Health Promotion International[JOURNAL]
Sun
200 papers
Dissuasive measures on tobacco products: a rapid review of global evidence.
Brown S, Banks E, Inthavong A … +1 more , Villarosa A
Health Promot Int · 2026 May · PMID 42200554 · Full text
New and innovative measures are needed to combat tobacco industry marketing strategies and reduce the harm caused by tobacco products. This rapid review aimed to identify and synthesize global evidence relating to dissua...
New and innovative measures are needed to combat tobacco industry marketing strategies and reduce the harm caused by tobacco products. This rapid review aimed to identify and synthesize global evidence relating to dissuasive tobacco product measures, defined as unappealing colours and/or messages directly applied to individual tobacco products to discourage uptake and motivate cessation. Scopus, PubMed, Ovid, and Google were systematically searched from January 2000 to September 2024 to capture all published evidence relating to dissuasive measures, regardless of study design and tobacco product investigated. 'Forward' and 'backward' citation searching was also conducted. Studies were assessed for quality using JBI critical appraisal tools. Forty-seven eligible publications from 6011 titles/abstracts were included, all relating to conventional cigarettes: 37 peer-reviewed journal articles, including 2 reviews, 29 empirical studies (19 quantitative, 9 qualitative, 1 mixed-methods) and 6 commentaries, 8 government publications, 1 market research report and 1 doctoral thesis. Evidence largely related to perceptions of dissuasive products and their likely impacts. No empirical evidence regarding the relation of dissuasive measures to tobacco control outcomes was located. When compared with standard cigarettes, darker coloured cigarettes-often brown and green-were perceived to be less appealing, whilst cigarettes with messages related to the impact of smoking on finances, others, mortality, and life expectancy were viewed as novel and effective, and capable of inciting behavioural change. The available evidence is generally supportive of dissuasive cigarettes as a tobacco control measure, although a lack of empirical evidence on tobacco control outcomes limits the findings.
Consumption of four unhealthy commodities and exposure to advertising, sponsorship, and promotion in Bamako, Mali.
Rosen HE, Dolo H, Khan AS … +6 more , Doumbia CO, Thiam S, Konate B, Diallo M, Doumbia S, Paichadze N
Health Promot Int · 2026 May · PMID 42200553 · Full text
Non-communicable diseases (NCDs) are the leading cause of death and disability globally and risks for many NCDs are associated with commercial determinants of health for tobacco, alcohol, ultra-processed foods (UPFs), an...
Non-communicable diseases (NCDs) are the leading cause of death and disability globally and risks for many NCDs are associated with commercial determinants of health for tobacco, alcohol, ultra-processed foods (UPFs), and sugar-sweetened beverages (SSBs). Our aim was to understand reported consumption patterns of these four commodities along with reported exposure to advertising, promotion, and sponsorship (APS), focusing on vulnerable groups including young adults (18-24), less wealthy (quintiles 1 and 2), and women. We conducted a systematic randomized household survey of adults at two sites in Bamako, Mali to collect socio-demographic factors and measure reported consumption and exposure to APS for the commodities. We calculated descriptive statistics and performed χ2 tests to assess differences by three vulnerable groups. We surveyed 984 participants and found high reported consumption of SSBs (78%) and UPFs (67%) at least once per week, together with low reported current tobacco use (11%) and low reported alcohol use (1%) in the past 30 days. More than half of participants reported exposure to APS in the past 30 days for SSBs (76%) and UPFs (57%) while tobacco and alcohol reported exposure was lower (38% each). Young adults had higher reported consumption of SSBs and UPFs and higher reported APS exposure for both commodities compared with older groups. Systems-level interventions are recommended including increasing the SSB tax, adding a UPF tax, and strengthening enforcement of the APS ban for tobacco. These findings suggest further research on the usefulness of an APS ban for SSBs and UPFs targeted to young adults.
A community-informed approach to develop a gardening model for the Bangladeshi community in Brooklyn, NY.
Chan SW, Kamal F, Dowd R … +3 more , Sultana S, Islam NS, Yi SS
Health Promot Int · 2026 May · PMID 42178225 · Full text
Nationally, there is increased investment in interventions that address diet-related chronic diseases however few studies and interventions are developed to reflect the values and lifestyles of many communities, presenti...
Nationally, there is increased investment in interventions that address diet-related chronic diseases however few studies and interventions are developed to reflect the values and lifestyles of many communities, presenting a barrier to participation. This study aims to better understand the motivators and barriers for the Bangladeshi American community in Brooklyn, New York to participate in diet-related interventions. Formative qualitative interviews were conducted in English and Bangla with Bangladeshi adults (n = 12) to understand current shopping/cooking behaviors, access and usage of food programs, awareness and interest in food programs, and future program preferences. Participants reported three key themes: centrality of community behaviors for program acceptability, creating opportunities to leverage community and social motivations, and addressing logistical concerns during program development. Gardening emerged as a promising program offering to increase access to fresh produce, strengthen community bonds, and foster cross-cultural understanding. Using community feedback, Harvest Share Seedlings, a community-informed home gardening program, was co-developed and implemented with farming and community partners to increase access to fresh produce for the Bangladeshi community. The findings highlight the need to understand and center community-specific considerations when designing and implementing food programs and interventions. Adopting a community-informed approach increases uptake and acceptability from the community, and ensures sustainability in the long run.
'We gout your back': a qualitative study to co-design educational gout resources with Pacific people in Aotearoa New Zealand.
Tu'akoi S, 'Ofanoa S, Tohi M … +6 more , Pauuvale A, Heather M, Lutui H, Lamont R, Goodyear-Smith F, 'Ofanoa M
Health Promot Int · 2026 May · PMID 42170956 · Full text
Pacific peoples in Aotearoa New Zealand experience some of the highest rates of gout worldwide. Although understanding gout and urate-lowering therapy is a key component of ensuring uptake and adherence to medication, Pa...
Pacific peoples in Aotearoa New Zealand experience some of the highest rates of gout worldwide. Although understanding gout and urate-lowering therapy is a key component of ensuring uptake and adherence to medication, Pacific communities have identified a lack of resources and tools to support this. The objective of this qualitative study was to co-design education resources for Pacific patients and communities in Aotearoa New Zealand, aiming to increase awareness of gout and of urate-lowering therapy. A Pacific Research Collective, comprising Pacific community members, health professionals, and researchers, led this study. Guided by the Samoan Fa'afaletui model, six co-design workshops were undertaken using semistructured talanga (interactive talk with a purpose), and this paper presents the results from the latter three workshops. Participants included Pacific community members and health professionals aged 20-75 years and included Samoan, Tongan, Cook Islands Māori, and Niuean ethnicities. Participants reviewed existing gout resources, developed prototypes, and provided iterative feedback. Data was collated in NVIVO, and reflexive thematic analysis was used to inductively develop five key themes: (i) a disconnect between existing gout resources and community needs, (ii) Pacific-centred approaches to improve understanding of gout, (iii) benefits of video resources, (iv) recognizing diverse Pacific audiences, and (v) reflections on final co-designed resources. This co-design process prioritized Pacific views and lived experiences to develop culturally grounded gout education resources that can be utilized in healthcare settings and community outreach programmes. Future research should continue to partner with communities to ensure education approaches are relevant, appropriate, and impactful.
Using systems archetypes to understand system behaviour and identify leverage points for change in local obesity prevention in The Netherlands.
O'Mara J, Crielaard L, Hagenaars L … +2 more , Stronks K, Waterlander W
Health Promot Int · 2026 May · PMID 42159192 · Full text
Participatory system dynamics (SD) approaches view public health problems as the result of a complex system of interactions. However, most public health research makes a direct leap from system mapping-often through caus...
Participatory system dynamics (SD) approaches view public health problems as the result of a complex system of interactions. However, most public health research makes a direct leap from system mapping-often through causal loop diagrams (CLDs)-to identifying actions for change, without trying to understand the behaviour of the system as a whole and how actions could intervene. This is possibly because robust methods are lacking. This study aimed to explore whether 'systems archetypes' can bridge this gap to (1) better understand system behaviour, (2) identify leverage points (LPs) for change deeper in the system, and (3) provide a more structured and traceable analysis. We developed a novel approach using 11 systems archetypes for a post hoc analysis of the LIKE project-a participatory SD project on childhood obesity prevention in Amsterdam, the Netherlands. For each LIKE mechanism, we compiled a complete archetype profile, including the storyline, CLD, and behaviour over time graph, for which two were cross-checked with empirical data over time. We identified six systems archetypes. The most common was 'fixes that fail', in which a 'fix' applied to a problem creates unintended consequences that reinforce the problem. This can lead to 'shifting the burden' in which resources are siphoned from addressing the root cause of the problem. Compared with the original analysis, we identified LPs deeper in the system and found that systems archetypes structured the process, suggesting that systems archetypes can effectively help public health researchers hypothesize how to change system behaviour.
Welcoming and caring schools: a health-promoting schools analysis from a 2-year Canadian universal school lunch pilot.
Michnik K
Health Promot Int · 2026 May · PMID 42159191 · Full text
To advance the long-term goal of a universal national school food program (SFP) in Canada, understanding the benefits of such programs is important. Through 2021-23, a universal curriculum-integrated school lunch pilot w...
To advance the long-term goal of a universal national school food program (SFP) in Canada, understanding the benefits of such programs is important. Through 2021-23, a universal curriculum-integrated school lunch pilot was introduced in two low-income and culturally diverse schools in Saskatoon, Saskatchewan, Canada. Case study research and interviews with 43 school staff were conducted over the course of the pilot to understand school and student-level benefits. Following an inductive-deductive analysis informed by a Health Promoting Schools (HPS) approach, it was found that the universal lunch enhanced the schools' social environment and supported teaching and learning. Results demonstrated that the pilot improved the well-being of students through creating welcoming and caring spaces in the school, supporting student achievement and attendance, enriching student food exposure and healthy eating, and enhancing opportunities for learning. Furthermore, the introduction of the universal lunch was reported to reduce the stigma of school lunch and support staff wellness. This research suggests freshly prepared, nutritious, and inclusive universal lunch programs can be an effective policy approach to support health promotion in schools. Recognizing the holistic benefits of universal lunch programs can help health and education sectors and other partners work together to advance lunch programs as school-wide, HPS interventions.
How is health equity considered in scale-up guidance? A scoping review of process models for scaling public health innovations.
Marshall S, Frolov E, de Carvalho Corôa R … +3 more , Koorts H, Milat A, Lee K
Health Promot Int · 2026 May · PMID 42159190 · Full text
Scale-up guidance is valuable to guiding efforts to increase the reach and impact of public health innovations. Health equity, that is, 'the absence of systematic disparities in health between groups' is often a motivato...
Scale-up guidance is valuable to guiding efforts to increase the reach and impact of public health innovations. Health equity, that is, 'the absence of systematic disparities in health between groups' is often a motivator for scale-up though it is unclear how 'equity' is considered within existing scale-up guidance. This scoping review aimed to identify the equity considerations articulated within existing scale-up models. Five databases and grey literature were systematically searched. Articles were included if they explicitly developed a model/framework to guide the process of scaling-up public health innovations. Search results were screened, and content analysis was undertaken. Of the 29 scale-up models identified, 24 included mention of equity terms or equity-related characteristics, however there was variation in how equity was conceptualized and the extent to which it was incorporated. Seven domains were developed to describe how equity was considered: (1) Equity acknowledged in the supporting text as an important factor when scaling-up; (2) Equity positioned as a guiding principle or cross-cutting theme; (3) Equity considered in scalable innovation design or intended population; (4) Equity incorporated into scale-up planning and strategy development; (5) Equity assessed within context and environment assessments; (6) Equity factored into resource allocation and workforce planning; (7) Equity considered in stakeholder engagement. There was considerable variation in how equity was considered which offers opportunities for enhancements. Existing and future scale-up models can be strengthened by applying a more consistent equity focus, and providing more comprehensive, actionable guidance for undertaking equitable scaling of public health innovations.
Reconciliation or reputation: critical analysis of commercial sector commitments and framing in reconciliation action plans.
Leersen P, Fredericks B, Brown AD … +2 more , Browne J, Paradies Y
Health Promot Int · 2026 May · PMID 42101924 · Full text
Reconciliation action plans (RAPs) are increasingly used by commercial organizations in Australia to demonstrate commitment to Aboriginal and Torres Strait Islander peoples. Framed as tools to promote understanding and a...
Reconciliation action plans (RAPs) are increasingly used by commercial organizations in Australia to demonstrate commitment to Aboriginal and Torres Strait Islander peoples. Framed as tools to promote understanding and address historical injustice, these documents also serve organizational interests, particularly in reputation management and corporate social responsibility (CSR). This research critically examined the structure, practices, portfolios, resources, and transparency of high-level RAPs of for-profit organizations operating in the state of Queensland, Australia. Drawing on frame analysis, critical discourse analysis (CDA), and commercial determinants of health frameworks, this study explored how reconciliation and associated commitments are defined, justified, and operationalized within corporate discourse. The analysis showed that resource-rich corporations leveraged their power to manage reconciliation as a corporate asset rather than address structural inequities. Five overlapping frames, 'instrumental reconciliation, performative accountability, symbolic leadership, truth signalling, and substantive recognition', were identified through which reconciliation is positioned within corporate discourse of legitimacy, measurement, and control. While many organizations adopt languages of codesign, self-determination, and cultural safety, translation into demonstrable processes and measurable outcomes remains inconsistent and limited. These findings highlight how RAPs can both provide entry points for engagement while simultaneously reinforcing existing power relations. The research contributes to understanding the commercial determinants influencing Aboriginal and Torres Strait Islander health and wellbeing, calling for stronger accountability, transparency, and Aboriginal and Torres Strait Islander leadership within corporate reconciliation agendas.
International consensus on school health literacy responsiveness: findings from a modified Delphi process.
Chu TC, Elmer S, Cruickshank V … +3 more , Peralta LR, Kelly RK, Nash R
Health Promot Int · 2026 May · PMID 42096641 · Full text
There is a lack of validated tools to assess health literacy responsiveness, defined as the organizational capacity of schools to create accessible and equitable environments that support health literacy development, in...
There is a lack of validated tools to assess health literacy responsiveness, defined as the organizational capacity of schools to create accessible and equitable environments that support health literacy development, in school settings internationally. This study, the second phase of a three-part research program, aimed to develop a school-based health literacy assessment tool through a systematic, multi-step development process. Building on a prior scoping review that identified 629 items from existing tools, 210 refined items were presented to 22 international experts via a modified Delphi survey. Experts rated relevance, domain fit, and need for revision. Consensus, derived from qualitative analysis of expert feedback, revealed 47 items as highly important, 119 as potentially relevant, and 44 as unsuitable for schools. Expert feedback informed conceptualization of organizational health literacy in schools. The items reflect practical considerations, cross-national, and multidisciplinary perspectives. Findings highlight strong support for domains such as communication, engagement, and workforce development. The next phase includes pilot testing and validation to support implementation of a tool to promote health literacy among students, teachers, and leaders.
Developing a patient reported measure on out-of-pocket healthcare expenditure among Aboriginal patients: a formative study.
Ryder C, Sharpe P, Sallows G … +16 more , Coombes J, Mahoney R, Goodman A, Hughes JT, Sleep J, Johnson T, Pearson O, Oster C, Karnon J, Drummond C, Omodei-James S, Otieno L, Henderson P, D'Angelo S, Cominos N, Bonevski B
Health Promot Int · 2026 May · PMID 42085664 · Full text
Healthcare costs not subsidized by the government and are covered by patients, are known as out-of-pocket healthcare expenditure (OOPHE). In Australia, OOPHE disproportionately impacts Aboriginal households, particularly...
Healthcare costs not subsidized by the government and are covered by patients, are known as out-of-pocket healthcare expenditure (OOPHE). In Australia, OOPHE disproportionately impacts Aboriginal households, particularly in rural and remote regions. Currently no patient reported measures (PRM) to assess OOPHE exist, despite being an identified priority in Aboriginal communities. This study developed and psychometrically evaluated (validity and test-retest reliability) of an OOPHE PRM for Aboriginal households in outer regional to remote areas. This Aboriginal led study was governed by an Aboriginal Governance Group, which involved a 4-stage process: (i) identification of community-derived OOPHE themes; (ii) item development and expert judgment quantification; (iii) exploratory factor analysis (EFA) to determine factor structure through pilot testing with Aboriginal participants; and (iv) assessment of reliability and stability through test-retest methods. Stage 1 identified OOPHE themes (i.e. barriers, financial strain), informing development of a 15 item PRM in Stage 2. In Stage 3, 39 Aboriginal participants completed Test 1, with EFA revealing a two-factor model; Factor 1 (8 items, internal consistency = 0.91) and Factor 2 (6 items, internal consistency = 0.85). In Stage 4, 32 participants completed Test 2, with over 60% of items showing substantial to perfect agreement (κ = 0.61-0.87) and scale-level reliability as good to excellent (ICC = 0.75-0.92). Two items performed poorly and were removed, resulting in a final 13-item PRM. The OOPHE PRM demonstrates promising psychometric properties as a culturally grounded measure of OOPHE burden among Aboriginal families, supporting advocacy for equitable policy, funding, and health system reform.
Sustaining Healthy Communities in rural settings: lessons from multisectoral teams in Alberta, Canada.
Gillies C, Baay C, Liu JKK … +1 more , Patterson S
Health Promot Int · 2026 Mar · PMID 42046903 · Full text
The Alberta Healthy Communities Approach (AHCA) supports communities in creating environments that support healthy behaviors and reduce the risk of cancer and chronic disease. In this 4-year project, participating rural...
The Alberta Healthy Communities Approach (AHCA) supports communities in creating environments that support healthy behaviors and reduce the risk of cancer and chronic disease. In this 4-year project, participating rural communities implemented an iterative five-step process that included establishing multisectoral teams (MSTs) to develop, implement, and evaluate health promotion initiatives aligned with local priorities. Communities received implementation support through mentoring and facilitation, evidence-based tools, and seed funding. This study examined: What factors are essential to sustaining the AHCA in rural communities? Nineteen communities and 258 MST members participated. Community perspectives on factors and strategies influencing sustainability were captured through surveys and focus groups. Data were analyzed using conventional content analysis and codebook thematic analysis, and findings were synthesized narratively. Five key factors were identified, including: strong local leadership, community engagement, municipal support, capacity building, and maintaining collaboration. Strategies that supported sustainability included: developing transition plans and sharing responsibilities across MST members; maintaining ongoing, tailored engagement activities and using multiple communication channels; engaging local government early and aligning initiatives with municipal priorities; identifying training, mentoring, and shared learning opportunities; and investing continuously in relationships and trust building. These findings offer actionable recommendations for strengthening rural health promotion efforts and sustaining MSTs and community-led initiatives. Overall, the study highlights that proactive sustainability planning is a key contributor to the long-term success of community-led health promotion in rural settings.
How do Australian workplaces support breastfeeding mothers in 2025? A content analysis to develop a 'Supportive Workplace Checklist'.
Blanch B, Cooklin AR, Bridges N … +1 more , Amir LH
Health Promot Int · 2026 Mar · PMID 42037008 · Full text
Few studies have described uptake and implementation of breastfeeding friendly workplace initiatives from employers' perspectives in Australia. Our aim was to describe how Australian breastfeeding friendly workplaces rep...
Few studies have described uptake and implementation of breastfeeding friendly workplace initiatives from employers' perspectives in Australia. Our aim was to describe how Australian breastfeeding friendly workplaces report supporting breastfeeding mothers in paid employment. We explored the characteristics and/or workplace profiles of Australian BFWs listed on a publicly available Australian Breastfeeding Association (ABA) website. Each BFW provides: a lactation space, lactation breaks and a supportive workplace culture. Based on these profiles, systematic reviews, published literature, and information on the ABA website, we created a 46-item inventory of supportive workplace factors and counted the number of factors present per profile. On 1 October 2025, we identified 138 BFWs on the ABA website, most commonly from federal government and government agencies (n = 30; 22%) and hospitals and health care service industries (18; 13%). Fifty-seven (41%) organizations published a workplace profile. Of a possible 46, the median number of supportive factors or workplace benefits was 13 (IQR: 10-17.5). Three frequently reported factors: supportive workplace culture (93%), flexible work conditions (74%), and work-life balance (70%). Workplaces demonstrated many ways to support breastfeeding mothers. Future studies should focus on better understanding employers' perspectives of providing workplace supports and whether the lived experiences of mothers returning to work match the purpose of each workplace initiative.
Integrating health promotion into the educational mission: a 25-year bottom-up institutional trajectory in a Chilean university.
Castillo-Rosales M, Araya-Piñones A, van Niekerk Bakit N … +4 more , Brito I, Afonso de Andrade Brunherotti M, Alfaro-Navarro V, Bakit T
Health Promot Int · 2026 Mar · PMID 42037007 · Full text
Although universities worldwide are increasingly adopting health promotion strategies, there remains limited longitudinal evidence on how these initiatives are institutionally integrated and sustained over time, especial...
Although universities worldwide are increasingly adopting health promotion strategies, there remains limited longitudinal evidence on how these initiatives are institutionally integrated and sustained over time, especially in Latin American contexts. This study explores the 24-year trajectory (1999-2023) of the first Health Promotion Policy implemented at a Chilean university, providing rare insights into a long-term bottom-up institutional process. In analytical terms, the VIVE UCN Evaluation Model was applied using the milestones (M), actors (A), processes (P), and challenges (C) (MAPC) framework, a convergent mixed-methods design that combined a qualitative documentary analysis of 47 official and unofficial sources with quantitative analysis using descriptive statistics. The MAPC framework was applied to documents from 1999 to 2023, including policy texts, management reports, and evaluation records, to systematically identify milestones, actors, processes, and challenges shaping the policy trajectory. Findings reveal that community participation and collective ownership were key to the policy's institutionalization, shifting health promotion from isolated initiatives into an educational and organizational commitment. By documenting a sustained, bottom-up experience from the Global South, this study contributes new longitudinal evidence to the field of health-promoting universities. Ultimately, integrating the health promotion policy into the educational mission demonstrates a long-term commitment to creating healthy settings and empowering the academic community to address the social determinants of health-both goals recommended by the World Health Organization for higher education institutions.
Australia's proposed gambling reforms may be good for industry, but not for public health.
Thomas S, Pitt H, McCarthy S … +2 more , Murray M, Daube M
Health Promot Int · 2026 Mar · PMID 42028844 · Full text
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Cardiovascular disease risk reduction interventions for indigenous women: an umbrella review.
Rahman T, Bingham A, Carrington MJ … +5 more , Chenhall R, Eades F, Joshy G, Banks E, Eades S
Health Promot Int · 2026 Mar · PMID 42011628 · Full text
Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women-particularly Indigenous women-whose CVD needs differ in...
Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women-particularly Indigenous women-whose CVD needs differ in terms of symptom presentation, healthcare access, receipt of guideline-recommended care and sociocultural roles. This review aims to summarize the effectiveness of CVD prevention interventions in Indigenous women in the USA, Canada, New Zealand and Australia. Umbrella review of systematic reviews and randomized and non-randomized interventions examines the effectiveness of pharmacological and nonpharmacological interventions in reducing CVD risk in target countries in Indigenous adult studies with ≥50% women. Systematic searches were conducted across six electronic databases between January and February 2024 (update: February 2025). Quality assessment applied standard methods and evidence was synthesized qualitatively. The protocol was PROSPERO registered (CRD42024575310). Six systematic reviews and 16 primary studies (7 randomized and 9 non-randomized; 11,473 participants; 50%-100% women) in Indigenous participants were included. Evidence was limited and generally of low certainty. Four randomized studies were exclusively in Indigenous women (Australia and USA). Only one pharmacological study was identified, investigating vitamin D in reducing blood pressure. Non-pharmacological interventions demonstrated potential to improve CVD risk factors, primarily adiposity, blood pressure, lipids, and glucose. Participant involvement was generally limited and continuation was problematic. This first umbrella review on CVD risk reduction in Indigenous women suggests an urgent need for high-quality evidence to inform and make CVD prevention accessible and equitable for them. Future studies should employ consumer-led, innovative, and context-specific strategies to ensure inclusive recruitment and sustain participant engagement.
A decade on: exploring the Okanagan Charter's continued international relevance for health promotion in higher education.
Noonan A, Tierney A, Norton C … +2 more , McNally K, Woods CB
Health Promot Int · 2026 Mar · PMID 42003728 · Full text
Over the past decade, the Okanagan Charter has guided health promotion in higher education, but shifts in the sector have raised questions about its ongoing global relevance. This study explored international stakeholder...
Over the past decade, the Okanagan Charter has guided health promotion in higher education, but shifts in the sector have raised questions about its ongoing global relevance. This study explored international stakeholder perspectives on the Charter's applicability and identified priority areas for potential revision. An anonymous, cross-sectional survey was developed on Qualtrics and distributed internationally via purposive sampling. The survey included 19 ordinal-scale questions, each paired with a related open-ended question and demographic questions. Quantitative data were analysed descriptively and with independent samples t-tests, while qualitative data were examined using Braun and Clarke's reflexive thematic analysis. A total of 488 participants from 48 countries responded (English, n = 455; Spanish, n = 43). The majority were aged 35-44 years (28%) and 71% identified as female. Respondents held diverse and often multiple roles, including health and well-being professionals (42%), academics (33%), administrators (26%), and students (9%). Collectively, 1951 comments were submitted. Among the participants who completed all 19 questions exploring the relevance of each Charter component (n = 330), 77.3% recommended revising at least one area. Four overarching thematic areas were identified: evolving contexts and concepts, leadership and governance, implementation and evaluation, and language syntax and comprehension. While the Okanagan Charter remains a valued document, most respondents advocated for targeted revisions to better reflect the evolving needs of higher education. These findings highlight key areas for consideration in any future iteration and underscore the importance of continued global dialogue to support healthier campus environments.
Facilitating food security systems change in regional Australia through a strengths-based, co-design process.
Chiera I, Doe J, Stoneham M … +2 more , Devine A, Godrich SL
Health Promot Int · 2026 Mar · PMID 42003727 · Full text
Food security is a multifaceted, 'wicked' issue that refers to the sufficient physical, social, and economic access to food at all times. Given its complexity, food security action requires a systems-based, collaborative...
Food security is a multifaceted, 'wicked' issue that refers to the sufficient physical, social, and economic access to food at all times. Given its complexity, food security action requires a systems-based, collaborative, and adaptive approach. This paper outlines the application of a strengths-based, co-design process to support food security systems change among government and community-led initiatives operating in rural, regional, and remote areas of Western Australia. Baseline, semistructured interviews were conducted with leaders of food initiatives to understand whether and how the initiatives were contributing to food security systems change and identify the 'windows of opportunity' where initiatives could be strengthened. Participants co-designed actions to address the 'windows of opportunity' and enhance their initiatives. Six months after the co-design process, follow-up interviews were conducted to understand which actions had been implemented. Interview data were analysed thematically using NVivo. Twenty-seven initiative leaders co-designed an action plan, which included 244 actions in total. Based on the 10 six-month follow-up interviews that were conducted, 28 actions were implemented across nine initiatives. Initiative leaders were most likely to implement actions that required fewer resources and could leverage existing activities in comparison to actions that required collaborating or engaging with government representatives. To enhance food security systems change, initiative leaders require support to undertake actions related to government advocacy and collaborating with government organizations.
The role of schools in mental health promotion and prevention: a document analysis of Swedish local mental health policies.
Rydstad L, Eriksson C, Larm P … +1 more , Fjellfeldt M
Health Promot Int · 2026 Mar · PMID 41994975 · Full text
It has been recognized that schools play a key role in promoting well-being and preventing mental health problems among children and adolescents. The local context is crucial for realizing the school's health-promotive p...
It has been recognized that schools play a key role in promoting well-being and preventing mental health problems among children and adolescents. The local context is crucial for realizing the school's health-promotive potential. This study aimed to explore how the role of schools is approached in Swedish municipal policy documents governing mental health efforts. A qualitative document analysis using the READ approach was conducted. Seventy-three municipalities were selected and asked to provide policy documents on mental health; twelve policy documents met the inclusion criteria and were analyzed using conventional content analysis. The analysis identified the school as a central actor across the documents. Four categories were constructed: (i) the school as a context influencing mental health, (ii) the school as a platform for reaching all children and adolescents with mental health interventions, (iii) the school as responsible for detecting mental health problems, and (iv) the school as a collaborating partner in mental health efforts. The analysis highlighted a primarily individualized and often medicalized understanding of mental health problems, positioning health professionals as key actors. Although the school's role as a context influencing mental health was clearly acknowledged, teachers, pedagogical support and social relationships were overlooked in relation to this role. The school's role in mental health efforts was thus largely detached from its educational mission. Finally, there was substantial variation in the activities expected of schools across municipalities. Hence, despite schools' recognized importance, their role in mental health efforts was subject to local interpretation of national policy within a decentralized school system.
Engaging youth in systems thinking for active recreation: piloting a Collective Intelligence approach.
Ma J, Cao D, Hogan M … +4 more , Bolton KA, Salmon J, Vilhelmsen M, Koorts H
Health Promot Int · 2026 Mar · PMID 41989088 · Full text
Youth active recreation is influenced by complex interactions among factors in the active recreation system. Systems approaches can help identify ways to intervene; however, young people are rarely involved in this proce...
Youth active recreation is influenced by complex interactions among factors in the active recreation system. Systems approaches can help identify ways to intervene; however, young people are rarely involved in this process. This study piloted the use of Collective Intelligence (CI), a participatory systems approach, to engage young people in identifying barriers to active recreation and co-creating solutions. Three CI workshops were conducted in Victoria, Australia, involving nine participants aged 12-17. In each workshop, participants generated and prioritized barriers, co-created systems maps, and collaboratively designed solutions aligned to the mapped systems. Field notes captured reflections on facilitation and youth engagement. Across workshops, 48 barriers were identified and grouped into eight categories: Shyness and social skills, Lack of support, Financial, Time, Space and equipment, Public Transport, Safety, and Medical. Participants then co-created solutions across individual (n = 5), community (n = 11), and government (n = 5) levels. Individual-level strategies focused on enhancing social skills; community-level ideas focused on public transport and inclusive spaces; Government actions included subsidies for extracurricular activities. Reflections highlight the value of CI to engage young people in articulating interconnected influences in their lived experience with active recreation. Key strengths of the process included making complexity visible and actionable. Challenges included uncertainty of upstream issues, uneven participant engagement, conflation of terms, and maintaining focus. This study offers actionable strategies to potentially overcome these challenges for anyone who wants to engage young people in systems thinking. The inclusion of a youth researcher was valuable in supporting young people to contribute their ideas.
Using legal capacity building to achieve Sustainable Development Goal 3.4: a global case study.
Slattery C, Malone A, Zhou S … +1 more , Jones H
Health Promot Int · 2026 Mar · PMID 41989087 · Full text
The McCabe Centre for Law and Cancer's international legal training programme (ILTP) aims to raise the capacity of government lawyers from low- and middle-income countries to use the law to address noncommunicable diseas...
The McCabe Centre for Law and Cancer's international legal training programme (ILTP) aims to raise the capacity of government lawyers from low- and middle-income countries to use the law to address noncommunicable diseases (NCDs). We used qualitative data to evaluate impacts of this long-term capacity-building programme to complement tangible impacts, such as law and policy reform found in an earlier evaluation. We undertook 17 interviews with alumni of and stakeholders involved with the ILTP over the period 2014-23. The interviewer conducted semistructured interviews. Two reviewers used inductive content analysis to code the interviews. We found that alumni and stakeholders valued the programme's role in building networks of participants with legal skills relevant to NCDs and in empowering individuals to become champions for NCDs. Interviewees also took a broader view of impact than the completion of individual law and policy reform projects, considering many law and policy changes, regional initiatives, and leadership roles of alumni beyond those formally supported as part of the programme to have been a key impact of the programme. The study highlights the need to invest in NCD legal capacity building and leadership for the long term. We find that building a community of people with the skills, confidence, and commitment to act on NCDs is a key impact of such programmes, in addition to laws and policies developed.
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