fidelity, which in the end resembles more enforcement than it does co-construction, especially in multi-level and ecological approaches (Pettigrew et al. 2014). Instead, programmes may be considered added ingredients, “something extra” brought to and introduced to local ecology. When this added opportunity, or sometimes constraint, enters the context, interactions occur to result in short to long term outputs and outcomes on different levels of the local ecology (Trickett & Beehler 2013). Programme implementation is thus an enabling (or constraining) process towards a combination of expected achievements: (1) a potential impact on the targeted health issue; and potential outputs, i.e. (2) health capacity building, which materializes through the development of health-related actions and projects, and last butnot least, (3) settings’ and communities’ capacity to promote health, which includes the development of local level policy (St Leger & Young 2009).Our proposal is to understand and question the implementation process in school settings. The strong idea, and almost advocacy conveyed through this work, is the belief that a strong anchoring in the differences and potentialities of contexts has to also show in research designs. It is crucial to hope to upscale practice and provide support to professionals, starting where people are, and potentiating existing resources.For the purpose of acquiring a detailed and complex understanding of what is at play during implementation, the focus was set on what kind of outputs are created by the implementation of single programme over time, as well as what factors and combinations of factors can be deduced to influence implementation, from a long-term perspective. The format of this study is retrospective in order to capture potential outputs and processes that are not accessible on a short-term basis. Two types of outputs shall be considered: the development of health-related policy on a school level, and actions implemented by staff after participation to the programme; and potential health capacity building outputs. Three leads were undertaken for this research (1) pinpointing outputs of implementation on a staff and school level from a long-term perspective, and (2) understanding what key factors and combinations of key factors are involved in the effects observed, (3) and also identifying putative recurrences in combinations of contextual factors (Pommier et al. 2010)

Implementation of school-based health promotion programmes: using a realistic evaluation framework to determine the key factors involved in successful implementation of complex interventions

International audienc

Comprendre les mecanismes de mise en œuvre de dispositifs de promotion de la sante : Des contextes d'interventions à l'activité des professionnels

International audienceLes orientations internationales (Marmot, 2011) comme la stratégie nationale de santé en France (Tourraine, 2014) placent la lutte contre les inégalités de santé et l’action sur les déterminants de la santé au cœur des politiques de santé. Des dispositifs a visée promotrice de santé (OMS, 1986) sont mis en place tant en vue de créer des environnements favorables à la santé que de permettre à chacune et à chacun de développer des compétences en matière de santé. Le milieu scolaire est ainsi largement sollicité.Pour autant, les travaux disponibles montrent que l’efficacité des dispositifs mis en œuvre reste relative. Alors que les dispositifs « one-shot » clé en main, opérations uniques et ponctuelles demeurent peu efficaces, les programmes de plus longue durée, adaptés aux contextes (Stewart-Brown, 2006), reflet de la nécessité d’une formation globale et sur le long terme des professionnels (Contu, Sotgiu, et les CompHp project partners, 2012; Dempsey et al., 2011) ont une plus grande pertinence (St Leger & Young, 2009).La perspective sous-tendant notre travail ne se limite pas à inventorier les ingrédients d’une implantation réussie, elle est centrée sur l’adaptation à la spécificité des contextes de mise en œuvre. Il est en effet souhaitable (Green, 2006) que les dispositifs puissent être réinventés et customisés (Rogers, 1995) à partir de processus et fonctions généraux communs (Hawe, Shiell et Riley, 2009). Les professionnels, de par leur créativité et leur individualité, redéfinissent sans cesse leur mission (Leplat, 2000; Nagels, 2008) et ne peuvent être relégués au rôle de simple effecteur ; le dispositif devenant ainsi une forme de prescription supplémentaire.Les facteurs susceptibles d’influencer l’implantation et la pérennisation sont complexes et impliquent les populations et leur capacité à se saisir des dispositifs (Durie et Wyatt, 2007); les professionnels et leur façon de redéfinir leur tâche et d’organiser leur activité (Simar & Jourdan, 2010); les différentes strates du contexte (micro, méso et macro) (Glasgow, Lichtenstein, & Marcus, 2003).Cette communication tentera dans un premier temps d’identifier les modèles et outils conceptuels permettant de comprendre les mécanismes à l’œuvre lorsqu’un dispositif est mis en œuvre à l’échelon d’une communauté. Nous développerons ensuite notre approche qui s’insère dans une perspective écologique dynamique (Hawe, Shiell et Riley, 2009). L’intégration de la compréhension des liens, rétroactions (Hawe, Shiell et Riley, 2009) et construction des diverses strates et composantes (Glasgow et al., 2003) d’un système dynamique à plusieurs niveaux (individuel, professionnel, communautaire et national) apportera du sens aux phénomènes étudiés (Shareck, Frohlich et Poland, 2013). L’unité d’analyse de choix est celle des communautés et pratiques communautaires, qui ont le potentiel de « traduire » les principes scientifiques en actions efficientes (Butterfoss, Goodman, Wandersman, 1993; Specter, 2008; Wandersman, 2003; Wandersman et Florin, 2003 ; dans Fagan, Hanson, Hawkins et Arthur, 2009 ; Shareck, Frohlich et Poland, 2013). La communication proposera ensuite une mise en œuvre de cette approche à partir de l’analyse des dynamiques en cours dans 45 projets dans 15 pays européens dans le cadre du Projet Européen Hepcom (promotion de l’activité physique et prévention de l’obésité infantile) financé par le Plan Santé de l’union européenne 2008-2013. Seront plus particulièrement présentées les modalités d’analyse des déterminants contextuels (micro, méso et macro) et professionnels (redéfinition et organisation de la tâche) en jeu dans l’implantation d’un dispositif

Parents' perspectives on conflict in paediatric healthcare: a scoping review

Background Conflict in paediatric healthcare is becoming increasingly prevalent, in particular relation to paediatric end of life. This is damaging to patients, families, professionals and healthcare resources. Current research has begun to explore perspectives of healthcare professionals (HCPs), but the parental views on conflict are lacking.Objectives This scoping review explores parental views on conflict during a child’s end of life. In addition, parental views are mapped onto HCPs’ views.Methods A search was completed of the databases CINAHL, PubMed, Web of Science, Embase and Medline between 1997 and 2019, focused on parents of children with involvement with palliative or end-of-life care referring to conflict or disagreements.Results The review found 10 papers that included parental views on conflict. Data on conflict were categorised into the following seven themes: communication breakdown, trust, suffering, different understanding of ‘best interest’, disagreements over treatment, spirituality and types of decision-making. In particular, parental expertise, perspectives on suffering and ways of making decisions were significant themes. A subset of themes mirror those of HCPs. However, parents identified views of conflict unique to their perspective.Conclusions Parents identified important themes, in particular their perspective of what constitutes suffering and ‘best interest’. In addition, parents highlight the importance of being recognised as an expert

Implementation and Sustainability Dynamics of School-based Health Education Projects

International audienceI - INTRODUCTION:Prioritizing health inequalities reduction emphasizes the relevance of targeting health determinants in public health interventions. The school, as a focal point in communities, offers great potential for such interventions, thus endorsing a crucial role in implementing public health strategies on an international(Marmot, 2011)or national level, with for example the National Health Strategy in France(Cordier et al., 2013).In French schools, the policies implemented are consistent with a health promoting approach, focusing on academic achievements for all and citizenship (MEN, 1998), thus calling for project management, credentialing of all stakeholders and new partnerships (MEN, 2011). The preceding Health Education Policy coherently follows up from the National Health Policy and is integrated in school projects as formalized on an academy level (MEN 2011). Health Education exists in the French Educational System as a transversal entity associating clearly defined content such as clear health education learning objectives within existing academic disciplines (e.g. developing social and citizenship competency), associated with more implicit objectives such as working on common values, social and physical environment management, collective work. Teacher training has been strengthened, development of health education related competencies made evident in concurrently structured of policies (MEN 2013). In practice, policies are implemented through programmes and projects which also impact professional practice development in health education.Nevertheless, one cannot fail to observe, that implementation of health promoting policies sometimes proves difficult on a school level (IUHPE, 2010), and on a professional level, especially among teachers. As stated in the literature, in schools, professional practices are heterogeneous due to difficulties in grasping what is at stake in health education. Among the potential factors impacting health education practice, one may distinguish from institutional, professional, personal and contextual factors(Simar & Jourdan, 2010), the very context of the school also proving critical (Guével, Pommier, Jourdan, D., 2013). Programmes based on support and professional training tend to be more efficient, as long as training is sufficiently intensive and consistent with professional identity and core activities(Simar & Jourdan, 2010). While “one shot” interventions, unique and/or isolated actions prove little efficacy, programmes adapted to context-specifics(Stewart-Brown, 2006), based on transdisciplinary coalitions(Kegler, Steckler, Malek, McLeroy, 1998)engaged in collaboration which includes the community as a partner(Dempsey, Barry, Battel-Kirk, and the CompHp project partners, 2011)show greater relevance(St Leger, Young, 2009).Based on these conclusions, the arising question focuses on how academic level health policies, which include implementation of health promotion programmes, amongst other things, impact school health promoting dynamics in terms of what is carried out in actual facts? This retrospective study on a 10 year period aims at understanding how a health policy is structured on the level of an academy, as well as how it may have an impact on health promotion implementation dynamics on a school level. II THEORETICAL PERSPECTIVE:Our perspective thus draws on system-thinking(Glasgow, Lichtenstein, Marcus, 2003)and complexity theory(Gatrell, 2005)to focus and consider the potential contextual factors which impact professional practice in health promotion and may repercuss on the adoption of a programme and its sustainability. Among the potential factors that have been identified on a theoretical level, policy-related factors, programme-related factors, asreference prescriptive guidelineswill be explored, bearing in mind professionals’ individuality and creativity as well as how missions and tasks are redefined and carried out(J. Leplat, 2000)accordinglyThe aim of this study is consequently to explore the complex contextual factors linked to policy and programme implementation (macro level), completed with the understanding of their potential impact on the school itself, (micro and meso levels)(Glasgow, Lichtenstein, Marcus; 2003).MethodIII METHODS: This research is based on a three-study design focusing on three case-studies (Yin, 2009) based on professionals implementing a health promoting project in school settings, in variable time-frames, scales and levels of complexity. The first study aims at providing a retrospective overview of the potential factors identified in an initial programme theory elaborated in a realistic evaluation framework » (Pawson, Tilley, 2004). Data collection is ongoing and involves 2 schools that have been exposed to a healthy eating programme in different timeframes over a ten year period, thus taking into account variability in public health policies. Data collection focuses on the contextual factors in play in initial project elaboration, its adaptation in time, its adoption by professionals and stakeholders and finally its sustainability. Interviews with the project managing team, project document analysis are used to elicit and identify critical context-specific and professional-specific factors in a complex and dynamic perspective. Focus groups will be organized in the selected schools involved in the project in the last ten years to focus on collective work, sustainability and potential retroactions on the project.Expected OutcomesIV EXPECTED OUTCOMES: In analyzing the results, we expect to conceptualize the complex interactions between micro, meso and macro contextual moderating factors and their impact on professional practice and project implementation and sustainability in the field of school-based health promotion. The focus on school professionals exposed to the programmes at the initial elaboration phase of the programme (t), as well as at a later stage of evolution (t plus 10 years) already points out variability in impact of the programme, and also sustainability. In analyzing the data collected, we intend to elaborate a typology of impacts and pinpoint the corresponding modulating factors. This will lead to designing a framework for support to professional practice based on adaptation and potentiating of action in specific contexts. Potential recommendations for policy-making may also be drawn in a bottom-up perspective. V FOCUS OF THE COMMUNICATION PROPOSAL: This publication aims firstly at presenting the overall theoretical standpoint in the first study of our research framework in exposing the results of the currently ongoing retrospective study. First results from the other two studies will be briefly presented to broaden the perspective

Comprendre les mécanismes de mise en œuvre de dispositifs de promotion de la santé, projet européen HEPCOM : Des contextes d'interventions en réseau à l'activité des professionnels

International audienc