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. 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 PresentationTRANSCRIPT
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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
Dr. Sima Hamadeh - Public Health 2014
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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)
Click icon to add picture
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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
Dr. Sima Hamadeh - Public Health 2014
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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
Dr. Sima Hamadeh - Public Health 2014
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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
Dr. Sima Hamadeh - Public Health 2014
Major findings
Major themes
Synthesis per
respondent group
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Results
Dr. Sima Hamadeh - Public Health 2014
Facilitators
Leadership Multidisciplinary team action Active participation Collaboration Coordination Advocacy Timing Evaluation Dissemination of results
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Results
Dr. Sima Hamadeh - Public Health 2014
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
Dr. Sima Hamadeh - Public Health 2014
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Thank You !!
Dr. Sima Hamadeh - Public Health 2014