Evidence-Based Programs in the context of today’s Knowledge Society and Research and Development, Transfer and Innovation (R&Di) activities; (2) To provide a Classification of Programs based on the degree of specialization required for appropriate professional use in line with the requirements of the Code of Ethics in Psychology; (3) To tentatively propose a Protocol for the Registration of Evidence-Based Educational Psychology Programs; and (4) Finally, to identify some implications of the protocol. We conclude that there is a need for a General Register of validated programs.The turn to evidence-based interventions is significant for Psychology in general and for Educational Psychology in particular. Although there is a great deal of published evidence for program validation, there is currently no protocol for the evaluation of educational psychology evidence-based intervention programs and there is no General Register of such programs to act as a central information depository. This article has four objectives: (1) To assess the significance of the turn to  Psychological Intervention Programs gave some 360,000 results, Educational Intervention Programs produced some 4.5 million publications, and Educational Psychology Intervention Programs gave 3 million results. Those figures demonstrate the large volume of work concerning the creation and use of Programs, properly so called.The development of Psychology as a science and of the discipline of Educational Psychology has led to a proliferation of conceptual models in each area of study and the development of assessment and intervention tools to implement those models in professional practice. A Google Scholar search for Intervention Program describes a set of components or structured decisions and actions intended to have a particular effect in a given personal or social environment  activities; (2) To provide a Classification of Programs based on the degree of specialization required for appropriate professional use consistent with the requirements of the Code of Ethics in Psychology; (3) To tentatively propose a Protocol for the Registration of Evidence-Based Educational Psychology Programs for Educational Psychology Intervention Programs; and (4) Finally, to identify some implications of the protocol. We conclude that there is a need for a General Register of validated programs.Consequently, this article has four objectives: (1) To assess the significance of the turn to The Research, Development, and Innovation (R&Di) chain as it operates in the Knowledge Society has achieved much, as we can see by considering the links in that chain individually  and intervention (Programs) fall into this category: they are technological (in the true sense of the term) developments in a conceptual domain in a given area of knowledge and as such should be developed and applied scientifically. Consequently, the knowledge they are based on—the underlying theoretical model and other principles and assumptions—should be clear.The transfer of such innovations for use in a given population requires the systematic collection and assessment of evidence to identify the results of an intervention. This closes the circle by allowing theoretical prediction and outcomes to be compared and contrasted.Knowledge Transfer Departments are the channel through which those activities are carried out. In essence, the mission of Knowledge Transfer Departments is to encourage research, development and (ultimately) knowledge transfer. They also promote the appropriate use of programs based on robust evidence that allows the effects of interventions to be predicted with a high level of confidence.University Turn to Evidence-Based Programs has become more prevalent.For all those reasons, the Turn to Evidence-Based Program has developed with the notion of scientific evidence in other areas . The use of evidence-based interventions requires the adoption of criteria for the evaluation and review of intervention programs.The provision of evidence for any treatment or intervention program is a key to moving toward high-quality scientific psychological interventions. In many fields of Health Sciences  and in eAlthough it may seem obvious, words are currently being used indiscriminately in a way that makes it hard to identify the area of study from which Educational Psychology Intervention Programs originate. Because of that lack of clarity, three types of intervention program are being used without their natures and scopes being fully clear.For these purposes, an Intervention Program can be characterized as a suite of formal decisions, i.e., planned, explicit decisions that are contextualized, systematized, and intended to have specific effects. Those effects may be intended to arise within a family, a school, among teachers or students and concern the processes of development, learning, or teaching in any of those settings that in the aggregate constitute the process of education. We can categorize intervention programs as follows. Educational Intervention Programs fall conceptually and functionally under the umbrella of Educational Science, which is the suite of disciplines dedicated to the scientific study of different aspect of education in specific societies and cultures. That group of disciplines reflects the integration of all the sciences that may focus on a given educational problem, namely: Pedagogy, Comparative Pedagogy, General and Specific Didactics, Sociology, Anthropology, Philosophy, Economics, Theology (where applicable), and Psychology. Consequently, we can use the term Educational Intervention Program for any program that: (1) addresses an educational problem from an educational perspective; (2) falls within the combined field of any of those disciplines; and (3) is capable of being implemented by a professional educator with no specific qualifications beyond a teaching qualification and subject expertise in the curricular subject to which the Program relates. Most subject-specific educational programs come under this heading. Educational intervention programs are generally used by teachers in schools.This category is made up of professional programs that are closer in concept to interventions as understood in Psychopedagogical (a classification used in Spain), Pedagogical, and Educational Guidance . AlthougIt should be noted that Psychopedagogy in a sense makes Psychology and the other disciplines subordinate to Pedagogy and Didactics, its core disciplines. These programs are essentially pedagogical in focus, with some ancillary elements or insights from other disciplines, such as Psychology. Thus, such programs are not necessarily based on models, assessment techniques, or interventions from within Psychology. This can be exemplified by comparing a Health Education Program drawn up as part of the general education of students  and a prEducational Psychology . If a Program concerns learning, it will seek to improve the learning process and the skill of learning to learn in any of its conceptual, procedural or attitudinal aspects. Programs to improve teaching also fall into this category.This group is for all Intervention Programs specific to the adjustment, treatment and improvement of any difficulties and problems that arise in the macroprocesses of development and learning.Specific academic guidance and career-orientation programs are in this group.This category includes all Intervention Programs associated with computer-supported innovation relating to the improvement of a process, product, or service within educational psychology: Apps, Computer Programs, etc.Optimization of Personal and Social Development. If a program is intended to support learning under stress conditions, it would be in the specific area of Optimization of the Learning Process.Level 3 is for the specific type of treatment within the broader Level 2 area. For example, an Emotional Intelligence program would be in the specific area of It is important to capture the nature of the Program in terms of the level at which intervention is made.Programs intended to optimize the processes of development or learning in their initial phases before the emergence of educational problems.Programs aimed a rechanneling development processes when the first symptoms of maladjustment or difficulty have appeared.Programs aimed at intervening when problems have manifested.Programs aimed at prevention of the unwanted side effects of prior interventions.This section contains:The basic details of a program: its name, the specific problem addressed, year of creation, the authors, and any registered intellectual property rights (IPR).The structure of the Program, the materials for the Program, the publisher (if any), the English language version (if any), and any consents.The details for use and transfer, the person to contact to use the program and any R&Di contracts when a Knowledge Transfer Department is involved.Integral to an evaluation of an Intervention Program is an explicit statement of the underlying theoretical model and the supporting empirical evidence published in recognized international scientific publications. Such evidence is generally in the form of published peer-reviewed articles or manuals.There are numerous models in educational psychology that have been confirmed by evidence. Programs can be analyzed by issue, field of intervention and how up to date they are. As a general proposition, reviews of specific research topics and manuals of research review  describePublished peer-reviewed reports of research and impact assessments that set out the effects of the Program and the general procedure for each study in sufficient detail for it to be replicable are also required for full evaluation of a Program. To that end, information is required as follows:Sample: inclusion and exclusion criteria, type of sample.Validity and reliability of instruments used to validate a program, whether part of the program itself or other instruments recognized by the scientific community.The details of the procedure should be sufficiently clear to enable replication in new samples. It is essential to provide Ethics Committee approvals and where applicable the Pre-Clinical Registration of the validation study.The study design  should bThe results should be presented clearly and unambiguously relative to the expected effects of Program implementation. This section, depending on the nature of the results submitted and the design, is key to determining the nature of the evidence provided and its strength.The list of published research should be provided. That will enable the sufficiency and adequacy of the evidence to be determined.Following Strong evidence: Results are consistent and designs are robust  and well-implemented.Medium evidence: Results are consistent but the design has a medium level of consistency .Weak evidence: Results have consistency but the design is very weak with descriptive data.Evidence non-existent: No results are provided that constitute evidence and the design is very weak.Professional field1.1. Optimization of processes of development, teaching, and learning .1.2. Management of special educational needs and learning difficulties.1.3. Academic and career guidance.1.4. Research, Technological Development, and Innovation in Psychopedagogy.Specific field2.1. Optimization of processes of learning.2.2. Optimization of processes of development.2.3. Optimization of processes of teaching.2.4. Management of special educational needs in development processes.2.5. Management of special educational needs in learning processes.2.6. Academic guidance.2.7. Career guidance.2.8. Research, Technological Development and Innovation in Psychopedagogy.Subprogram3.1. Psychomotor Development3.2. Personal  Development3.3. Social-Ethical Development3.4. Cognitive Development3.5. Linguistic Development.Type of program4.1. Preventive (primary prevention)4.2. Palliative (secondary prevention)4.3. Treatment (tertiary prevention)4.4 Retrospective (Stage 4 prevention)Name of the Program:Problem addressed:Year of creation:Authors:Intellectual Property Registration:Structure OF Intervention Program:Materials:Publisher (if any):Previous English-language version (if any) and associated consents (if any):Translation into English (if any):Details of use and transfer:Contact:Existence of R&D contract for use (if any):Theoretical Basis. Theoretical models on which program is based. Recent evidence:Validation method:2.1. Participants.2.2. Instruments.2.3. Procedure.2.4. Data design and analysis.Results obtained: synthesis of results.References to significant publications (peer review system):Evaluation proposal :5.1. Strong evidence:5.2. Medium evidence:5.3. Weak evidence:5.4. Evidence non-existent:General area1.1. Optimization of processes of development, teaching, and learning .1.2. Management of special educational needs and learning difficulties.1.3. Academic and career guidance.1.4. Research, Technological Development, and Innovation in Psychopedagogy.Specific area2.1. Optimization of processes of learning.2.2. Optimization of processes of development.2.3. Optimization of processes of teaching.2.4. Management of special educational needs in processes development processes.2.5. Management of special educational needs in learning processes.2.6. Academic guidance.2.7. Career guidance.2.8. Research, Technological Development, and Innovation in Educational Psychopedagogy.Subprogram3.1. Psychomotor Development.3.2. Personal  Development.3.3. Social-Ethical Development.3.4. Cognitive Development.3.5. Linguistic Development.3.6. Language Learning.3.7. Mathematical Learning.3.8. Social Learning.3.9. Personal Learning.Type of program4.1. Preventive (primary prevention).4.2. Palliative (secondary prevention).4.3. Treatment (tertiary prevention).4.4. Retrospective (Stage 4 prevention).Name of the program: ALADO Program to Prevent Alcohol Abuse in Adolescents.Problem: Prevention of Alcohol Consumption by Adolescents.Year of Creation: 2012.Authors: Lead researchers:Dr. Jesús Enrique de la Fuente AriasDr. Inmaculada Cubero TalaveraParticipating researchers:Dr. Francisco Javier Peralta SánchezDr. María Dolores Sánchez RodaIntellectual Property:Teacher guide: ISBN: 978-84-938657-3-3Intervention guide: ISBN: 978-84-938657-2-6ALADO is an online program for the prevention of the consumption and abuse of alcohol. It is aimed at young people aged 12–16 and is split into nine modules that progressively educate participants about the undesirable effects of alcohol consumption. The program provides the essential tools to enable young people to reduce or avoid the consumption of alcohol through management of their own behavior.To make participants aware of the effects of alcohol consumption for adolescents, particularly, on their brains. The program seeks to decisively change attitudes to alcohol and to give participants strategies to regulate their own behavior so that they can avoid excessive alcohol consumption. We offer participants mechanisms to access pertinent information through a fun, attractive online platform, which has been designed and structured to appeal to young people.To teach young people that alcohol is a drug that has negative effects on our health.To encourage abstinence from alcohol.To teach and offer behavioral strategies to truly say NO to alcohol, particularly in social situations where there is peer pressure.The program is conceived as a school activity to be carried out in the classroom and includes help and guidance for tutors and teachers. However, ALADO is available online and so can also be used in the home. It has been developed to be free-standing so that anyone who wants to can register and use the program content. That gives control to the family and allows the activities to be completed in the home.ALADO has a parent-teacher space called Parent-Teacher School with materials that explain and train about the effects of alcohol consumption and the different ways that the problem is addressed at national and regional level. It also offers links to websites and internet portals concerning the prevention of alcohol consumption. Parents and teachers can find valuable reading material for active involvement in the education of their children in a culture based on saying NO to alcohol. By way of example from that material:The Guide to Prevention from the National Drug Addiction Plan.Alcohol: Clinical Committee reports.NIDA prevention program.It is always your choice.Guidance for SPAN parents and strategies for taking action.Adolescence is a developmental stage of biological and cognitive maturation, which is characterized by experimental, risky behaviors. That prototypical behavior pattern is perfectly reflected in the unfortunately notorious pattern of heavy weekend binge drinking in which abstinence during the week is followed by abuse at the weekend. Although an adolescent might not always see that pattern of alcohol consumption as risky to their health, science has shown that a habit of intermittent intake in a consumption-relapse pattern is associated with neurobehavioral changes, with a tendency toward increased alcohol consumption and an increased risk of addiction in adulthood. The most recent research has shown that young people are unfortunately less susceptible to alcohol intoxication. In other words, adolescents are more resistant to alcohol’s sedative effect and so may drink larger volumes in less time…“an adolescent can take more…” Paradoxically and despite their apparent non-susceptibility to its sedative effects, alcohol affects the adolescent brain more severely than the adult brain, because young brains are still developing.Concerned at the alarming rise in alcohol abuse in our young people, a group of experts working in neurobiological research and educational psychology at the University of Almería joined forces and knowledge on ALADO, a project to develop an ALcohol prevention program for Adolescents (“with wings” in Spanish).Financed by the Ministry of Innovation, Science and Business of the Regional Government of Andalusia, the aim of the program is to bring about change in capacity and attitudes concerning excessive alcohol consumption in adolescents. ALADO is a pilot that seeks to transfer knowledge derived from research to society, to a group as highly vulnerable as adolescents.This ambitious project aims to develop the first completely free-standing software for secondary school students, parents and teachers to prevent the consumption and abuse of alcohol. The strategy is to give students the necessary information and tools to be able to reflect on the effects of alcohol consumption and to prompt a change in attitudes toward alcohol.As a pilot project, the expert group in Almería implemented the program in secondary schools to work with students in the 12–16 age range before they had become habituated to the consumption of alcohol. ALADO was implemented in the classroom in curriculum time over a period of 1 year.Using appropriate evaluation tools, the effectiveness of ALADO was assessed using a pre-post test of the attitudes and behavior of our adolescents before and after their experience of ALADO.www.alado.es Printed material: http://www.investigacion-psicopedagogica.org/revista/new/index.php. Education & Psychology R&DI .Publisher: Publication associated with the Electronic Journal of Research in Educational Psychology. Previous English language version: No.Translated into English: No.jfuente@ual.es; icubero@ual.es; fjperalta@ual.es; R&D Use Agreement: From OTRI at the University of Almería.Details of use and transfer: Contact: Model of Competence to interact with alcohol . The proA total of 148 adolescents aged 12–16 took part in three Spanish schools with different social and cultural contexts.The Scale for the Evaluation of Facts, Concepts, and Principles concerning Alcohol .The SRQ Self-Regulation Questionnaire in its 21-item abridged form for adolescents . A total of eight items to evaluate attitudes and values toward alcohol (α = 0.825).The Adjustment Scale in interaction with alcohol, which contains four times (α = 0.915). This scale belongs to the Inventory of Knowledge, Attitudes, and Interaction with Alcohol .The data-gathering instruments were used during the course of the 2009–2010 academic year as part of the Alado Excellence Project (2007–2010) through an online tool created for the purpose.Consent to cooperation by participating schools and pupils was requested from each School Council, the teachers involved and the families (parents) of participating students. The project was approved by the Bioethical Committee of the University of Almería and by the School Council of each participating school. The students participated voluntarily. Parents were informed in writing. Since the participants in the project were still minors, both the parents and the management of the schools gave written informed consent to the research. Data were protected in a registered archive as required by the Spanish Data Protection Act.We used a quasi-experimental method with repeat measurement and inferential analysis (ANOVA and MANOVA).The results showed a principal effect for the variable Treatment, the variable Level of Self-Regulation and an interaction effect for Treatment × Self-Regulation in the conceptual and attitudinal subcompetency for interaction with alcohol. The results are discussed relative to new technology that allows evaluation and intervention in the prevention of alcohol consumption in adolescents. An important implication of this work is the importance of the psychological variable self-regulation. It also supports the suitability of educational psychology interventions in new technology formats in the prevention of alcohol consumption in adolescents as a commercial activity.References for publications in the evidence report: Final evaluation proposal :Strong evidence:Medium evidence:Weak evidence:Evidence non-existent:Protocol for the Registration of Evidence-Based Educational Psychology Programs. The proposal made here is preliminary and could be adapted to other areas of Psychology.In summary, it seems reasonable following National Register of Evidence-Based Educational Psychology Programs, similar to the register that exists for Psychological Tests  those that are not evidence-based – and have therefore not been validated – from those that have been. In summary, the proposal made in this article would be a step forward in the scientific improvement of the profession of Psychology in general and Educational Psychology in particular  and University of Almería  Project I+D (AL18-SEJ-DO31-A-FEDER).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The REATIVA program was found to be efficient in the promotion of individual and family health during the transition to retirement as an active and healthy aging process. New methodologies and intervention strategies were identified that could improve the efficacy of the program; namely, the involvement of more family members and using a blended approach.Retirement is a major life transition in adulthood that can cause vulnerability in individuals and their families. REATIVA is a face-to-face health intervention program that aims to promote the perception of self-efficacy and facilitate the transition to retirement of individuals and families. This article presents the efficiency of this program. A quasi-experimental study was conducted on 56 new retirees and families enrolled in the Portuguese National Health Service. The efficiency of the program was evaluated with the General Self-Efficacy (GSE) scale, which assesses self-efficacy, and the Retirement Adaptation Perception (EPFAR) scale, which assesses the perception of adaptation to retirement. The data were processed in IBM SPSS 27 software. An average positive change was found regarding the GSE and EPFAR in all participants of the REATIVA program. Notably, the MANOVA test with Greenhouse–Geisser correction revealed a significant effect of the program over time in the EPFAR scale (F = 17.405,  The transition to retirement is an event in the human lifecycle that occurs in late midlife and is characterized by a process of adaptation to change in a temporal space, determined by how its protagonists achieve systemic homeostasis . It invoHowever, regardless of the adaptation phase and/or the perception they present in this period of their lives, both individuals and families who experience the transition to retirement seem to agree that it is a life-changing event that requires greater adaptive effort in how to act, be, and feel as a family . This trPerceived general self-efficacy refers to people’s perceptions of their competence in performing a certain task to achieve a certain goal or outcome, which influences how they feel, think, and act, these being the foundation of human decision-making and perseverance . Taylor However, because this perception may vary due to instability and influence, individuals with high self-efficacy tend to be proactive in structures. In contrast, when self-efficacy is low, individuals are less able to exploit the opportunities provided by the system ., such as awareness of the new retiree status, knowledge about ageing adaptation process, family support and community network support [These considerations indicate the relevance of analyzing the results of other variables that constitute resources for successful retirement, support . Therefo1 in promoting active and healthy aging in individuals and couples experiencing the transition to retirement.This article aims to present the results of the assessment of the efficiency of the REATIVA program1 and EG2), who were both submitted to the REATIVA program and filled in the assessment questionnaires in the pre-test (Av1) and post-test (Av2) assessments  without any prescriptive intervention who filled in the assessment questionnaires in the pre-test and post-test assessments; and two experimental groups  before the transition to retirement of one of the spouses.For the EGThe inclusion criteria for selecting the groups were:After the intervention’s objectives were explained and the individuals meeting the inclusion criteria were identified, they were contacted by phone and invited to participate in the REATIVA program.Formal interviews were carried out with the coordinating teams of the health units where the program was to be implemented to present the objectives and the intervention model and to request their collaboration in identifying potential participants and their authorization to use their facilities for this study;All participants signed the informed consent form after having been informed of all the procedures and ethical principles inherent to the participation in a research study of this nature.Before implementing the REATIVA program:The REATIVA program  consisteFor the purpose of conducting an immediate assessment of the efficiency of this program, the assessment instruments were applied before and after the program’s implementation to measure the GSE and EPFAR variables.1 (26.8%), 12 in the EG2 (21.4%), and 29 in the CG (51.78%). Considering this was a quasi-experimental study, the participants were randomized based on the homogeneity present for the sociodemographic variables of age, gender, and education level.Participants were recruited through five randomized health-care centers in Portugal. The sample was selected in a first phase through Family Nurse identification. After the initial contact of 75 participants, 57 accepted the offer to participate in the study. After the beginning of the sessions, one participant decided to drop out of the program for typical reasons. A total of 56 individuals participated in the study: 15 in the EGde facto union (85.7%), and had more than 9th grade but no higher education (39.3%). Considering only the retirees (87.5%) and the length of retirement, 14.2% had been retired for 3–4 years, 8.9% for less than 1 year, 8.9% for 4–5 years, 10% for 1–3 years, and 3.6% for more than 5 years. During their working lives, 32.1% of the participants had administrative or similar jobs; 10.7% were specialists in intellectual and scientific professions; 10.7% were unskilled workers; 7.1% were technicians and intermediate level workers; 5.4% were manual laborers, artisans, or similar; 3.6% were senior public administration employees, managers, and company executives; and 3.6% were farmers and skilled workers in the agricultural and fishing sectors. When questioned about their job satisfaction, 23.2% were very satisfied, 16.1% were satisfied, 8.9% were dissatisfied, and 1.8% were very dissatisfied. When asked how satisfied they were at the time with the prospect of retiring, 16.1% reported being satisfied, 12.5% reported being very satisfied, and 8.9% reported being dissatisfied.Regarding the overall sociodemographic characterization, the participants of the three groups were aged between 48 and 72 years , mostly female (57.1%), married or in a Schwarzer and Jerusalem’s (1995) General Self-Efficacy Scale (GSE) , based oThe REATIVA project (PTDC/MHC-PSC/4846/2012) research team developed the Positioning Scale for Adaptation to Retirement (EPFAR) based on the evidence gathered during the previous stages of its development. Focus groups were conducted with new retirees  and inteThis instrument consisted of 28 items distributed across the seven dimensions corresponding to the main factors that cause greater vulnerability during retirement transition. Four items were allocated to each of the topics addressed in the intervention . This scale has shown good reliability when validated with the Portuguese population .Before the statistical analysis, the reliability of the instruments for assessing the evolution of the GSE and EPFAR variables was determined by measuring the internal consistency of the items that the participants responded to at the pre-test assessment (Av1) and post-test assessment (Av2). The GSE scale showed overall good psychometric characteristics, with total Cronbach’s alpha values of 0.884 (Av1) and 0.742 (Av2). The EPFAR showed high reliability, with total Cronbach’s alpha values of 0.865 (A1) and 0.810 (A2).p = 0.784); Av2) and the EPFAR variables ; Av2) had normal distributions in both assessments.Then, the distribution of these variables was determined through the test of adherence to normal distribution, which revealed that both the GSE  and mode (Mo)), location (minimum (Min.) and maximum (Max.)), and dispersion (range (R) and standard deviation (SD)) used to determine how the GSE and EPFAR variables evolved, as well as a paired-samples t-test for paired samples was used to compare the self-efficacy means before and after implementing the program and showed a positive and statistically significant evolution of the GSE variable in the experimental groups  and the EG2 . A slight decrease in the GSE mean was also observed in the CG, but the differences in the GSE values were not significant between the two assessment moments . The significant change in the self-efficacy of retirees submitted to the REATIVA program suggests that they began to believe more in their personal abilities.The results were favorable in both the EG1.An analysis per item found that items 4  and 8  were responsible for the level of significance obtained in EG2, the significant increase in self-efficacy was caused by item 7  and item 9 . Here, the items regarding more passive coping strategies—namely, calmness and thoughtfulness—were further strengthened after the program was implemented.In EG1 and EG2 before (Av1) and after (Av2) the implementation of the REATIVA program (The EPFAR was assessed in the EG program . A simil1:M(Av2-Av1) = 0.367; SD = 0.366/EG2:M(Av2-vA1) = 0.237; SD = 0.469/CG:M(Av2-A1) = 0.093; SD = 0.325). However, as this evolution was only significant in EG1 , it seems that the REATIVA program effectively improved the perceived adaptation to retirement of the individual participants.All groups showed a positive mean evolution in this variable  = 0.66; t = 2.320; p = 0.036/EG2: M(Av2-Av1) = 0.51; t = 2.283; p = 0.046) suggested that the program was effective in achieving one of its main objectives: facilitating the perception of efficacy in dealing with the changes and challenges inherent to the retiree status of the participants.Thus, in the “Retiree Status” dimension, the results obtained for the item “I can identify goals for my future life” (EG1: M(Av2-Av1) = 0.60; t = 3.154; p = 0.007/EG2: M(Av2-Av1) = 0.15; t = 3.614; p = 0.005) highlighted the program’s psycho-emotional effect on its participants. In addition, the program also contributed to an increase in the participating couples’ efficacy in coping with the stress caused by this experience (“I can manage everyday stress” (EG2: M(Av2-Av1) = 0.727; t = 3.730; p = 0.004)).In the “Mental Health” dimension, the results obtained for the item “I feel in harmony with my current life” (EG1: M(Av2-Av1) = 0.67; t = 2.646; p = 0.019)). Nonetheless, EG2 participants did not have the same perception (M(Av2-Av1) = 0.45; t = 0.690; p = 0.506), which raises questions about the diversity and characteristics of the current supply of resources aimed at couples.The results in the “Support Networks” dimension showed that the program was effective in providing the individual participants with a broader understanding of the community resources available to them for their adaptation needs (“The resources in my community are sufficient” (EG1: M(Av2-Av1) = 0.47; t = 2.168; p = 0.048)).Regarding the “Economic Management” dimension, the program’s empowerment effect on individual participants was also evident, reflected by their perception of an increase in expense planning  = 0.60; t = 2.553; p = 0.023 / EG2: M(Av2-Av1) = 0.02; t = 2.764; p = 0.020) shows that the program promoted a greater demand for and sharing of intimacy in its participants. The program also seems to have contributed to the perception of more effective communication among couples  = 0.04; t = 2.390; p = 0.038) and of conjugality in life projects among the new retirees who participated individually  = 0.73; t = 2.955; p = 0.010).In the “Family and Conjugality” dimension, the positive evolution observed in the item “I am sexually satisfied” (EG1: M(Av2-Av1) = 0.60; t = 2.806; p = 0.014/EG2: M(Av2-Av1) = 0.69; t = 2.319; p = 0.043). This supporting attitude was expressed in the greater perception of happiness that grandchildren brought to their grandparents (“My grandchildren make me happy” EG1: M(Av2-Av1) = 0.73; t = 3.214; p = 0.006)).In the “Family and Parenting” dimension, the perception of support and assistance focused on grandchildren became evident in both groups after the program’s implementation . Nevertheless, it is crucial to understand that this process is progressive, affects all individuals, and, like other life processes, implies becoming aware of it and acting to promote balance ,14.The REATIVA program seems equally relevant in raising awareness and developing skills that promote conjugality. This study’s results confirm the need for middle-aged couples to reflect and work on their conjugality, which often falls into the background due to work, parenting, and other life demands .4 found that, after the spouse, these individuals perceived grandchildren as a relevant source of support during their transition. Furthermore, due to the emotional nature of this relationship, it was also confirmed that reinforced relationships between grandparents and grandchildren are a major source of pleasure and affection during a stage of life that retirement makes vaster. However, because the closeness between the two generations often depends on the children’s request, these programs are also relevant for promoting the grandparents’ integration into the family life and, consequently, into successful transgenerationality [Finally, the program also raised new thoughts about the development of parenting, particularly giving meaning to intergenerationality. In a study conducted with 432 new retirees, Loureiroionality .One of the aspects that could be used to promote intergenerationality are new technologies and the development of competencies in the use of these technologies, since new generations are enthusiastic about it and can be facilitators in teaching their grandparents. This could be a methodological strategy implemented by REATIVA.Some studies have proven that digital health may help older adults improve several health determinants . AlthougThis study encountered several limitations, such as the sample size. Another was the cultural bias in the variables studied, as they were context-specific, multifactorial, and likely to vary quite significantly depending on the group’s embedded cultural factors. For example, in Portugal, family support is very relevant for individual development, which may not be the case for individuals from other countries. Thus, result interpretation should consider the lack of generalizability, and cultural adaptations are needed if the program is implemented in other countries. In addition, the instruments used only provide quantitative data. Regarding the EPFAR scale, it is likely distorted by social desirability bias, making it difficult to explore an increasingly deep-rooted issue.We present some recommendations for future research related to the above-mentioned limitations. Future similar studies should use a larger sample and compare variables in populations from different locations to avoid sample size limitations and cultural bias. In addition, adequate instruments should be used to analyze qualitative aspects for better result interpretation. It would also be interesting to study the follow-up of the retirees that have participated in the REATIVA program to monitor its effects. The program should also be implemented with other family members, such as children or grandchildren, to measure its effect on retirees.In the future, we also recommend that the program use a blended approach, allowing it to be more accessible, and that people be more involved in the development of their skills for active and healthy ageing. It is recommended to implement the program using innovative methodologies and strategies, including blended sessions and informatics tools, the internet, and social media.1 and EG2 to determine its effectiveness. A control group (CG) consisting of recent retirees was also included but had no intervention. The participants of these groups measured the effectiveness of this program by completing the General Self-Efficacy Scale (GSE) and Positioning Scale for Adaptation to Retirement (EPFAR).The REATIVA program was implemented with the EGThe REATIVA program proved to be efficient in accomplishing its purpose; namely, the promotion of the perception of general self-efficacy and positioning for adaptation to the transition to retirement. Its effectiveness was evident in the positive change in perceived self-efficacy identified in the retirees who participated in the program, suggesting that they now believe more in their competencies in starting, carrying out, and successfully performing specific tasks that may require effort and perseverance in the face of adversity.The REATIVA program is being implemented in the healthcare surveillance of Portuguese new retirees with success. More studies are needed with larger groups. Further, the program is under review and adaptation in order to be implemented in other countries; namely, Portuguese-speaking (Brazil) and culturally similar (Spain) countries.


Workplace health promotion (WHP) are often depicted as an opportunity for pursuing a better and broader well-being condition under the assumption that working environments affect the physical, mental, and social well-being of individuals who spend large proportion of waking hours at work. While most empirical studies provided medical evidence to the effectiveness of WHP programs, scholars question the instrumental purposes of these programs founded on the belief that “healthy workers are better workers”. Little is known, for instance, about the design of WHP programs and their acceptance by workers. Our study addresses this gap, analyzing the co-production of a WHP program in an Italian research institute promoted by the healthcare authority, the local government and the national center for prevention and security in the workplaces. To this aim, we adopt the notion of boundary object investigate how different stakeholders reclaim to take part and being involved in this process, re-shaping their goals and their boundaries and why a WHP program or parts of it may be rejected or re-negotiated by its recipients. Our analysis reveals how each stakeholder contributes to re-shape the WHP program which emerges as the modular product of the composition of each matter of concern. Most notably, the strong rooting in a clinical perspective and the original focus on only workers at risk is gradually flanked by initiatives to involve all employees. Moreover, workers draw a line as for the legitimacy of employers’ intervention in the personal sphere of health promotion, embracing interventions addressing diet and physical activity while rejecting measures targeting smoking and alcohol consumption. A growing number of companies have been developing workplace health promotion (WHP) programs for their employees. Before the outbreak of the Covid-19 pandemic, most of these programs dealt with one or more of the four pillars of primary prevention  with the aim of improving the overall well-being of workers and preventing chronic diseases. Although the pandemic has shifted the focus of some programs (or interrupted them), it is possible to state that WHP still represents a relevant benefit for the workers who could enjoy it.WHP programs represent a broad set of initiatives for the improvement of the health status of individuals and communities, stemmed by long-standing campaigns and movements prompted by different international institutions in the Seventies. Most of these programs promote healthy behaviors, outlining the assumptions that are supposed to drive an individual to a condition of well-being.WHP is an umbrella-concept that outlines different initiatives that organizations adopt and develop for improving the health status of workers  to converge toward shared objectives. While the definition of good health status pertains to factors that include objective and standardized medical criteria as well as subjective perceptions, the development of these programs requires to design actions sufficiently adaptable for people and social groups with different needs, beliefs, and expectations about their health conditions.Considering the complexity of this issue, we can frame WHP interventions as boundary objects, “objects which both inhabit several intersecting social worlds” .The notion of boundary object has been introduced by Star and Griesemer . The autThe notion of boundary objects has been discussed and developed from several authors who, starting from the work of Star and Griesemer, expanded this concept, proposing further types, definitions, and fields of application .From our point of view, two more insights are particularly pertinent for understanding how a WHP program can be developed through a process of co-production. Nabatchi and colleagues  outline These insights match the points considered earlier when discussing the representation of a WHP program as a boundary object. The development of a WHP program can take the form of a co-production process, as it implies both the definition of a plan or arrangement and the shaping of the ongoing interactions between the actors who are involved in its implementation.From this point of view, all actors should mobilize to promote a shared representation of this boundary object while adapting it to their own needs and preferences.  involved in the co-production of a WHP intervention can collaborate across these boundaries reaching an agreement on a shared and acceptable health promotion program.On these assumptions, the notion of co-production can be adopted as an analytical device for identifying and analyzing the making of a WHP program. The latter, intended here as a boundary object at the core of co-production processes, is shaped through the collaboration between different individuals and communities that, following the state of art, have heterogeneous or even conflicting goals, interests and ethical positions. The aim of this contribution is to understand how the different actors  promoted by FBK, a multidisciplinary research center in Italy. FBK has more than 500 workers, employed with research and office roles .Over the years, the research center has developed an occupational welfare system mainly addressing work-life balance, training, education, sports as well as health. In this study, we report the development of a WHP project which started as primary prevention program of Type 2 Diabetes and cardiovascular diseases and developed into a more articulated health promotion initiative.We focus our attention on the design of this program, observing the different actors that were called (or asked) to participate to this process and their relations and “reactions” to the progressive stages of development of the program. We argue that this collaboration took the un-expected form a co-production process.The second and the third author were involved as social researchers in charge of supporting the design of the program since its beginning to develop a research action activity to support it. With this aim different qualitative techniques were adopted. The first source of data is the participant observation of the different phases of design and implementation of the program, starting from the presentation of its first draft to its finalization. The second author, who has been the project manager of the program, kept a research diary of all the meetings he participated to. The diary has been kept following a reflexive approach for which also researchers, with their personal attitudes and cultural backgrounds , can influence and re-direct the co-production dynamics at stake  participated to the first and the second focus group. The participants of the other focus groups were workers who asked to participate after receiving an open invitation sent by e-mail to the whole workforce.Empirical data were analyzed using template analysis King , a modelWe shall present our findings describing the process of negotiation of the details of the Workplace Health Promotion program, our boundary object. By following the trajectory from its inception (the preliminary idea) to its end  we shall show how the program was modified as new stakeholders were involved so to inhabit each different social world. We shall introduce our findings presenting the institutional context that framed and created the conditions for the WHP initiative to take place.In Italy the safeguard of workers has been traditionally limited to occupational safety. However, the program under scrutiny has been promoted in an evolving and more favorable context, when WHP programs started to be promoted at an institutional level by different actors .Without claiming to be exhaustive, we try to summarize the most significant changes at both national and local levels.the state of complete physical, mental and social well-being, consisting not only of an absence of sickness or sickness” (art. 2);it promoted a broad conception of health, conceiving it as “it claimed that occupational physician, in addition to help employers in the protection of health and psychological integrity of workers, can be involved in the implementation and enhancement of volunteers' health promotion programs, "according to the principles of social responsibility” (art. 25).The promulgation of act on health and safety at work (known as Legislative Decree N.81/2008) has been important for the diffusion of WHP for two reasons:European Network for Workplace Health Promotion, an international network aimed at supporting the development of WHP in Europe. INAIL has thus become more interested in promoting and financing projects directed at safeguarding the general well-being of workers.Moreover, the National Institute for Insurance against Accidents at Work (INAIL) became a member of the 2015–2020 Local plan for the Health”, promulgated by the Local Healthcare Authority (LHA). This policy stressed the need of implementing broader organizational programs addressed to the promotion of healthy lifestyles among workers.At local level, it is important to mention the “In this scenario, the pressures made by national and local bodies for adopting and/or developing WHP programs became stronger, laying the basis for the wide adoption of these initiatives. As well known in organization studies  and the occupational physician.the retooling of a digital platform previously tested with overweight children and adolescents for educating the target group with respect to nutrition issues;a screening, coordinated by the occupational physician, for assessing the health risks of each worker, through a survey and face-to-face meetings;the enrollment of a counselor for supporting workers in lifestyle changes.Three main initiatives were envisioned:The first working proposal of the program satisfied the expectations of both organizations, interested in conducting research on a novel topic, and the occupational physician, interested in developing new competencies to be proposed to other customers. Or, to adopt the vocabulary introduced in the previous section, the working proposal was a boundary object that made possible the cooperation among the parties involved.The research center’s HR office, to leverage its experience in designing and managing the internal organizational welfare program ;INAIL's local branch, to reinforce the credibility of the initiative by partnering up with the most relevant institution in the promotion of WHP at the national level;the Department of Health and Social Policies of the local government and the Local Healthcare Authority (LHA), to involve the research center’s most relevant stakeholders in the crafting of WHP initiatives to be replicated in the region.The group also decided to strengthen the proposal by inviting other actors to join, each with a different motivation:The new actors involved agreed on the first working proposal. At this stage the main contribution of the new partners was the cooperation in detailing and revising the questionnaire adopted to select participants to the WHP initiative and, most notably, the request of the LHA to coordinate the activities dealing with the issue of promoting changes in workers’ lifestyles. It was decided that a counselor of the LHA would organize face-to-face meetings with workers to promote healthier lifestyle habits setting personalized nutrition and physical activity targets.Such specifications to the original proposal were the first initiatives for the co-production of the program. The boundary object was reconfigured to make it capable of mediating across the social worlds of the new actors involved. The co-production involved external agencies that provided legitimacy and accreditation to the program. Internally, the HR office provided stability and consistency to the program with respect to former initiatives. This strategy aimed at stabilizing the program, conforming it to a wider logic of delivery of occupational welfare services.While the “original proposal with modifications” served well the purpose of allowing the cooperation of all parties involved, an un-expected event led some radical changes.The questionnaire to determine the eligibility to be enrolled in the WHP program was made available electronically to all workers of the research center who could voluntarily take part in the survey. The questionnaire, through a list of standardized items, was intended to identify individuals at high risk of developing type 2 diabetes and cardiovascular diseases. However, only 30 workers (among approximately 500) met the criteria to be included in the program.Such a result was not surprising for the occupational physician, and it was regarded with favor by the research unit involved, which was used to have pilot experimentations with similar numbers. On the contrary, the other parties considered these low figures not compatible with their involvement. Both the Local Healthcare Authority and the local government believed that the technology could have helped to create affordable workplace health promotion initiatives and make them available for a larger percentage of the workforce. Similar concerns with different motivations were expressed by the HR department. The organizational welfare policy of the research center was to offer services to all the workers, and the HR department pushed to have a more inclusive prevention program, one that could address the needs of the whole workforce. These considerations led to complement the original proposal with additional activities addressed to the whole workforce. In detail, it was decided to host seminars about healthy lifestyles inviting prestigious speakers, make some interventions in the canteen, and add healthy options in the vending machines in the relax areas. The co-production, in this phase, through these additions to the original proposal extended the scope of the WHP initiative from health prevention to well-being promotion and such modification allowed to keep the alignment of the actors around the initiative.At the same time, the shift from a ‘strictly medical’ intervention to a more lifestyle-oriented program paved the way to include the recipients of the program as a new actor of the process.This choice has been prompted by the second and the third author, who had already been involved in projects adopting participatory techniques. The assumption that including the potential end-users of the program in its design would pave the way for its success led the researchers to actively involve the workers in its implementation. This belief is well-grounded in the strand of studies concerning co-production that informed the participation of the second and the third author in the project.At this stage, there was a two-headed program. On the one hand, a preventive initiative framed in clinical terms targeting 30 workers while, on the other hand, a well-being program to be offered to all 500 employees. The first was already defined in detail while the latter was still to be finalized. Five focus groups were thus organized, with a twofold purpose of involving workers in the design of the program and promoting it among the workers.Each focus group discussed the main goals of the program and all of the activities that would be proposed to workers. Two focus groups were carried out with employees previously involved in the development of other well-being programs. These workers were identified as key informants , as well as potential recipients of the new program. The other three focus groups were conducted with employees recruited through an open invitation.The information gathered from the focus groups outlined mixed reactions to the program. Most workers appreciated the focalization of the program on lifestyles. Many of them reported to have already undertaken different attempts to modify their daily routines, adopting healthier behaviors habits .Interviewer: in the future, if you should enhance the initiatives for the physical activities promoted by the recreational club, what would you do?Worker 1: I think (…) that a comfortable locker room where you can go and get changed after a run would already be a great success. In addition, having the possibility of having a gym with 3–4-5–6-7 machines would be very, very important in my opinion, for letting off the stress…Worker 2: I fully agree. I love biking, and sometimes I go to work by bike (…).Worker 3: I would like interventions promoting the usage of public transport or the moving walk. When I go to work on foot, I risk getting hit … Transforming the lanes around our workplace into pedestrian areas could be a good idea …(Focus group 2 with the workers).Worker 1: in this project, I would start to change the approach. There is a growing desire on the part of the colleagues for a broader involvement in decision making (…). Better communication and greater transparency are needed.(Focus group 1 with the workers).However, the focus groups pointed out some discrepancies between the needs and expectations of the workers and the benefits that the program should provide. The workers suggested several solutions to promote healthy lifestyles in the workplace, such as an internal gym for physical activity, and the construction of a pedestrian area in the district around the workplace (see the first above reported excerpt), but also the introduction of vending machines with healthy snacks, and ‘recharge’ rooms for workers, on the model of big IT companies . This demonstrated the willingness of the workers in participating to the design of the program (explicitly reported in the second excerpt), besides their health condition, suggesting services addressing the whole workforce. In the focus groups emerged the representation of the WHP program as yet another initiative of occupational welfare of the research center; as such, their expectation was of being aligned to the other services offered to all employees.Worker 3: when a Super-boss comes and says: “we thought of you!” I remain a little bit puzzled.Worker 4: the official conference with the heads (of the center) in suits and making a boring speech (…) does not make sense! The project should be presented by someone who already does sports, such as someone from a recreational club. An expert, rather than a boss, could be important.(Focus group 1 with the workers).Furthermore, the workers who participated in the focus group suggested how the project should be promoted to be attractive to the workforce. Sceptical of top-down interventions, focus group participants suggested peer-to-peer initiatives to be more effective. Following these suggestions, the project was launched with a kick-off meeting where, alongside the top management, researchers outlined the scientific basis of the program and emphasized the importance of a broader adhesion and participation. Beyond the possibility of enjoying the potential benefits offered by the program, participation in the program was also asked for supporting its evaluation and improvement.Worker 3: In my opinion, alcohol consumption is a touchy subject because the line between addiction and conscious consumption is very subtle. I may agree with eliminating alcoholic beverages from the canteen (…) but, from my perspective, promoting the total elimination of alcohol from the workers’ daily life is problematic (…). To intervene on drinking and smoking is fine when there is a form of addiction that interferes with the work. I do not think smoking 2–3 cigarettes per day is a form of addiction that impacts productivity and absenteeism (I guess not).[Focus group 2 with the workers].The focus groups also uncovered the different meanings the workers attached to the four dimensions of health prevention. A clear distinction emerged between nutrition and physical activity on the one hand, and the consumption of alcohol and tobacco on the other hand. Workers appreciated the initiatives targeting the canteen as well as the supply of fitness courses offered at discounted rates. However, the participants to the focus group opposed measures addressing alcohol consumption and smoking, arguing that these habits refer to individual preferences. As underlined in the above reported excerpt, an intervention on alcohol consumption is tolerable only when this latter interferes on working activity, in terms of productivity or occupational safety.Finally, workers expressed concerns regarding data protection, requiring that only the occupational physician should be given access to them and not share it with HR department. Although most workers recognized the fairness of HR in personal data management practices, they pointed out the need of balancing the trade-off between the epidemiologic purposes of the program and privacy concerns of their participants. They thus urged HR to assure the workers about privacy issues, and the policies of personal data protection.The inclusion of workers in the focus groups contributed to change the design of the WHP initiative, translating it into a fully-fledged co-production process. As the WHP program crossed another social boundary, it was re-arranged to accommodate the visions and priorities of another actor in the process.the risk assessment process, originally designed to identify the workers to be included in the program because of their risky health status, was redesigned also for providing a personalized evaluation of their health status from the occupational physician;all workers could download the mobile app, regardless of their health status ;with the help of the recreational club, some additional initiatives were developed: seminaries with nutritionists, courses of postural gym and a walking group;in itinere process of monitoring of the health conditions of participants: beyond tailoring and taking care of individual health conditions, this service was intended to gather information to improve the program and the activities it provided.the program provided for an The final version of the project included most of the suggestions emerged from the focus groups. While the purpose of evaluating, preventing, and reducing health risks was maintained, several changes signaled the reconfiguration of the program:In the final version, the original focus of the program (the creation of a platform for helping workers with a high risk of developing cardiovascular diseases and/or Type 2 diabetes) became just one of the services (renamed as prevention services) within a broader program of workplace health promotion.In this study we considered a WHP program as an arrangement that can foster the promotion of healthier behaviors by actors inhabiting intersecting social worlds, within and outside an organization. Starting from this assumption, we focused our analysis on the collaborative processes performed by the actors to re-shape the program.how do different actors come to agree on a shared workplace health promotion program?;on what terms a workplace health promotion program become acceptable by its main intended beneficiaries, the employees?From this viewpoint, we adopted the notions of boundary object and co-production as analytical tools that enable us to respond to two questions:The first question deals with the procedural aspects or the making of the WHP program and how consensus is built around it. The short answer to our question is that the final agreement was not the result of moving toward a shared definition of health prevention but rather the incorporation of the different perspectives of each stakeholder.Our research shows how new stakeholders were identified and included at each step of the process. A main result of this study is that at each stage the WHP program is not altered but rather enriched. Each new stakeholder brings to the table their perspective and an updated version of the program addresses the concerns raised. As a result, the WHP initiative becomes a modular program which takes into account each and every issue raised by all the stakeholders at different stages of the process. Each actor inscribes its (his/her) perspectives in the WHP program which is not the result of a mediation rather the emerging product of the composition of each matter of concern.For instance, the original program rooted in strong clinical perspective and addressed to employees with cardiovascular risk and aimed at a sub-set of the workforce of the research center is nor abandoned nor re-shaped. Rather, it is flanked by other initiatives designed to involve all employees excluded. Each specific initiative is the core concern of a sub-set of the stakeholders, and it is regarded with little interest by others.“a shared language that can be used by different communities to present or represent their specific knowledge”, allowing “individuals from different communities to communicate across boundaries”  strengthened the positions of the HR department and the recreational club among the stakeholders paving the way for some of the additional initiatives made available in the final program .Secondly, employees involved in the focus groups drew a line concerning what they deemed to be the legitimacy of employers’ intervention in the personal sphere of health promotion. With regard to the four pillars of prevention, employees regarded positively interventions addressing diet and physical activity while measures targeting smoking and alcohol consumption were described as intrusive. While employees did not deny the impact of smoking and drinking on health, these were represented as social activities concerning to the preferences of the individuals that should not be addressed by a company-led health initiative.While employees did not take part to the meetings in which the details of the protocol were discussed, their inputs contributed to shape its final version.The involvement of employees through the focus groups led to several changes of the final program, excluding specific measures targeting smoking and drinking. Moreover, the whole WHP program was rebranded as a part of the organizational welfare initiatives of the research center to leverage on the overall positive evaluation of such services.With regard to the analytical lenses adopted in our study, our findings suggest that while employees were never formally involved in the co-production of the program, they were able to steer and shape the program by presenting the expected benefits and the limitation of a health prevention program before its implementation.WHP programs inhabit different social worlds, since they are prompted by supranational initiatives, national and regional policies, as well as by healthcare providers. Within this multi-layered institutional mobilization, each experience of promotion of workers’ well-being programs represents both an opportunity and a challenge for workers and companies, as they provide a new stake in the relation between these actors. From this point of view, our study sheds light on the issues that may emerge in the design and shaping of a WHP program during its development. This is a point scarcely discussed in the interdisciplinary literature on this topic.Without having the improper ambition of generalizing the findings of our study, we propose some insights that may contribute to balancing the goals of WHP programs with the needs and preferences of their recipients, intended as actors who can have voice in its implementation rather than being mere recipients.Firstly, our study has emphasized how the design of a WHP program can lead to disagreements between the stakeholders of the program. While this can seem highly expectable and obvious, we noticed that disagreements have been tackled by adopting a process of co-production of the program. One of the main implications of this process of co-production was the re-shaping of the boundaries of the program. Co-production supported the participation of a higher number of workers, questioning the top-down and asymmetric structure of the program. This occurred without reaching a full consensus between the actors, neither from its beginning nor in itinere. On this basis, we claim that co-production can be a pattern for designing WHP programs that match heterogenous expectations while fitting with their expected effectiveness .Secondly, we claim that WHP programs should be designed considering ethical concerns too, beyond medical protocols. These concerns relate to the possibility of refusing to participate in the programs by their recipients. From this point of view, the issue is not the compulsoriness of participation since workers participate voluntarily. Ethical concerns should deal with the intrusiveness of a WHP program on individual lifestyles and preferences. The improvement of a specific dimension of health status may be contested and rejected by some workers. While co-production can be a way to tackle this issue, we claim that major attention should be given to ethical concerns in the institutional promotion of WHP programs. This reasserts the necessity of properly marking the boundaries of a welcome yet challenging initiative.


In an attempt to develop a preventative measure, we previously identified that bovine colostrum (bCM) contains functional factors that inhibit the binding of HuNoV P domain to its HBGA receptors. In this study, a candidate functional factor in bCM was identified as immunoglobulin M (IgM) using mass spectrometry, followed by database comparison. The natural antibody IgM was further verified to be a functional protein that inhibited HuNoV P protein binding to HBGA receptors through receptor‐binding inhibition experiments using bCM, commercial IgM, and fetal bovine serum. Our findings provide a foundation for future development of natural IgM into an antiviral drug, which may help to prevent and/or treat HuNoV infection.Human norovirus (HuNoV) is the primary viral pathogen that causes acute gastroenteritis (AGE) in humans. The protruding (P) domain of HuNoV interacts with cell surface histo‐blood group antigens (HBGAs) to initiate infection. Owing to the lack of an effective  The natural antibody IgM was verified to be a functional protein that inhibited HuNoV P protein binding to HBGA receptors through receptor‐binding inhibition experiments using bCM, commercial IgM and fetal bovine serum. For example, an enzyme‐linked immunosorbent assay (ELISA)‐based binding and blocking assay using recombinant capsid proteins as HuNoV model and saliva samples as HBGA sources has been developed [Human noroviruses (HuNoVs) are the leading viral cause of infectious acute gastroenteritis (AGE), resulting in substantial global morbidity and mortality , 2. Whil genomes . The cap genomes , 7, 8, 9 genomes , 11, muceveloped  and usedeveloped  to evalueveloped .Milk, especially bovine colostrum (bCM), is rich in antibodies and immune protective factors, such as immunoglobulins , lactofeIn this study, we conducted an in‐depth analysis to identify the bCM protein that blocks norovirus P protein–receptor interactions. We found that IgM, a natural antibody in bCM, is a functional protein that competitively binds to the GII.4 HuNoV P protein, thus hindering its binding to HBGA receptors and potentially inhibiting HuNoV infection. Therefore, our study provides a new foundation for the use of IgM in bCM in preventing HuNoV infection.Bovine colostrum (bCM) samples were collected from Holstein cows on day 3 after parturition or prolactin treatment. The milk samples were stored at −80 °C.IgM proteins in bCM were precipitated by water dialysis. Specifically, the bCM samples were dialyzed twice against ultrapure water at 4 °C for 3 h. Supernatants and precipitates (resuspended in distilled water) were recovered separately and stored at 4 °C.The P‐GST fusion protein containing the receptor‐binding domain of the GII.4 HuNoV VA378 strain (GenBank access #: GenBank: AY038600.3) was made as described previously , 22. Thiy), but negative for Lea and Lex antigens [−1 GII.4 HuNoV (VA398) P‐GST fusion protein were mixed with the tested samples and incubated at 37 °C for 1 h. The mixture was then added to the plate. Subsequently, the bound P‐GST fusion protein was detected using a rabbit anti‐GST polyclonal antibody (1 : 5000). The bound antibody was detected using a horse‐radish peroxidase (HRP)‐conjugated secondary antibody (1 : 10 000). The binding signal was defined as the optical density (OD) signal and was measured at 450 nm (OD450). The inhibition rate of each sample was calculated using the following formula:This assay was performed as previously described . Brieflyantigens . The salantigens . This saunblocked control was the OD of the binding between the saliva sample and P‐GST protein without mixing with the tested sample, while the ODnegative control was the OD of the binding signal of the saliva sample to GST only.The ODTwo components of bCM sample 1 (bCM1) were analyzed by 2D PAGE as described previously . Brieflyg, and the agarose was washed with PBST three times. Samples  were incubated with protein A + G agarose with or without Rab‐bIgM at room temperature for 1 h, and the total volume was adjusted to 500 μL using PBS. Subsequently, the fluid fraction was recovered and stored at 4 °C. The agarose was washed three times and stored at 4 °C.Removal of IgM from bCM samples was accomplished by an IP approach using excess protein A + G agarose (Beyotime) and a rabbit anti‐bovine‐IgM antibody . Briefly, 200 μL protein A + G agarose was incubated with 1 mg Rab‐bIgM overnight at 24 °C with an up and down rotation; fluid was discarded after 1 min of centrifugation at 500 × An equal volume of 5× loading buffer was mixed with the samples before and after treatment, which were boiled for 10 min. After separation by 10% SDS/PAGE, the proteins were transferred to a 0.45 mm PVDF membrane and blocked for 1 h with 5% nonfat dry milk at room temperature. Then, the membrane was incubated overnight at 4 °C with HRP‐conjugated polyclonal rabbit anti‐bovine IgM . After incubation with the secondary antibody for another hour, the membranes were developed with SuperSignal™ West Pico PLUS Chemiluminescent Substrate .450 was measured as previously described [ELISA‐based binding assay to test IgM and GII.4 HuNoV P protein interaction was performed. Pure bovine IgM (Rockland) or IgM‐containing fractions obtained from dialysis of bCM were coated onto microplates overnight at 4 °C. After blocking with 5% nonfat milk in PBST, P‐GST, GST, or other indicated materials were added and incubated at 37 °C for 1 h. Corresponding primary and secondary antibodies were used to detect bound proteins. The ODescribed .All procedures involving animals were approved by the Laboratory Animal Welfare and Animal Experiment Ethics Review Committee of China Agricultural University (No. AW42302202‐3‐1) and in accordance with the NIH Guide for the Care and Use of Laboratory Animals.graphpad prism software 7.00 . Statistical significance among data groups was calculated by the t‐test and was considered statistically significant when P values < 0.05. The data for molecular protein weights and isoelectric point (PI) values were analyzed using UniProt.Data are expressed as the mean ± standard deviations (SDs) and were analyzed using As per our previous experiment, bCM sample 1 (bCM1) comprised of two components . ComponeIgM belongs to the euglobulin family and has very low solubility in pure water. The two components of bCM1 were dialyzed against ultrapure water at 4 °C for 3 h, and the supernatant and precipitate (resuspended in distilled water) were recovered separately. The untreated samples, supernatants, and precipitates were tested for their ability to block P protein–HBGA interactions using the ELISA‐based blocking assay . The resTo further verify that IgM is the functional protein, as opposed to any other mature antibodies of non‐IgM molecules, IgM and other antibodies were preliminarily separated from all colostrum samples by dialysis and centrifugation by taking advantage of the precipitation features of IgM in pure water. The precipitated IgM was dissolved in distilled water, and the distribution of inhibition ability in different dialysis components was detected using a receptor‐binding inhibition experiment. The results showed that all colostrum samples behaved similarly to bCM1 after dialysis treatment in terms of inhibiting P protein–HBGA interactions. The inhibition ability of the precipitate was almost the same as that of the original sample, whereas the inhibition ability of the supernatant remained very weak. These data support that the functional proteins inhibiting P protein–HBGA interactions in all colostrum samples were IgM antibodies, as in bCM1, which were mainly present in the precipitate Fig. .To further verify IgM as the inhibitory factor of bCM, the IgM component was removed from bCM using co‐immunoprecipitation (Co‐IP). We showed that an anti‐bovine IgM antibody immobilized with Protein A + G could remove IgM from the bCM nearly completely, as shown by western blotting analysis that could not be detected IgM after removal Fig.  up. CoomWith the confirmation of the inhibitory effect of IgM, we inferred that effective IgM is not produced by acquired immunity; instead, it is most likely innate . If this is the case, IgM should be widely present in bovine and in the blood of fetal cows that have not been stimulated by external immunogens. Indeed, our data supported this conjecture, commercial pure bovine IgM bound the GII.4 HuNoV P protein, and inhibited its interaction with HBGAs, verifying that pure bovine IgM possessed an inhibitory ability . To prove this, water dialysis was used to treat two FBS samples from two different commercial brands, and the IgM in the samples was separated from other serum proteins. The untreated FBS, supernatants, and precipitates were tested for their ability to block P protein–HBGA interactions. The results were completely consistent with the initial hypothesis that the FBS from both different brands could inhibit P protein–HBGA interactions, and this ability was the same as that in bCM, which existed in the precipitation components after water dialysis treatment Fig. . It was HuNoV is the main cause of acute nonbacterial gastroenteritis in humans. The vast majority of HuNoV infections are caused by GI and GII, with GII being more prevalent than GI, causing more than 80% of all HuNoV infections , 30, 31.Streptococcus pyogenes that causes dental caries, Candida albicans that causes deep infections, Cryptosporidium, Escherichia coli, and Helicobacter pylori that causes gastroenteritis [Numerous studies have shown that bCM is high in nutritional value, growth factors, and hormones that promote the growth and development of infants and newborn animals . In addinteritis , 36. Hownteritis . IgM is nteritis . It is enteritis  such as nteritis  and muconteritis . In thisStreptococcus pneumoniae, E. coli BL21 [Thermite tularex [influenza virus [The production of natural antibodies does not require stimulation by external antigens and generally occurs during natural development . The recoli BL21 , Thermit tularex , and infza virus . In the E. coli expressed the P‐GST [On the contrary, in our previous study, we found that bCM blocks VLPs of two genotypes (GII.4 and GII.9) of HuNoVs binding to their viral receptors , therefohe P‐GST , after cIn summary, this study found that the natural antibody IgM in bovine colostrum binds HuNoV P protein, thereby inhibiting its binding to HBGA receptor and potentially blocking HuNoV infection. Our new findings provide a basis for potential application of bovine IgM in the prevention and treatment of HuNoV infection.The authors declare no conflict of interest.Author contributions are as follows. QH, ZX, LW, and HC contributed to data curation, formal analysis and methodology; MT and RZ contributed to conceptualization; QH and RZ contributed to writing—original manuscript; MT contributed to revision. All authors have read and agreed to the published version of the manuscript.


Targeted curricular interventions can increase preschool program quality and boost children’s academic and social–emotional readiness skills, but variable funding and weak organizational infrastructure in many community-based childcare centers may reduce the effective implementation of these programs.This study examined individual teacher and workplace predictors of the REDI program implementation, a targeted school readiness program that was adapted to support delivery in childcare centers. REDI was delivered by 63 teachers in 37 community-based childcare centers with center directors serving as local implementation coaches.Results showed that individual teacher factors  predicted the quality with which REDI activities and teaching strategies were delivered, and workplace factors were important predictors across multiple implementation indicators.Practice and policy implications for improving intervention implementation and corresponding program quality in childcare centers are highlighted. High-quality early childhood education (ECE) promotes school readiness skills and fosters long-term school success, with heightened benefits for preschool children from low-income families . Access Research-based Developmentally Informed [REDI] program) in childcare classrooms.Research conducted during the past two decades suggests that preschool program quality can be enhanced by enriching classrooms with evidence-based curricula and providing teachers with corresponding professional development support and coaching . HoweverChildcare centers serve one-third of children attending preschool in the United States . Unlike Not surprisingly, when compared on similar measures of observed preschool teaching quality, childcare centers show mean levels of emotional support and cognitive stimulation that are significantly lower than those documented in Head Start or school district pre-K classrooms . EvidencCurrent research suggests that the most effective strategies for improving preschool program quality and boosting child school readiness outcomes utilize two approaches . First, adherence to intervention guidelines, and (2) using the prescribed teaching strategies while delivering lessons and interacting with children in the classroom, reflecting quality in program delivery and generalized use of the recommended teaching strategies  completing the sequenced lesson plans as written, reflecting rategies . A limitResearch-based, Developmentally Informed) program delivered in Head Start centers  predicted the quality of teacher delivery of a language-literacy skills intervention , and consistent associations between teacher receptivity toward the intervention and both implementation quality and adherence. With few exceptions, the studies cited examined intervention implementation in Head Start or public pre-kindergarten contexts, leaving unknown questions about the value of these teacher characteristics as predictors of implementation in childcare settings.In contrast to teacher characteristics, workplace factors are rarely studied as predictors of preschool program implementation, but they may be key to understanding challenges associated with diffusing evidence-based programs in under-resourced childcare centers characterized by variable and generally low levels of infrastructure support. In the conceptual framework outlined by The early learning standards of the Prekindergarten teaching positions pay less, offer fewer benefits (including less time off), and provide teachers with fewer opportunities for professional development opportunities than similar positions in public schools . TeacherResearch suggests that a key characteristic of high-quality ECE programs is a high level of support for staff professional development and program improvement efforts . ReferreConceptually, working in a well-run center characterized by predictable schedules, stable staffing, and strong collegial working relationships should increase teacher willingness and capacity to invest effort in new program implementation . Center Originally evaluated in Head Start centers, the REDI program was recently adapted for use in childcare centers. REDI is an evidence-based, multi-component curricular enrichment program targeting social–emotional and early literacy skills. The foundation for REDI is a social–emotional curriculum, Preschool PATHS , which iAdaptations to REDI were made to accommodate the less-centralized structure of childcare centers and facilitate program scalability. First, given that online PD can reduce the burden of training , the REDteacher characteristics, especially baseline teaching skills and teacher receptivity to the intervention would predict implementation quality, including the quality of REDI curriculum implementation and the more generalized use of REDI teaching strategies in the classroom. Given that workplace factors may be especially relevant for program completion in childcare centers which are often under-resourced, it was hypothesized that workplace factors, including classroom resources, job satisfaction, organizational learning, and workplace challenges would predict implementation adherence, reflecting the amount of the REDI program that was delivered. We also explored the possibility that workplace factors would affect implementation quality. Finally, we explored the degree to which teacher characteristics and workplace factors might affect enthusiasm for and plans to continue REDI implementation in subsequent years.The current study explored teacher characteristics and workplace factors that may have affected the implementation of REDI in childcare centers. Implementation outcomes included: (1) adherence, reflecting the number of REDI lessons and activities that were delivered, (2) quality of REDI curriculum delivery, reflecting the quality with which the lessons and activities were delivered, (3) quality of generalized teaching strategies, reflecting the overall use of REDI-prescribed teaching practices in the classroom, and (4) plans to sustain REDI implementation in the future. Based upon prior research linking teaching attributes to implementation quality , it was During three successive years (2015–2017), licensed childcare centers serving preschool children in ten Pennsylvanian counties were sent emails describing the study. To be included, centers had to have: (1) at least one classroom that served at least five children of prekindergarten age, (2) a full-time director who could serve as a program coach, (3) an organized, regular daily schedule of activities , and (4) not currently be using a formal curriculum-based social–emotional learning program. Each year enrolled childcare centers were stratified by county and size (number of classrooms) and then randomized at the center level to either the intervention or “usual practice” control condition. This study focused on the centers randomized to the intervention condition. Teachers provided information about their education and teaching experience, and classroom observations were conducted prior to intervention initiation to assess baseline teaching skills. A certified REDI trainer (the fifth author) provided intervention training to center directors and teachers in October and coordinated the intervention delivery. Classroom teachers implemented the intervention through April, with local coaching provided by their center directors. Regional REDI consultants (experienced educators trained in the REDI program and coaching process) visited centers twice monthly for the first 2 months and monthly thereafter. They met with the center director to discuss teacher progress and offer coaching support. They also observed REDI lessons and rated the quality of intervention delivery. Post-intervention classroom observations were collected in May. The guidelines for the ethical conduct of research developed by the American Psychological Association were followed throughout this study, and all procedures were approved by the University’s Institutional Review Board.N = 63) from 37 childcare centers provided data for the current study. Teachers were predominantly female (98%) and White . They varied in age between 22 and 60 years of age . A small sample of teachers co-taught (9.5%) and all teachers were in classrooms with at least five children who were eligible to start kindergarten in the following year. The 37 center directors were 100% female and predominantly White . Directors’ ages ranged from 25 to 65 years , they had between 1 and 21 years of experience as directors  and varied in education . Two directors were replaced during the study, one just before the intervention period began, and the other mid-intervention. The majority of centers only had one participating preschool classroom .Preschool teachers . Teachers also self-reported their highest level of education on an 8-point scale .Teachers self-reported the number of years they had taught in a preschool classroom . Four items reflected teacher efforts to promote prosocial behaviors and social–emotional development  and were averaged across the observation periods to represent Emotional Support .The quality of teacher–student interactions was evaluated during pre-intervention observations using the Classroom Assessment Scoring System for Pre-K . In addition, after each 20-min observation, research assistants used a 5-point scale  to rate the quality of teacher’s talk in areas of vocabulary use, elaboration, cognitive challenge, and decontextualized language. These scores were averaged across items and across the three settings to reflect Richness of Talk in the classroom .Observers also rated the quality of classroom language use at baseline using the Classroom Language and Literacy Environment Observation CLEO; . CLEO obr = 0.33–0.78; p < 0.05) and similar patterns of association with implementation. Hence, an overall score reflecting Positive Teaching Practices was calculated by standardizing and averaging scores from the Instructional Support and Emotional Support dimensions of the CLASS Pre-K and the Non-directive Talk and Richness of Talk dimensions of the CLEO .Preliminary analyses showed that these different dimensions of teaching practices showed moderate to high levels of inter-correlation  during coaching sessions with directors and consultation sessions with REDI consultants. Director  and consultant ratings  were positively skewed and were within one point of one another 87% of the time. Director and consultant scores were averaged to create an overall rating of teacher intervention receptivity .Center directors and REDI consultants each rated teachers’ receptivity to intervention. Ratings measured the frequency of positive teacher responses .Observers documented classroom resources using the CLEO Literacy Environment Inventory (LEI). They rated 16 items describing the number of books and writing materials in the classroom, and three items describing the degree to which literacy-related activities were displayed . Items were rated on a 3-point scale (0–2). We standardized and averaged the literacy environment and literacy activities scores to create an overall classroom resources variable  teachers rated their satisfaction with their salary and benefits, workload, role, and job responsibilities (α = 0.85). Scores were averaged across the 11-items .Teachers rated their overall job satisfaction using an 11-item scale developed by strongly agree to strongly disagree) and summed for a total score .Teachers completed a 7-item rating scale to describe their center’s orientation toward innovation and professional development. Items reflected staff orientation toward and support for program improvement .At the end of the intervention year qualitative interviews were conducted with teachers to discuss their experiences with the REDI intervention see . A variaImplementation of the REDI program included adherence (percentage of lessons and activities that were delivered) and program quality . We also evaluated teacher and director plans to sustain REDI implementation in future years.M = 73.15%; SD = 28.13%; range = 3.86–98.00%).Adherence was measured using teacher reports of the REDI lessons completed during each week. Adherence scores were calculated for each component of REDI  and aggregated to reflect a teacher’s overall adherence to the program delivery plan. Adherence was calculated at the individual teacher level; adherence rates from teachers who left centers mid-year before having the opportunity to fully implement REDI were excluded from analyses. The number of lessons delivered over the course of the year were summed and divided by the total number of REDI lessons to calculate overall adherence as a percentage of the program that was delivered per teacher .Two aspects of REDI program delivery quality were measured: the quality with which teachers delivered the components of REDI  and the quality with which they used REDI teaching strategies throughout the day . In both areas, quality of delivery was rated by trained REDI consultants who observed teachers regularly throughout the school year. Consultants visited centers twice per month during the first 2 months of the academic year, and once per month thereafter. At each visit, consultants made efforts to watch teachers delivering the various components of REDI . They rated curriculum delivery quality using a 7-point scale ranging from M = 4.22; SD = 0.54; range = 2.78–5.00).REDI consultants also rated teachers on the quality with which they used REDI teaching strategies in generalized ways throughout the day. Specifically, REDI consultants rated teachers on their demonstration of each of 5 teaching strategies  using a 5-point scale. Sample items included: “teacher encourages children to communicate how they feel, particularly when they are upset. He/she validates the children’s feelings when they are expressed” (emotion communication and support) and “the teacher is physically and mentally available to children in the setting” (sensitivity and responsiveness). An overall score for quality of REDI teaching strategy use was created by averaging scores over time across the five core REDI teaching strategies .At the end of their intervention year, teachers and directors completed a 5-item scale describing their personal enthusiasm for the continued use of the REDI program in the future, and the degree to which they and their center colleagues value the program and support continued use in the future. Items were rated on a 5-point scale  and averaged to represent overall intentions for future program use  with ten iterations with all variables of interest included in the model using SPSS version 26. MI is a Monte Carol technique where missing data is replaced with estimated values based on the available data and is preferable over single imputation methods of accounting for missing data  and workplace factors . Because a small number of teachers shared directors, regression analyses included robust standard errors to account for clustering . While mlues see , we condBivariate correlations are presented in Next, consider correlations linking these variables with the implementation outcome measures. Intervention adherence had only one significant relationship: teachers in centers that faced fewer workplace challenges showed higher adherence delivering the REDI lessons than teachers in more organizationally challenged centers. The quality of REDI curriculum delivery was associated with baseline positive teaching practices, teacher receptivity to the intervention, and classroom resources. The quality of REDI generalized teaching strategies tended to be negatively correlated with teacher experience and positively correlated with positive teaching practices, receptivity to the intervention, and classroom resources. Finally, intentions to continue REDI implementation in the future was significantly associated with organizational learning and fewer workplace challenges.Separate regression analyses that included the full set of teacher characteristics and workplace factors and control variables were conducted predicting each of the four implementation outcomes. Teacher characteristics predicted 40% and workplace factors predicted 18% of the variance in quality of generalized use of REDI teaching strategies in the classroom . PositivThe results from the regression predicting intentions for future REDI implementation are presented in Evidence-based programs that enrich preschool classroom curricula and provide teachers with professional development supports can improve classroom quality . Such prResults supported the first hypothesis that baseline teaching skills and teacher receptivity to the intervention would support high-quality program implementation but not adherence. Baseline teaching practices and receptivity to intervention emerged as important teacher predictors of the quality of REDI lesson delivery and REDI teaching strategy use. In contrast, none of the teacher characteristics studied were significantly associated with intervention adherence.2R = 0.42). Interestingly, workplace factors were also significantly associated with quality of curricular delivery and intentions to implement REDI again in the future. Associations with program adherence and implementation quality are discussed further in the following sections.Study findings also supported the second hypotheses that workplace factors would support intervention adherence. Workplace factors were significantly associated with intervention adherence defined as the proportion of REDI activities completed  were higher on average than quality of generalized teaching strategy use (M = 4.22), likely because the guided lesson plans provided a helpful scaffold to support high-quality delivery (r = 0.86). Predictors of both of these dimensions of implementation quality included two teacher characteristics—baseline levels of positive teaching skills and a teacher’s receptivity to the intervention consultation and coaching. Strong teaching skills can enable preschool teachers to more easily adopt new strategies, given their classrooms are already well-managed . It is possible that our sample size over-inflated the R2  at Penn State. The participants provided their written informed consent to participate in this study.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was supported by the National Institute of Child Health and Human Development under Grant number HD079410; the Institute of Education Sciences under Grant number R305B090007; and a dissertation grant from the Society for the Study of School Psychology.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The views expressed in this article are ours and do not necessarily represent the granting agencies.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1023505/full#supplementary-materialThe Supplementary material for this article can be found online at: Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.Click here for additional data file.