The Physical Activity Promotion Environment In Mexican Health Care Settings

Purpose: The health care environment is recognized as a promising setting in which to promote physical activity (PA). Nearly 40% of Mexican adults are inactive and whether Mexican health care environments are promoting PA is unknown. The purpose of this study was to describe and compare the PA promotion environment in Guadalajara, Mexico. Methods: Forty primary care clinics and hospitals from the three health care systems in Guadalajara were sampled: 15 from the Secretary of Health, 14 from the Social Security Institutes and 11 from the private sector. A tool for measuring the PA environment of health care settings, including the availability of written PA materials, was developed. Face validity and inter-rater reliability of the tool were established (kappa=.75). Level of care (primary, secondary, and tertiary), number of floors and type of health care system of each clinic and hospital were also recorded. The tool was then used to assess the availability, accessibility, visibility, signage, cleanliness, and safety of all stairs, elevators, and green spaces at each health care setting and to record the presence of written PA materials including posters, brochures, leaflets, flyers, articles, and ‘cartels’ (hand-made posters) in the foyer and one waiting room of each clinic and hospital. Results: Thirty (75%) clinics and hospitals had stairs, 17 (42%) had elevators, 22 (55%) had green spaces and 11 (28%) had promotional PA materials (only posters or cartels). The availability of PA posters/cartels was significantly associated with health care system type (X2(2)=8.11, p\u3c.05) and with level of care (X2(2)=6.68, p\u3c.05), where primary care clinics from the Secretary of Health had significantly more PA promotional materials than clinics and hospitals from the other two systems. The health care PA environment score reflected by the stair, elevator, and green space indicators was not significantly different between the three Mexican health care systems (p\u3e.05); the score was low across the three systems (Mean=3.7, SD=2.7, Range=-2-10). Conclusions: Mexican health care settings are not PA friendly. Interventions to enhance the PA promotion environment in the three Mexican health care systems are needed to reach inactive patients

The Public Health Leadership and Implementation Academy for Noncommunicable Diseases.

PURPOSE AND OBJECTIVES: Low- and middle-income countries (LMICs) have a large burden of noncommunicable diseases and confront leadership capacity challenges and gaps in implementation of proven interventions. To address these issues, we designed the Public Health Leadership and Implementation Academy (PH-LEADER) for noncommunicable diseases. The objective of this program evaluation was to assess the quality and effectiveness of PH-LEADER. INTERVENTION APPROACH: PH-LEADER was directed at midcareer public health professionals, researchers, and government public health workers from LMICs who were involved in prevention and control of noncommunicable diseases. The 1-year program focused on building implementation research and leadership capacity to address noncommunicable diseases and included 3 complementary components: a 2-month online preparation period, a 2-week summer course in the United States, and a 9-month, in-country, mentored project. EVALUATION METHODS: Four trainee groups participated from 2013 through 2016. We collected demographic information on all trainees and monitored project and program outputs. Among the 2015 and 2016 trainees, we assessed program satisfaction and pre-post program changes in leadership practices and the perceived competence of trainees for performing implementation research. RESULTS: Ninety professionals (mean age 38.8 years; 57% male) from 12 countries were trained over 4 years. Of these trainees, 50% were from India and 29% from Mexico. Trainees developed 53 projects and 9 publications. Among 2015 and 2016 trainees who completed evaluation surveys (n = 46 of 55), we saw pre-post training improvements in the frequency with which they acted as role models (Cohen's d = 0.62, P <.001), inspired a shared vision (d = 0.43, P =.005), challenged current processes (d = 0.60, P <.001), enabled others to act (d = 0.51, P =.001), and encouraged others by recognizing or celebrating their contributions and accomplishments (d = 0.49, P =.002). Through short on-site evaluation forms (scale of 1-10), trainees rated summer course sessions as useful (mean, 7.5; SD = 0.2), with very good content (mean, 8.5; SD = 0.6) and delivered by very good professors (mean, 8.6; SD = 0.6), though they highlighted areas for improvement. IMPLICATIONS FOR PUBLIC HEALTH: The PH-LEADER program is a promising strategy to build implementation research and leadership capacity to address noncommunicable diseases in LMICs

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth:Results and Analysis From 49 Countries

BACKGROUND: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. METHODS: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations' human development index (HDI) classification (low or medium, high, and very high HDI). RESULTS: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. CONCLUSIONS: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.</p

Global matrix 4.0 physical activity report card grades for children and adolescents : results and analyses from 57 countries

Background: The Global Matrix 4.0 on physical activity (PA) for children and adolescents was developed to achieve a comprehensive understanding of the global variation in children’s and adolescents’ (5–17 y) PA, related measures, and key sources of influence. The objectives of this article were (1) to summarize the findings from the Global Matrix 4.0 Report Cards, (2) to compare indicators across countries, and (3) to explore trends related to the Human Development Index and geo-cultural regions. Methods: A total of 57 Report Card teams followed a harmonized process to grade the 10 common PA indicators. An online survey was conducted to collect Report Card Leaders’ top 3 priorities for each PA indicator and their opinions on how the COVID-19 pandemic impacted child and adolescent PA indicators in their country. Results: Overall Physical Activity was the indicator with the lowest global average grade (D), while School and Community and Environment were the indicators with the highest global average grade (C+). An overview of the global situation in terms of surveillance and prevalence is provided for all 10 common PA indicators, followed by priorities and examples to support the development of strategies and policies internationally. Conclusions: The Global Matrix 4.0 represents the largest compilation of children’s and adolescents’ PA indicators to date. While variation in data sources informing the grades across countries was observed, this initiative highlighted low PA levels in children and adolescents globally. Measures to contain the COVID-19 pandemic, local/international conflicts, climate change, and economic change threaten to worsen this situation

Assessing the physical activity environment in Mexican healthcare settings

Objective. To assess the informational, educational and instrumental environments among Mexican healthcare settings for their potential to promote physical activity (PA).Materials and methods. The Environmental Physical Activity Assessment Tool for Healthcare Settings (EPATHS) was developed to assess the PA environments of 40 clinics/hospitals representing the three Mexican healthcare systems in Guadalajara. The EPATHS assessed the presence and quality of PA enhancing features in the informational (e.g. signage),educational (e.g. pamphlets), and instrumental (e.g. stairs)environments of included clinics/hospitals. Results. 28 (70%) clinics/hospitals had more than one floor with stairs; 60% of these had elevators. Nearly 90% of stairs were visible, accessible and clean compared to fewer than 30% of elevators. Outdoor spaces were observed in just over half (55%) of clinics/hospitals, and most (70%) were of good quality. Only 25% clinics/hospitals had educational PA materials. Conclusions.The PA instrumental environment of Mexican healthcare settings is encouraging. The informational and educational environments could improve

The Influence of Physical Education Lesson Context and Teacher Behaviour on Student Physical Activity in Mexico

Objective: To explore the influence of physical education (PE) lesson context and teacher behaviour on moderate-to-vigorous physical activity (MVPA) in Mexican children during PE class. Methods: Trained observers rated the physical activity intensity (lying down, sitting, standing, walking, vigorous movement) of 232 students from grades 3 to 5, PE lesson context (management, general knowledge, fitness knowledge, fitness, skill practice, game play, free play), and teacher behaviour (promoting fitness, demonstrating, instructing, observing, managing, other task) during PE class in 20 public elementary schools in Mexico City using the System for Observing Fitness Instruction Time (SOFIT). Regressions with backward elimination were conducted. Results: Class duration was on average 33.6 minutes (SD=7.9). Boys (M=14.8 min, SD=6.8) spent more time in MVPA than girls (M=12.6 min, SD=6.1; p<.01). For boys, a model including game play (ß= 1.04, p<.001), skill practice (ß=.54, p<.01), and fitness (ß =.53, p<.05) explained 45% of the variance in MVPA (p<.05). For girls, a model including fitness (ß= .49, p<.05), fitness knowledge (ß= .19, p<.05), and other task (ß=.35, p<.05) explained 38% of the variance in MVPA (p<.05). Conclusion: Strategies and policies aimed at improving child physical activity levels during PE class should endorse the effective instruction and execution of fitness, game play, skill practice and PE lesson contextsObjetivo: Explorar la influencia del contexto de las clases de educación física (EF) y el comportamiento del maestro en la actividad física moderada-vigorosa (AFMV) en niños mexicanos. Métodos: Usando el método Sistema de Observación del Tiempo de Instrucción de la condición Física (SOFIT). Observadores entrenados midieron la intensidad de la actividad física (acostado, sentado, de pie, caminando, movimiento vigoroso) de 232 estudiantes de 3ro a 5to grado, el contexto de la clase, (gestión, conocimiento general, conocimiento de la condición física, condición física, práctica de habilidades, juego, juego libre), y el comportamiento del maestro (promoción de la condición física, demostración, instrucción, observación, gestión, otra tarea) durante la clase de EF en 20 escuelas públicas de educación primaria de la ciudad de México mediante el SOFIT. Se llevaron a cabo regresiones múltiples. Resultados: La duración promedio de las clases observadas fue de 33.6 minutos (DE = 7.9). Los niños (M = 14.8 min, DE = 6,8) pasaron más tiempo en AFMV que las niñas (M = 12.6 min, DE = 6.1; p <.01). En niños, el tiempo de clase dedicado al juego (â= 1.04, p <.001), la práctica de habilidades (â = .54, p <.01) y la condición física (â = .53, p <.05) explico el 45% de la varianza en AFMV (p <.05). En niñas, el tiempo de clase dedicado a la condición física (â= .49, p <.05), al conocimiento sobre la condición física (â= .19, p <.05), y otras tarea (â= .35, p <.05) explico el 38% de la varianza en AFMV (p <.05). Conclusión: Las estrategias y políticas encaminadas a la mejora de los niveles de actividad física de los niños durante la clase de EF deben suscribir la enseñanza efectiva y la promoción de la condición física, el juego, y el desarrollo de las habilidades práctica

Implementation Science to Address Health Disparities During the Coronavirus Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is disproportionally affecting racial and ethnic minorities. In the United States, data show African American, Hispanic, and Native American populations are overrepresented among COVID-19 cases and deaths. As we speed through the discovery and translation of approaches to fight COVID-19, these disparities are likely to increase. Implementation science can help address disparities by guiding the equitable development and deployment of preventive interventions, testing, and, eventually, treatment and vaccines. In this study, we discuss three ways in which implementation science can inform these efforts: (1) quantify and understand disparities; (2) design equitable interventions; and (3) test, refine, and retest interventions

Implementation science to address health disparities during the coronavirus pandemic

The coronavirus disease 2019 (COVID-19) pandemic is disproportionally affecting racial and ethnic minorities. In the United States, data show African American, Hispanic, and Native American populations are overrepresented among COVID-19 cases and deaths. As we speed through the discovery and translation of approaches to fight COVID-19, these disparities are likely to increase. Implementation science can help address disparities by guiding the equitable development and deployment of preventive interventions, testing, and, eventually, treatment and vaccines. In this study, we discuss three ways in which implementation science can inform these efforts: (1) quantify and understand disparities; (2) design equitable interventions; and (3) test, refine, and retest interventions