Dorine Collard

Background: For the past decade, community-based programmes have been a popular strategy for physical activity promotion. The implementation of these programmes is a complex process, characterized by (a) objectives that vary locally, (b) adaptions to the programme over time in response to a community's shifting needs, challenges and opportunities, (c) emergent outcomes, and (d) non-linear causality. This poses several challenges for evaluation, as commonly used evaluation designs mainly focus on predetermined programme components and outcomes. Such a traditional evaluation approach may overlook necessary but unanticipated programme developments or outcomes and provide limited opportunity to learn from these. The aim of this study was to develop a novel evaluation approach that considers the complexity perspective, in order to evaluate a large community-based programme for children's physical activity and health promotion in the Netherlands. Methods: An exploratory review of theoretical and methodological literature regarding community-based health promotion, complexity theory, developmental evaluation and theory based evaluation was conducted. Based on this review a novel evaluation approach was developed. Results: The developed evaluation framework focusses on elements of the complex and adaptive implementation process of community-based health promotion. These include the local programme theory, implementation, adaption, the influence of context and feedback loops, and intended as well as emergent and unintended outcomes. By studying each of these elements in practice using innovative qualitative methods, including Ripple Effects Mapping and the Critical Event Card tool, principles that guide effective health promotion across community contexts can be extracted. Practice-based knowledge can subsequently be validated in other contexts. Conclusions: The proposed evaluation approach aims to inform both research and practice (local and national programme planners and policy makers), by considering the implementation of community-based programmes as a complex process in evaluation. Using this evaluation approach will provide insight in how community-based health promotion programmes impact communities, and which mechanisms underly success or failure. The proposed evaluation approach may be relevant for other physical activity promotion programmes or policies. Since considering complexity in evaluation is a relatively new challenge in public health, we believe it is essential to share and deliberate on innovative evaluation approaches and methods.

Background: Healthcare professionals play an important role in motivating inactive people with a chronic disease (e.g. diabetes, cancer, heart disease) for physical activity. They can initiate a discussion about physical activity with the patient and refer to a physical activity (PA)-professional for more detailed action-planning through ‘physical activity on prescription'. However, the collaboration between healthcare and PA-professionals to refer and guide patients to physical activities is in its infancy and can be improved. To enhance this collaboration the aim of our study was to evaluate how the collaboration is shaped and what barriers were experienced. Methods: We conducted an exploratory study in which quantitative and qualitative research methods were used. Two online questionnaires were distributed among PA-professionals in the Netherlands (spring and autumn 2021). Questionnaires were returned by respectively 209 and 116 respondents. Questions on how the collaboration was shaped, how the collaboration worked and what barriers were experienced were asked. Besides that, two focus group discussions were held with PA-professionals (n = 8) focussing on barriers and opportunities to improve ‘Physical activity prescription'. Results: More than half of the Dutch PA-professionals indicate that they collaborate with healthcare professionals in primary care (56%) to guide patients to physical activities. Far fewer PA-professionals collaborate with healthcare professionals in secondary care (22%). Half of the respondents indicate that they experience the collaboration in physical activity prescription as insufficient (47%). Most important barriers are determined, for example healthcare and PA-professionals are unfamiliar with each other; there is uncertainty about roles and tasks of professionals involved; there is a lack of communication; PA-professionals sometimes do not have the skills to guide people with a chronic disease. Finally, a lack of time and budget limits the collaboration between professionals involved in physical activity on prescription. Conclusions: The collaboration between professionals to refer and guide inactive people with a chronic disease from the healthcare setting to physical activities can be improved by responding to the barriers that are indicated by this study. This study contributes to improving health-enhancing physical activity in an inactive target group and decreasing the prevalence of physical inactivity.

Samenvatting: Het percentage mensen met ernstig overgewicht neemt de komende jaren toe, vooral onder mensen met een kwetsbare positie, zoals groeperingen met een lage sociaaleconomische status (SES) en/of een niet-westerse migratieachtergrond. Overgewicht is een complex probleem dat vraagt om een integrale aanpak. Het doel van dit onderzoek is het voor deze doelgroepen identificeren van potentieel werkzame elementen van een integrale aanpak gericht op overgewicht. In dit exploratief kwalitatieve onderzoek zijn twaalf groepsinterviews met 25 professionals en vier focusgroepgesprekken met 24 mensen uit de doelgroep gehouden. In totaal zijn 41 potentieel werkzame elementen geïdentificeerd voor een succesvolle integrale aanpak. Deze zijn ingedeeld op het individuele, programma, gemeentelijk en landelijk niveau, en op de sociale en fysieke omgeving. Hiervan hebben achttien potentieel werkzame elementen specifiek betrekking op mensen met een lage SES en/of niet-westerse migratieachtergrond. Daarnaast zijn vier competenties van professionals geïdentificeerd die in potentie kunnen bijdrage aan een werkzame integrale aanpak: verbinden, durven, integraal werken, volhouden. De twee randvoorwaarden tijd en financiële middelen lijken relevant op alle niveaus. Dit exploratieve onderzoek laat zien dat een integrale aanpak van professionals niet alleen vraagt dat zij verschillende potentieel werkzame elementen (tegelijkertijd) inzetten, maar ook dat ze zich continu en proactief inspannen om dit te realiseren.

There is limited knowledge about how a settings-based approach can be best applied in a sports club setting. This qualitative exploratory study examined whether and how sporting programs focusing on individual behavior change (i.e., increasing physical activity levels of inactive people) and implemented on the micro-level of the sports club, can be a first step towards a settings-based approach (i.e., inclusion of the meso- and macro-level of the sports club). In addition, this study explored factors that influenced the inclusion of the meso- and macro-level of the sports club. Telephone interviews were conducted with representatives of sixteen sports clubs about program activities on all levels of the sports club. Thematic analyses were performed to explore stimulating and hindering factors. After multiple years, six sports clubs also had program activities on the meso-level and twelve sports clubs had activities on the macro-level. Program activities differed per level within a sports club and on the same level between sports clubs. Cultural and social factors influenced macro-level activities, while predominantly economic factors influenced meso-level activities. Based on these factors, sports clubs could develop, prioritize, and choose strategies that support them in developing a settings-based approach when increasing physical activity levels of inactive citizens.

Background: The organized sports sector has received increased interest as a setting to stimulate physical activity among inactive target groups. To include many inactive people and to obtain population health benefits, it is important that effective sporting programs are sustained (i.e. continuation of program activities) over a long period of time. This study identified the factors influencing the long-term sustainability of these kind of sporting programs located within local sports clubs in the Netherlands. Methods: Fourteen Dutch sporting programs aimed at increasing physical activity levels of inactive population groups and funded within the National Action Plan for Sport and Exercise (NAPSE) were the focus of this study. The programs were developed by ten Dutch National Sports Federations (NSFs) and implemented by different sports clubs in the Netherlands within a three-year funded implementation period (2008–2011). This research consisted of semi-structured face-to-face interviews with the program coordinators of the NSFs (n = 14) and semi-structured telephone interviews with representatives of sports clubs that provided the programs (n = 17 continued the program, n = 11 discontinued the program) six and a half years after the funding period ended (November 2017–March 2018). A sustainability framework with five pre-specified main themes (i.e. program design, implementation, trainer/coach, organizational setting, broader community environment) guided data collection and (deductive) thematic analysis. Results: Ten of the fourteen NAPSE funded sporting programs were sustained at the level of the NSFs. Most factors facilitating (+) and impeding (−) the long-term sustainability of the programs were common to both NSFs and sports clubs, like program adaptation (+) and a lack of program financing (−). Program evaluation (+) and high program costs (−) were specific factors mentioned by NSFs, while factors related to human resources (e.g. lack of volunteers (−)) or the sports club nature (e.g. social aspect in program design (+)) applied to sports clubs. The factors were summarized in the form of a checklist. Conclusions: Key factors influencing the long-term sustainability of the sporting programs were identified. The results can be used to develop strategies to promote long-term sustainability of these kind of programs and inform funding guidelines in countries with a similar organized sports infrastructure.

Health-enhancing physical activity (HEPA) promotion programs are implemented in sports clubs. The purpose of this study was to examine the characteristics of the insufficiently active participants that benefit from these programs. Data of three sporting programs, developed for insufficiently active adults, were used for this study. These sporting programs were implemented in different sports clubs in the Netherlands. Participants completed an online questionnaire at baseline and after six months (n = 458). Of this sample, 35.1% (n = 161) was insufficiently active (i.e. not meeting HEPA levels) at baseline. Accordingly, two groups were compared: participants who were insufficiently active at baseline, but increased their physical activity to HEPA levels after six months (activated group, n = 86) versus participants who were insufficiently active both at baseline and after six months (non-activated group, n = 75). Potential associated characteristics (demographic, social, sport history, physical activity) were included as independent variables in bivariate and multivariate logistic regression analyses. The percentage of active participants increased significantly from baseline to six months (from 64.9 to 76.9%, p < 0.05). The bivariate logistic regression analyses showed that participants in the activated group were more likely to receive support from family members with regard to their sport participation (62.8% vs. 42.7%, p = 0.02) and spent more time in moderate-intensity physical activity (128 ± 191 min/week vs. 70 ± 106 min/week, p = 0.02) at baseline compared with participants in the non-activated group. These results were confirmed in the multivariate logistic regression analyses: when receiving support from most family members, there is a 216% increase in the odds of being in the activated group (OR = 2.155; 95% CI: 1.118–4.154, p = 0.02) and for each additional 1 min/week spent in moderate-intensity physical activity, the odds increases with 0.3% (OR = 1.003; 95% CI: 1.001–1.006, p = 0.02). The results suggest that HEPA sporting programs can be used to increase HEPA levels of insufficiently active people, but it seems a challenge to reach the least active ones. It is important that promotional strategies and channels are tailored to the target group. Furthermore, strategies that promote family support may enhance the impact of the programs.