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Luoghi di Prevenzione: the holistic approach in training on strategies for bringing about change in high- risk lifestyles Paola Angelini – Public Health Service of the Emilia-Romagna Region Sandra Bosi – Luoghi di prevenzione Reggio Emilia

Luoghi di prevenzione - LDP A regional reference Centre for the training of operators on health promotion Coordinated by the Reggio Emilia League against cancer and jointly managed by the Local Health Unit, the M unicipality and the Province of Reggio Emilia, with the support of the Emilia-Romagna Region

Luoghi di prevenzione - LDP As well as being a physical and organizational setting, LDP is: • – A model for the implementation of health promotion actions – A training and guidance program for lecturers, trainers and health workers on the use of interactive techniques based on the motivational approach to change – An experiential learning through workshops with cognitive, emotional and relational components

A model for health promotion programs 1. Planning and designing health promotion actions in a shared way and through educational, social and health networks to ensure that the actions are integrated, multidisciplinary and consistent. 2. Putting the complexity of the individual at the center of the programs 3. Empowerment: • from body to corporeity • from the mind/ the brain to the whole learning person • from the user to the citizen 4. To facilitate and promote active involvement of operators in change

Reference point of LDP method Transtheoretical M odel of Change Professionals and users assess how willing they are to adopt change: change in life style but also in their professional working approach

Reference point of LDP method The pattern that connects • The focus is on the relationships between concepts rather than on individual concepts • “What pattern connects the crab to the lobster, and the orchid to the primrose and all four of them to me?”

Interactive techniques and motivational approach to change LDP methodology is based on the active involvement of people and the use of interactive techniques that motivate change in behavior and help individuals to set their own health goals The training stages are: • Exploration of personal and professional life experiences of lifestyles • Experiential scientific laboratory • Emotional analysis through expressive techniques (painting, writing, etc.) • In-depth study of decisional paths (protection factors and risk factors)

An experiential learning LDP methodology is grounded in life skills development supported by different languages, facilitating self-exploration and empowerment in decision making. By using different languages communication is made easier and self-awareness and consciousness of the self are developed.

Experiential learning The training and activities setting of LDP uses the following methodologies, in small groups: • Welcome: Brainstorming and focus group • Exploring experiences: a scientific lab, relaxation and guided imagination • Decisional skills: Role play and playback theatre • M otivational process: creative writing, art therapy, music workshop

The web platform www.luoghidiprevenzione.it

Results Every year: • about 18,000 young people are involved in LDP health promotion projects; • 1,000 health operators and 1,400 teachers receive training on LDP methodology • 800 people in risk target groups are involved in selective prevention initiatives The network of “ Health Promoting Schools” : up to now 82 secondary schools out of 480 in the Emilia-Romagna region have put into practice projects consistent with our goals and methodology The LDP method is currently shared with another 4 Italian regions as a good practice for supporting change in high-risk lifestyle

Results Good planning, solid grounding in methodology and epistemology do not automatically result in effective action. For two LDP projects effectiveness was evaluated in cluster randomized controlled trials: • “ Scuole libere dal fumo” (Smoke-free schools) involved 1,383 students aged 14-15 in 20 secondary schools. The trial has been completed and the relevant paper has been submitted to “Preventive medicine” • “ Paesaggi di prevenzione” (Landscapes of prevention) involved 5,482 students aged 12-13, and 3,840 aged 14-15. Data analysis is underway.

“SCUOLE LIBERE DAL FUM O” TRIAL : PRELIM INARY RESULTS Post-test analysis: non-smokers at the baseline 25.0 20.0 1+ 15.0 1-19 % 10.0 5.0 20+ 0.0 baseline follow-up Daily smoking (20+), control arm Daily smoking (20+), intervention arm Frequent smoking (1-19), control arm Frequent smoking (1-19), intervention arm Past 30-day smoking (1+), control arm Past 30-day smokings (1+), intervention arm

Conclusions A holistic approach, acting on the social, healthcare and educational networks, is useful in countering an unhealthy lifestyle. Working on the training of operators with strategies that envisage interaction between cognitive, emotional and relational factors increases their skills in motivational approaches, making it easier to change the individual’s behavior and the contexts and dynamics of working groups