Objectives Policy-makers rarely consult adolescents during health policy development. However, adolescent perspectives on health can inform public health policies and programs. As part of the development of an Indiana state plan for adolescent health, we used qualitative methods to describe adolescents' “emic” views of health, and discuss implications for a state health policy for youth. Patients and Methods We conducted 8 adolescent focus groups in geographically and culturally diverse regions of Indiana. Each group was audio-recorded, transcribed, and analyzed using qualitative methods. Results Participants described health as a shared responsibility between adolescents and adults in their lives. They identified a key role for supportive adults in initiating and maintaining health behaviors. Physical, financial, and informational environments could support or hinder healthy behaviors and outcomes. While adolescents' descriptions of physical health and risk behaviors were similar to adult formulations, adolescents described mental health as “stress and fatigue,” an interaction between the adolescent and their environment, rather than depression and anxiety, individual pathologies. Respect for decision-making capacity, seeking adolescent input, and providing harm reduction messages were identified as particularly important. Conclusions Adolescent perception of health can inform policies and programs, and should be sought prior to policy development.
Best practices for adolescent sex education recommend science-based approaches. However, little is known about the capacity and needs of organizations who implement sex education programs on the local level. The purpose of this research was to describe successes and challenges of community organizations in implementing science-based sex education. Using qualitative methods, we interviewed program directors and educators in 17 state-funded adolescent pregnancy prevention/sex education programs as part of a larger mixed methods evaluation. Semi-structured interviews focused on success and challenges faced in implementing science-based approaches to program design, implementation and evaluation. Interviews were audio-recorded, transcribed and analyzed using a thematic approach. Grantees included a range of programs, from short programs on puberty and HIV for late elementary students, to skills-based curricular sex education programs for high schools, to year-long youth development programs. Key aspects of curricular choice included meeting the needs of the population, and working within time constraints of schools and other community partners. Populations presenting specific challenges included rural youth, youth in juvenile justice facilities, and working with Indiana's growing Latino population. Programs selfdeveloping curricula described challenges related to assessment and evaluation of impact. Programs using commercial curricula described challenges related to curricular selection and adaptation, in particularly shortening curricula, and adapting to different cultural or social groups. A remarkable degree of innovation was observed. The use of qualitative methods permitted the identification of key challenges and successes in a state-sponsored small grants program. Information can be used to enhance program capacity and quality.
Objective: The promotion of walking could be a feasible population-level physical activity strategy because it requires little planning, is low cost and can be done year-round across settings. Community, nonprofit organisations offer one means by which to help increase walking through community programmes. The US Cooperative State Research, Education, and Extension Service has a history that spans more than a century and is known for quality in the delivery of educational programmes to help improve the lives of people in communities across the USA. The purpose of this study was to evaluate the effectiveness, feasibility and acceptability of the Get WalkIN’ intervention – an initiative supported by this programme – from the perspectives of both programme participants and county extension educators. Methods: Participants were recruited from 15 county extension sites in the Midwest region of the USA. Intervention emails targeted self-efficacy, social support, goal-setting and benefits/barriers to walking. To assess the perceptions of feasibility and acceptability of the intervention, participants and extension educators were asked to respond to a series of Likert-type scale and open-ended questions. Self-reported physical activity was assessed using the Godin Leisure-Time Physical Activity Questionnaire. Results: On average, participants and extension educators agreed that the programme was easy to use and would consider either recommending the programme to a friend or implementing the programme again within the community. Post-intervention, 69.1% of respondents were classified as sufficiently active compared to 60.5% pre-intervention. Conclusion: The use of the county-based US Cooperative State Research, Education, and Extension Service is an effective option for health promotion programming. Furthermore, a theory-based, email-mediated intervention is a valuable strategy as an independent and convenient way to facilitate increase in physical activity.
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