What are the main factors that influence the implementation of disease prevention and health promotion programmes in children and adolescents?

Summary

The issue

Many disease prevention and health promotion programmes are directed at the health of children and young people because they can prevent both immediate problems (mortality and morbidity) and long-term problems. However, even where there is evidence to support such public health interventions, implementation in different settings and countries has met with varying degrees of effectiveness and sustainability. The issues addressed in this synthesis concern the main reasons for the success or failure of such programmes in Europe.

Findings

Evidence exists to support use of the following disease prevention and health promotion interventions:

• immunization programmes;
• folic acid supplementation during pregnancy;
• promotion of breast feeding;
• prevention of sudden infant death syndrome;
• promotion of use of cycle helmets, child restraints, etc.;
• smoking cessation aids;
• screening for post-natal depression; and
• psychosocial interventions for those at high risk of mental health problems.

The factors that affect the successful implementation of such programs are:

• national planning, political factors and capacity;
• availability of data about the target population and intervention impacts;
• influence of socioeconomic factors and special considerations regarding the age of target population;
• burden of the health problem to society, family and individual;
• use of intervention in a multifactorial setting;
• communication strategies through media and school to reach vulnerable and minority groups; and
• engagement of all levels of the society (from government to individual) in the process.

Policy considerations

The research evidence shows that the most effective programmes for children and young people are carried out at the government level, supported by society in general, and promote national policies to decrease poverty and increase social equality. The second most effective interventions are coordinated government policies such as pricing, legislation and other policies. (E.g. the most effective interventions against tobacco use are increasing the price of tobacco, banning tobacco product advertising, banning smoking in public places and legislation prohibiting the sale of tobacco products to young people.) There is also evidence that simultaneous, multidimensional inputs at national, local and individual level increase the effectiveness of general health promotion campaigns. The health promotion interventions that are least likely to work are ones that deal with single issues, are ‘negative in the message’, and delivered at only one level of society.

Type of evidence

This synthesis is a narrative, non-systematic review of scientific (mainly sociological) and grey literature.