Objective: Research has shown that developing health literacy in early life is critical to reducing lifestyle-related diseases, with schools being identified as central settings for this purpose. This paper examines how one classroom-based health educational programme, IMOVE, helped Danish primary school pupils develop health literacy related to physical activity. It discusses curriculum-integrated health education’s contribution to promoting health literacy. Design: Qualitative classroom observation. Setting: IMOVE was implemented in 12 school classes (grades 5–7) in four public schools in Copenhagen, Denmark, during the autumn and winter of 2013–2014. Participants numbered 281 pupils and nine teachers. Method: We used Nutbeam’s conceptualisation of health literacy as a theoretical framework to assess which levels of health literacy the programme would promote; we assessed these using data derived from 59 IMOVE lesson transcripts. Results: IMOVE primarily contributed to the development of functional health literacy by building a relational understanding between everyday practice and step numbers. We observed the presence of interactive health literacy in discussions about how pupils and teachers could change their daily practices. Only a limited number of discussions supported the development of critical health literacy. Conclusion: Our findings suggest that educators can successfully integrate health literacy development into classroom-based curriculum teaching, with pupils’ own step counts and associated reflections positively influencing learning. However, in this study, classroom teaching was limited to a focus on cognitive skills and only partially supported the development of more critical health literacy skills. Our findings call for further research into approaches to support classroom-based critical health literacy development.

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BackgroundSince stakeholders’ active engagement is essential for public health strategies to be effective, this review is focused on intervention designs and outcomes of school- and community-based noncommunicable disease (NCD) prevention interventions involving children and young people.MethodsThe review process was based on the principles of scoping reviews. A systematic search was conducted in eight major databases in October 2015. Empirical studies published in English, French, Portuguese, and Spanish were considered. Five selection criteria were applied. Included in the review were (1) empirical studies describing (2) a health intervention focused on diet and/or physical activity, (3) based on children’s and young people’s involvement that included (4) a relationship between school and local community while (5) providing explicit information about the outcomes of the intervention. The search provided 3995 hits, of which 3253 were screened by title and abstract, leading to the full-text screening of 24 papers. Ultimately, 12 papers were included in the review. The included papers were analysed independently by at least two reviewers.ResultsFew relevant papers were identified because interventions are often either based on children’s involvement or are multi-setting, but rarely both. Children were involved through participation in needs assessments, health committees and advocacy. School-community collaboration ranged from shared activities, to joint interventions with common goals and activities. Most often, collaboration was school-initiated. Most papers provided a limited description of the outcomes. Positive effects were identified at the organisational level (policy, action plans, and healthy environments), in adult stakeholders (empowerment, healthy eating) and in children (knowledge, social norms, critical thinking, and health behaviour). Limitations related to the search and analytical methods are discussed.ConclusionThere are very few published studies on the effectiveness of interventions based on children’s involvement in school- and community-based NCD prevention programmes. However, interventions with these characteristics show potential benefits, and the merits of complex multi-setting approaches should be further explored through intervention-based studies assessing their effectiveness and identifying which components contribute to the observed outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3779-1) contains supplementary material, which is available to authorized users.

The use of peer-to-peer approaches in health promotion interventions targeting youth seems to be a strategy with great potential. The aim of this study was to synthesize and assess the elements and conditions that contribute to the effectiveness of youth-led physical activity interventions. This was done using a scoping review addressing the following three research questions: What are the theoretical and intervention rationales behind peer-led physical activity interventions? What can be established regarding the effects of such interventions on participants and peer leaders? How can such interventions be strengthened? The review included 43 studies on the peer-to-peer approach, with youth in the role as peer leaders, in physical activity interventions. The identified studies suggest that youth peer leadership initiatives can increase physical activity for youth and children. However, the studies varied on a range of parameters and did not reveal any clear patterns of factors associated with impact.

The rising global burden of noncommunicable diseases (NCDs) among people with low socioeconomic status (SES) has heightened awareness of the need for primary prevention programs in low-SES neighborhoods. Social inequity in health is apparent in mental, social and physical aspects of health among people living in low-SES neighborhoods. Viewing this problem from a life course perspective and adopting a vulnerable population approach points to the importance of inducing sustainable health behavior changes in children and young people living in low-SES neighborhoods. One important factor in lowering the risk of many NCDs while improving mental health is the promotion of physical activity (PA). In this paper, we argue that lowering the risk of many NCDs and improving mental health is best achieved through setting-based programs that facilitate long-term PA behavior changes in children and adolescents living in marginalized neighborhoods. Empirical evidence indicates that extrinsic motives for participating in physical activities, such as improving health, are insufficient when long-term participation is the goal. Therefore, we argue that interventions with the aim of affecting long-term PA in low-SES neighborhoods and thereby reducing social inequities in health should include activities that aim to create more intrinsic and autonomous motivations by building on more broad and positive understandings of health and participation. Here, we advocate that sports-based recreation (SR) holds several advantages. If implemented well, SR has the potential to be a health-promoting activity that is meaningful and motivating in itself and that involves physiological health-promoting aspects (e.g., PA), a social aspect (e.g., positive relations with others), and a psychological aspect (e.g., positive experiences of oneself). Further, we suggest four practicalities that should be considered when conducting interventions: the cost of participating, the location, the facilities required, and the suitability of the SR activities.

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Health promotion increasingly involves collaboration with civil society organisations and the private sector rather than being implemented exclusively by public sector stakeholders. Health in All Policies (HiAP) is an approach that promotes health in policy-making across public sectors. This study explored intersectoral integration and collaboration for health promotion at a local community level through a qualitative single case study of a local community network in Denmark: the Husum Health Network. The paper describes and discusses strengths, weaknesses, and challenges of HiAP-inspired local efforts to build alliances and supportive environments for health within an inter-organisational community-based network. The data were generated from participant observations made at 11 meetings and events organised by the network partners and nine qualitative, semi-structured interviews with Husum Health Network partners conducted from August 2014 to February 2015. The data were analysed using a theoretical framework introduced by Axelsson and Axelsson (2006) to characterise aspects of integration and differentiation between organisations. With high levels of structural and functional differentiation between the partners, the network provided an opportunity to exercise inter-organisational integration at the local level. Integration was fostered by knowledge sharing, face-to-face interaction, and communal events. However, the loose structure of the network was a challenge to its sustainability and achievement. We argue that Health in All local Policies is a meaningful concept in the context of local community development only when referring to the polices and strategies of all stakeholder organisations involved in decision-making and agenda setting, and not just local government institutions.

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