Canadian public health association’s annual conference

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CANADIAN PUBLIC HEALTH ASSOCIATION’S ANNUAL CONFERENCE Public Health 2014 - Toronto May 29, 2014.

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Canadian public health association’s annual conference. Public Health 2014 - Toronto May 29, 2014. School Health Policies in Lebanon:. How can we get there? Dr. Sima Hamadeh Assistant Professor of Public Health Nutrition Haigazian University Saint Joseph University. Overview. - PowerPoint PPT Presentation

Transcript of Canadian public health association’s annual conference

Page 1: Canadian public health association’s  annual conference

CANADIAN PUBLIC HEALTH ASSOCIATION’S

ANNUAL CONFERENCE

Public Health 2014 - Toronto

May 29, 2014.

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How can we get there?

Dr. Sima Hamadeh

Assistant Professor of Public Health Nutrition

Haigazian University

Saint Joseph University

School Health Policies in Lebanon:

Dr. Sima Hamadeh - Public Health 2014

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Overview

Lebanon

Health problems Call for policies Research study

Methodology, results & conclusion

Moving to action Challenges & opportunities

Dr. Sima Hamadeh - Public Health 2014

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Globalization, Health & Food Food globalization is having a catastrophic

effect on the health of the nations in both the developing & developed countriesDelisle, H. & Strychar I. Obesity at adolescence: prevention is timely even in low income countries. SCN news, 2006; 32:51-57.

Nutrition transition is taking place at a fast rate with changes related to Food Lifestyle factors Healthcare systems Hamadeh S. & ElZein H. Epidemiology of obesity in children and adolescents: Prevalence and Etiology – (Ch

8)Middle East and North Africa (MENA) Countries. New York: Springer 2011.

Dr. Sima Hamadeh - Public Health 2014

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Nutrition transition

Lebanon has been experiencing a nutritional transition in food choices during the past years from typical Mediterranean diet into the fast food pattern http//www.who.int/countryfocus

http//www.fao.org/ag/agn/nutrition/lbn_en.stm

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Obesity & Overweight

Recent Lebanese studies found obesity in Lebanon is mainly due to poor dietary practices & sedentary lifestyle (Naja et al., Eur J Nut,2011 ; Nasreddine et al., Publ Health Nut, 2011 ; Hwala et al., World Rev Nut Diet,2005)

Dr. Sima Hamadeh - Public Health 2014

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Obesity & Overweight

Prevalence of Overweight & Obesity:1) ≠ between Lebanese regions

2) higher : ♂ , less educated, lower income families

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Obesity & Overweight

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… ?!

This highlights a clear need to draw on the

latest scientific evidence

to take action &

to further recommend mobilization efforts

(Government, Intl agencies, local communities…)

Dr. Sima Hamadeh - Public Health 2014

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Call for policies

Findings alert to the importance of formulating policies & nutritional strategies to curb the obesity rise in the country

School Health Strategy (SHS), 2009

Previous studies Strategies & policies

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11Objectives: To improve the health status of youth & the school personnel To provide a safe learning environment for students & a safe workplace for staffTo reinforce the relationship between education & health professionals & the community

School Health Strategy in Lebanon (2009)

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Research study

Perceptions of different stakeholders to the eventual School Nutrition

Policy in Lebanese schools

Hamadeh S. & Marquis M. 2013 (3 articles) Research summary published in the SCN news No39, 2011 of the United Nations

System Standard Committee on Nutrition (UNSCN)

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Objective

To explore the facilitators & the barriers to the SHS implementation by studying stakeholders’ perceptions of an eventual School Nutrition Policy in Lebanon SHS objectives Role distribution SHS pertinence

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Methodology

Exploratory Qualitative Research : Social marketing approach

Socio-behavioral, organizational changes and communication theories & models

Health Belief Model Rossister-Percy Motivational Model Theory of trying Protection Motivation Theory Diffusion theory Communication theory Theories of Organizational Change

Integrated conceptual framework To guide the planning & the evaluation of the policy

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Individual variables

Perceptions (benefits, barriers, severity,

susceptibilty)Cues to action

Demographic variables Psychosocial variables

Personal efficacy

Organizational variables Innovation

Communication Organization (school)

Applied research Inter-organizational

relationshipsTime

Community variables

AttitudeIntention

ImplicationAnterior actions

Probabiblity

School Nutriti

on Policy

Social structure

Motivation

Mobilization Social conflict

Knowledge

Integrated conceptual framework to study perceptions

associated with an eventual development of School Nutrition

PolicyHamadeh S, Marquis M, 2013.

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Methodology

Sample : N = 115 participants 32 multidisciplinary key stakeholders 8 schools (35 adults & 48 youth )

4 Private schools (2/region)

4 Public schools (2/region)

Semi Rural

-1 Director *-3 students (10-12 y) & 3 students (12- 14 y)-1 Focus group (parents-teachers)*-1 Food service manager *

-1 Director *-3 students (10-12 y) & 3 students (12- 14 y)-1 Focus group (parents-teachers)*-1 Food service manager *

Urban

-1 Director *-3 students (10-12 y) & 3 students (12- 14 y)-1 Focus group (parents-teachers)*-1 Food service manager *

-1 Director *-3 students (10-12 y) & 3 students (12- 14 y)-1 Focus group (parents-teachers)*-1 Food service manager *

* Recruited in only 4 schools

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Methodology

Data collection (2 open-ended questionnaires) Directed & semi-structured individual

interviews Key stakeholders, students, directors & food

services managers Focus groups (6 to 8 participants)

Teachers & parents

Analysis Thematic qualitative analysis

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Major findings

Major themes

Synthesis per

respondent group

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Results

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Facilitators

Leadership Multidisciplinary team action Active participation Collaboration Coordination Advocacy Timing Evaluation Dissemination of results

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Results

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Barriers

Lack of data Lack of resources Lack of cooperation (public-private

sectors)

Miscommunication Inappropriate school

environments Social structures Socioeconomic & political status Parental & social role modeling

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Physical environment - Public schools

Urban Semi rural

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Physical environment - Private schools

Urban Semi rural

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Food services – Schools

Public Private

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Results- Conceptual framework The innovative holistic conceptual framework:

Useful in understanding the dynamic of health behaviors & the external influences on human behaviors

Offers perspectives on how School Nutrition Policy is intended to work & to produce desired changes

Can guide other national & Intl. research to develop and evaluate the components of school health policies by adapting the conceptual framework for their needs

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24 Moving to action

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Moving to action

Steps of

SNP development

•Explore the context •Define objectives•Identify appropriate theoretical model

•Allocate resources •Chose indicators •Establish partnerships

Planning

•Training & networking •Systematic implementation of multisectoral & comprehensive strategies

•Monitoring & feedback (with sufficient flexibility)

Implementation •Formative evaluation

•Process & outcomes evaluation

•Costs •Other consequences (feasibility for other groups, regions, countries)

Evaluation

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Challenges & Opportunities

School Nutrition Policies

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Challenges …

Government & Other sectors Lack of data Lack of collaboration & cooperation Lack of motivation & mobilization Lack of resources (financial &/or human) Absence of multidisciplinary approach Absence of ongoing consultation Social conflict (role & power distribution) Political, religious & region considerations

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Opportunities… M

ultich

anne

l

com

mun

icat

ion

Th

e “c

omm

unic

atio

ns m

ap”

is

com

plex

, var

iabl

e & u

nfam

iliar

How ?

What ?

When ?

To whom ?

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Opportunities…

Ecosocial model adapted from Renaud et al., 2007.

Parties politiques

Universités

Groupes de

pression

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School Nutrition PoliciesHow We Get There ??

School

Nutrition

Policies

Legislation

Community

develo-pment

Fiscal change

Re-orientati

on of services

Organiza-tional changes

Health educatio

n

National

stra

tegie

s

+

sub-s

trate

gies

Multifactoral

approach

Intersectoral

collaboration

Regional

focus

Community

based

Socially oriente

d

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Thank You !!

Dr. Sima Hamadeh - Public Health 2014