Tools for local health in all policies implementation: evidence from an explanatory case study of Kuopio, Finland.

AIMS: This paper describes the use of three governance tools for health in all policies utilised to facilitate implementation in the municipality of Kuopio, Finland: impact assessments, a city mandate (the Kuopio strategy), and shared budgets. METHODS: An explanatory case study was used. Data sources included semistructured interviews with 10 government employees and scholarly literature. Realist scientific methods were used to reveal mechanisms underlying the use of tools in health in all policies. RESULTS: Strong evidence was found supporting initial and new theory/hypotheses regarding the use of each tool in achieving positive implementation outcomes. Impact assessments facilitated health in all policies by enhancing understanding of health implications. The Kuopio strategy aided in implementation by giving credence to health in all policies work via formal authority. Shared budgets promoted intersectoral discussions and understanding, and a sense of ownership, in addition to allowing time to be spent on health in all policies work and not financial deliberation. CONCLUSIONS: Findings confirm the efficacious use of three governance tools in implementing health in all policies in Kuopio. Knowledge and evidence-based guidelines on local health in all policies implementation are needed as this policy approach continues to be recognised and adopted as a means to promote population health and health equity.

Italian adolescents' perception of tele-psychodrama treatment during the COVID-19 Pandemic.

BACKGROUND: Psychodrama is an experiential group psychotherapy that is used to enhance adolescents' wellbeing. The COVID-19 pandemic forced the adaptation of this method to an online setting. OBJECTIVE: This qualitative study investigated whether and how tele-psychodrama provides psychological support to adolescents, in order to better understand its strengths and weaknesses. PARTICIPANTS: 14 adolescents from Northern and Central Italy. METHOD: 14 interviews were conducted at the end of group tele-psychodrama treatment and were analysed with qualitative thematic analysis. RESULTS: Three themes were identified: (1) contribution of tele-psychodrama to adolescents' well-being; (2) implementation of psychodrama to the online setting; and (3) (the) shortcomings of tele-psychodrama. CONCLUSIONS: Despite the differences between online and in-person psychodrama, all the participants expressed their appreciation of group tele-psychodrama, which contributed to their overall psychological wellbeing and helped them process difficulties that emerged during the lockdowns.

A Realist Explanatory Case Study Investigating How Common Goals, Leadership, and Committed Staff Facilitate Health in All Policies Implementation in the Municipality of Kuopio, Finland.

BACKGROUND: Health in All Policies (HiAP) encompasses collaboration across government and the consideration of health in various governmental sector's policies and decisions. Despite increasing advocacy, interest, and uptake in HiAP globally, empirical and evaluative studies are underrepresented in this growing literature, particularly literature on HiAP implementation at the local level. Finland has been a pioneer in and champion for HiAP. METHODS: A realist explanatory case study design was used to test hypotheses about how HiAP is implemented in Kuopio, Finland. Semi-structured interviews with ten government employees from various sectors were conducted. Data from interviews and literature were analyzed with the aims of uncovering explanatory mechanisms in the form of context-strategy-mechanism-outcome (CSMO) configurations related to implementation strategies. Evidence was evaluated for quality based on triangulation of sources and strength of evidence. We hypothesized that having or creating a common goal between sectors and having committed staff and local leadership would facilitate implementation. RESULTS: Strong evidence supports our hypothesis that having or creating a common goal can aid in positive implementation outcomes at the local level. Common goals can be created by the strategies of having a city mandate, engaging in cross-sectoral discussions, and/or by working together. Policy and political elite leadership led to HiAP implementation success because leaders supported HiAP work, thus providing justification for using time to work intersectorally. How and why the wellbeing committee facilitated implementation included by providing opportunities for discussion and learning, which led to understanding of how non-health decisions impact community wellbeing, and by acting as a conduit for the communication of wellbeing goals to government employees. CONCLUSION: At the municipal level, having or creating a common goal, leadership from policy and political elites, and the presence of committed staff can facilitate HiAP implementation. Inclusion of not only strategies for HiAP, but also the explanatory mechanisms, aids in elucidating how and why HiAP is successfully implemented in a local setting.

Tele-psychodrama therapy during the COVID-19 pandemic: Participants' experiences.

Italy was severely hit by the COVID-19 pandemic. In early March 2020, a series of legislative decrees have been issued, establishing the restrictions that all Italian citizens are required to respect, according to which it is strictly forbidden to leave the house if not for reasons of necessity, health, or work. This qualitative study investigated which aspects clients find helpful or hindering in shifting to group tele-psychodrama due to the COVID-19 pandemic, after participation in an in-person psychodrama group. Participants were 15 adults who were members of a pre-existing in-person psychodrama group that shifted to a tele-psychodrama group format facilitated by two psychodrama therapists. The Client Change Interview was used at the end of the tele-psychodrama as a post-treatment assessment. All the interviews were transcribed and then underwent a thematic analysis. The analysis yielded six shared themes: the role of tele-psychodrama sessions during COVID-19 pandemic; perceived effectiveness of tele-psychodrama; main advantages of tele-psychodrama; limitations encountered during the online intervention; the termination of tele-psychodrama; and the relationship with the therapist. The findings provide preliminary evidence for the clinical practice of tele-psychodrama and lays the groundwork for further studies that can contribute to the use of electronic platforms in psychodrama interventions.

A structural model of well-being, spontaneity and self-efficacy: Italian validation between adolescents and young adults.

INTRODUCTION: The passage from adolescence to young adulthood introduces many challenges and chances aimed at promoting independence, financial self-sufficiency, assumption of responsibilities and separation from parents. Literature shows that in the continuum between these two phases of life, many factors intervene, producing significant differentiations. METHODS: This study considered three dimensions - well-being, measured through the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); spontaneity, measured through the Spontaneity Assessment Inventory-Revised (SAI-R); and self-efficacy, measured through the General Self-Efficacy scale (GSE). The study involved two groups of Italian participants: 495 adolescents, aged between 13 and 19 years, selected at a high school; and 368 young adults, aged between 18 and 30 years, recruited by snowball sampling. RESULTS: Results of confirmatory factor analysis for each instrument in each group indicate the validity of the three instruments for both age groups. No significant differences were found between adolescents and young adults on total or subtotal scores of the CORE-OM, except for the risk factor. Conversely, the mean scores obtained with SAI-R and GSE were very different between adolescents and young adults. CONCLUSIONS: The results of path analysis show a significant mediation of spontaneity in the link between self-efficacy and all specific psychological distress domains for adolescents. Instead, there is a significant mediation of spontaneity between self-efficacy and all specific psychological distress domains except the risk domain for young adults.

A structural model of well-being, spontaneity and self-efficacy: Italian validation between adolescents and young adults / Um modelo estrutural entre bem-estar, espontaneidade e autoeficácia: validação italiana entre adolescentes e adultos jovens

Abstract Introduction: The passage from adolescence to young adulthood introduces many challenges and chances aimed at promoting independence, financial self-sufficiency, assumption of responsibilities and separation from parents. Literature shows that in the continuum between these two phases of life, many factors intervene, producing significant differentiations. Methods: This study considered three dimensions - well-being, measured through the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); spontaneity, measured through the Spontaneity Assessment Inventory-Revised (SAI-R); and self-efficacy, measured through the General Self-Efficacy scale (GSE). The study involved two groups of Italian participants: 495 adolescents, aged between 13 and 19 years, selected at a high school; and 368 young adults, aged between 18 and 30 years, recruited by snowball sampling. Results: Results of confirmatory factor analysis for each instrument in each group indicate the validity of the three instruments for both age groups. No significant differences were found between adolescents and young adults on total or subtotal scores of the CORE-OM, except for the risk factor. Conversely, the mean scores obtained with SAI-R and GSE were very different between adolescents and young adults. Conclusions: The results of path analysis show a significant mediation of spontaneity in the link between self-efficacy and all specific psychological distress domains for adolescents. Instead, there is a significant mediation of spontaneity between self-efficacy and all specific psychological distress domains except the risk domain for young adults.

Resumo Introdução: A transição da adolescência para a idade adulta envolve muitos desafios e oportunidades de promover independência, autossuficiência financeira, assunção de responsabilidades e a saída da casa dos pais. A literatura mostra que, na passagem entre essas duas fases do ciclo vital, muitos fatores podem intervir, gerando mudanças significativas. Métodos: Este estudo considerou três dimensões psíquicas: bem-estar, investigado através do Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); espontaneidade, investigada através do Spontaneity Assessment Inventory-Revised (SAI-R); e autoeficácia, investigada por meio da escala General Self-Efficacy (GSE). O estudo envolveu dois grupos de participantes italianos: 495 adolescentes com idade entre 13 e 19 anos, selecionados em uma escola de ensino médio; e 368 jovens adultos com idade entre 18 e 30 anos, recrutados por meio de amostragem em bola de neve. Resultados: Os resultados da análise fatorial confirmatória para cada instrumento em cada grupo indicaram a validade dos três instrumentos para as duas faixas etárias. Não foram observadas diferenças significativas entre adolescentes e jovens adultos nos resultados total e subtotal do CORE-OM, exceto pelo fator risco. Por outro lado, os resultados médios obtidos nos instrumentos SAI-R e GSE foram muitos diferentes entre adolescentes e jovens adultos. Conclusões: Os resultados da análise fatorial mostram uma mediação significativa da espontaneidade entre a autoeficácia e todos os domínios das dificuldades psicológicas específicas dos adolescentes. Em contraste, há uma mediação significativa da espontaneidade entre a autoeficácia e todos os domínios específicos das dificuldades psicológicas dos jovens adultos, exceto para o domínio risco.

A scoping review of the implementation of health in all policies at the local level.

OBJECTIVES: Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts in order to improve population health and health equity. HiAP implementation can involve engagement from multiple levels of government; however, factors contributing or hindering HiAP implementation at the local level are largely unexplored. Local is defined as the city or municipal level, wherein government is uniquely positioned to provide leadership for health and where many social determinants of health operate. This paper presents the results of a scoping review on local HiAP implementation. METHODS: Peer reviewed articles and grey literature were systematically searched using the Arksey and O'Malley framework. Characteristics of articles were then categorized, tallied and described. RESULTS: 23 scholarly articles and four government documents were identified, ranging in publication year from 2002 to 2016 and originating from 14 countries primarily from North America and Europe. A wide range of themes emerged relating to HiAP implementation locally including: funding, shared vision, national leadership, ownership and accountability, local leadership and dedicated staff, Health Impact Assessment, and indicators. CONCLUSION: Common themes were found in the literature regarding HiAP implementation locally. However, to better clarify these factors to contribute to theory development on HiAP implementation, further research is needed that specifically investigates the facilitators and barriers of HiAP locally within their political and policy context.