Effectiveness of the population-based Check your health preventive programme conducted in primary care with 4 years follow-up [the CORE trial]: study protocol for a randomised controlled trial

BACKGROUND: The periodic health check-up has been a fundamental part of routine medical practice for decades, despite a lack of consensus regarding its value in health promotion and disease prevention. A large-scale Danish population-based preventive programme ‘Check your health’ was developed based on available evidence of screening and successive accepted treatment, prevention for diseases and health promotion, and is closely aligned with the current health care system. The objective of the ‘Check your health’ [CORE] trial is to investigate effectiveness on health outcomes of a preventive health check offered at a population-level to all individuals aged 30–49 years, and to establish the cost-effectiveness. METHODS/DESIGN: The trial will be conducted as a pragmatic household-cluster randomised controlled trial involving 10,505 individuals. All individuals within a well-defined geographical area in the Central Denmark Region, Denmark (DK) were randomised to be offered a preventive health check (Intervention group, n = 5250) or to maintain routine access to healthcare until a delayed intervention (Comparison group, n = 5255). The programme consists of a health examination which yields an individual risk profile, and according to this participants are assigned to one of the following interventions: (a) referral to a health promoting consultation in general practice, (b) behavioural programmes at the local Health Centre, or (c) no need for follow-up. The primary outcomes at 4 years follow-up are: ten-year-risk of fatal cardiovascular event (Heart-SCORE model), physical activity level (self-report and cardiorespiratory fitness), quality of life (SF12), sick leave and labour market attachment. Cost-effectiveness will be evaluated according to life years gained, direct costs and total health costs. Intention to treat analysis will be performed. DISCUSSION: Results from the largest Danish health check programme conducted within the current healthcare system, spanning the sectors which share responsibility for the individual, will provide a scientific basis to be used in the development of systems to optimise population health in the 21st century. TRIAL REGISTRATION: The trial has registered at ClinicalTrials.gov with an ID: NCT02028195 (7. March 2014)

Effectiveness of a brief theory-based health promotion intervention among adults at high risk of type 2 diabetes:One-year results from a randomised trial in a community setting

AbstractAimTo examine the effect of a brief theory-based health promotion intervention delivered in the community on health behaviour and diabetes-related risk factors among Danish adults at high risk of diabetes.MethodsA randomised trial was conducted among 127 individuals aged 28 to 70 with fasting plasma glucose: 6.1–6.9mmol/l and/or HbA1c: 6.0–<6.5% (42–<48mmol/mol) recruited from general practice in Holstebro, Denmark. Participants were randomised to a control group or to receive the intervention delivered over four 2h group sessions during five weeks, and two further sessions after one and six months. Questionnaire data and clinical measures were collected at baseline, three months and one year after intervention. Primary outcomes; total-fat intake <30% of energy intake; saturated-fat intake <10% of energy intake; fibre-intake≥15g/1000kcal; weight reduction >5%; changes in physical activity.Results85% attended one-year follow-up. After adjusting for gender, age and education, Odds ratio (OR) (95% CI) intervention vs control: total-fat intake <30% energy intake: 0.52 (0.22;1.20), saturated-fat intake <10% energy intake: 1.22 (0.52;2.87), fibre intake ≥15g/1000kcal: 1.18 (0.48;2.92), weight reduction >5%: 2.47 (0.95;6.39). β(95% CI) between intervention vs control in changes from baseline: IPAQ, MET min/week: −236 (−2760; 2288), waist circumference,cm: −2.5 (−4.5; −0.5); systolic blood pressure, mmHg: −4.6 (−8.8; −0.3).ConclusionA brief theory-based health promotion intervention delivered in the community indicated effect on weight, waist circumference and systolic blood pressure at one year among Danish adults at high risk of diabetes. No effect was shown on diets or physical activity

Building school-based social capital through 'We Act - Together for Health' - a quasi-experimental study

Abstract Background Social capital has been found to be positively associated with various health and well-being outcomes amongst children. Less is known about how social capital may be generated and specifically in relation to children in the school setting. Drawing on the social cohesion approach and the democratic health educational methodology IVAC (Investigation – Vision – Action – Change) the aim of this study was to examine the effect of the Health Promoting School intervention ‘We Act – Together for Health’ on children’s cognitive social capital. Method A quasi-experimental controlled pre- and post-intervention study design was conducted with 548 participants (mean age 11.7 years). Cognitive social capital was measured as: horizontal social capital (trust and support in pupils); vertical social capital (trust and support in teachers); and a sense of belonging in the school using questions derived from the Health Behaviour in School Children study. A series of multilevel ordinal logistic regression analyses was performed for each outcome to estimate the effect of the intervention. Result The analyses showed no overall significant effect from the intervention on horizontal social capital or vertical social capital at the six-month follow-up. A negative effect was found on the sense of belonging in the school. Gender and grade appeared to be important for horizontal social capital, while grade was important for sense of belonging in the school. The results are discussed in relation to We Act’s implementation process, our conceptual framework and methodological issues and can be used to direct future research in the field. Conclusion The study finds that child participation in health education can affect the children’s sense of belonging in the school, though without sufficient management support, this may have a negative effect. With low implementation fidelity regarding the Action and Change dimension of the intervention at both the school and class level, and with measurement issues regarding the concept of social capital, more research is needed to establish a firm conclusion on the importance of the children’s active participation as a source for cognitive social capital creation in the school setting. Trial registration https://www.isrctn.com/ISRCTN8520301

Newly arrived refugees’ perception of health and physical activity in Denmark

Refugees health status after receiving asylum in their new country is often poor, both physical and mentally. Despite that, European countries rarely offer programmes specifically targeted health and health behaviour for newly arrived refugees. This study investigated newly arrived refugees’ perspective on health and in particularly physical activity (PA) upon granted asylum in Denmark. A transnational migration perspective provides the theoretical framework in this study. Semi-structured interviews with twenty newly arrived refugees provide data for the interpretative phenomenological analysis (IPA). Health manifests itself in varied ways to the newly arrived refugees and a broad and holistic perspective on health, was evident. Overall PA had important benefits, such as pain relief, better physical fitness, lose weight, a stronger body, to stay active, cater to mental health and in general something of interest to the newly arrived refugees. However, the informants experienced several barriers for doing PA and living healthy lives. Time, pain, low income, job insecurity, mental strain, discourse of health and PA (health promotion), external expectations and demands (municipality and government in Denmark), precariat living conditions and general worrying were amongst the most explicit barriers. In addition, the question of how the newly arrived refugees are positioned in their families seems vital, as patriarchal family structures seem to prevent some from doing PA. Based on the results, we underline the importance of involving refugees in developing health promotion activities while considering of their unique experiences and transnational background

Health literacy and related behaviour among pregnant women with obesity : a qualitative interpretive description study

Background: Obesity in pregnant women is increasing worldwide, affecting the health of both mother and baby. Obesity may be associated with inadequate health literacy, a central competence when navigating antenatal health information and services. This study explores women’s health literacy by examining their knowledge, motivation and skills to access, understand and evaluate health information and the related behaviour among a sample of pregnant women with a prepregnant body mass index (BMI) > 25 kg/m2. Methods: An inductive, qualitative study using an interpretive description methodology. Data was collected through ten semi-structured interviews with pregnant women with a prepregnancy BMI > 25 kg/m2 attending antenatal care at the midwifery clinic at Aarhus University Hospital in the Central Denmark Region. Results: Pregnant women with obesity understand general health information provided by health professionals, but translating this knowledge into specific healthy behaviours presents a challenge. Although difficulties navigating booking systems and available digital services contribute to this problem, apps can help facilitate navigation. However, successful navigation may depend on adequate e-health literacy. Conflicting information from health professionals, social media and families also present a challenge for pregnant women, requiring a broad skillset for critical evaluation and resolution. Conclusions: Adequate health literacy is necessary for pregnant women receiving antenatal care to (i) translate general health information into personalised healthy behaviour, (ii) access and navigate complex and digitalised systems, and (iii) critically evaluate conflicting information. Person-centred differentiation in the organisation of antenatal care may benefit vulnerable pregnant women with inadequate health literacy

Cultural adaptation and validation of the Health Literacy Questionnaire (HLQ): robust nine-dimension Danish language confirmatory factor model

Health literacy is an important construct in population health and healthcare requiring rigorous measurement. The Health Literacy Questionnaire (HLQ), with nine scales, measures a broad perception of health literacy. This study aimed to adapt the HLQ to the Danish setting, and to examine the factor structure, homogeneity, reliability and discriminant validity. The HLQ was adapted using forward-backward translation, consensus conference and cognitive interviews (n&nbsp;=&nbsp;15). Psychometric properties were examined based on data collected by face-to-face interview (n&nbsp;=&nbsp;481). Tests included difficulty level, composite scale reliability and confirmatory factor analysis (CFA). Cognitive testing revealed that only minor re-wording was required. The easiest scale to respond to positively was \u27Social support for health\u27, and the hardest were \u27Navigating the healthcare system\u27 and \u27Appraisal of health information\u27. CFA of the individual scales showed acceptably high loadings (range 0.49-0.93). CFA fit statistics after including correlated residuals were good for seven scales, acceptable for one. Composite reliability and Cronbach\u27s &alpha; were &gt;0.8 for all but one scale. A nine-factor CFA model was fitted to items with no cross-loadings or correlated residuals allowed. Given this restricted model, the fit was satisfactory. The HLQ appears robust for its intended application of assessing health literacy in a range of settings. Further work is required to demonstrate sensitivity to measure changes

National indicators of health literacy: ability to understand health information and to engage actively with healthcare providers - a population-based survey among Danish adults

Health literacy is a multidimensional concept covering a range of cognitive and social skills necessary for participation in health care. Knowledge of health literacy levels in general populations and how health literacy levels impacts on social health inequity is lacking. The primary aim of this study was to perform a population-based assessment of dimensions of health literacy related to understanding health information and to engaging with healthcare providers. Secondly, the aim was to examine associations between socio-economic characteristics with these dimensions of health literacy

The Health Literacy in Pregnancy (HeLP) program study protocol : development of an antenatal care intervention using the Ophelia process

A pregnant woman needs adequate knowledge, motivation, and skills to access, understand, appraise, and apply health information to make decisions related to the health of herself and her unborn baby. These skills are defined as health literacy: an important factor in relation to the woman’s ability to engage and navigate antenatal care services. Evidence shows variation in levels of health literacy among pregnant women, but more knowledge is needed about how to respond to different health literacy profiles in antenatal care. This paper describes the development protocol for the HeLP program, which aims to investigate pregnant women’s health literacy and co-create health literacy interventions through a broad collaboration between pregnant women, partners, healthcare providers, professionals, and other stakeholders using the Ophelia (Optimising Health Literacy and Access) process. The HeLP program will be provided at two hospitals, which provide maternity care including antenatal care: a tertiary referral hospital (Aarhus University Hospital) and a secondary hospital (the Regional Hospital in Viborg). The Ophelia process includes three process phases with separate objectives, steps, and activities leading to the identification of local strengths, needs and issues, co-design of interventions, and implementation, evaluation, and ongoing improvement. No health literacy intervention using the Ophelia process has yet been developed for antenatal care

The Relationship between Health Literacy and Health Behaviour in People with Diabetes: A Danish Population-Based Study.

Background. People with diabetes who have poor health behaviours are at greater risk for a range of adverse health outcomes. We aimed to investigate the relationship between health literacy and health behaviour (smoking, alcohol, physical activity, and diet) in people with diabetes. Methods. The study was based on respondents aged 25 years or older from a population-based survey in 2013 who reported having diabetes (n = 1685). Two dimensions from the Health Literacy Questionnaire were used: "understand health information" and "actively engage with healthcare providers." We used logistic regression to examine the association between health literacy and health behaviour. Results. After adjustment for sociodemographic factors, individuals with diabetes who found it difficult to understand information about health had higher odds of being physically inactive (OR: 3.43, 95% CI: 2.14-5.51) and having unhealthy dietary habits (OR: 3.01, 95% CI: 1.63-5.58). Similar results were observed for individuals who found it difficult to actively engage with healthcare providers. No associations were found between the two dimensions of health literacy and smoking and alcohol consumption. Conclusion. When developing health services and interventions to improve health behaviour among people with diabetes, our results suggest that they may benefit by including focus on health literacy.Peer Reviewe