Dirk Gansefort

Purpose: To timely tackle malnutrition in hospital patients, the implementation of a new malnutrition practice is needed. We aimed to determine the readiness of nutrition support hospital staff for implementing a new malnutrition practice, using the Patient-Generated Subjective Global Assessment (PG-SGA) instrument. Participants and Methods: A cross-sectional assessment of readiness among nutrition support hospital staff was conducted using semi-structured interviews. Interviews were scored across five dimensions of the community readiness model: Knowledge of efforts, Leadership, Community climate, Knowledge of the issue, and Resources for efforts. A general score and a dimension score (mean and standard deviation) were calculated. Scores could range from 1 (no awareness) to 9 (community ownership). Results: In total, 11 respondents, including physicians (n=2), dietitian (n=1), physiotherapists (n=3), speech therapists (n=2), nutritional assistants (n=2), and a manager (n=1) were interviewed. The general community readiness score was 4.0± 0.3, indicating the preplanning stage for the implementation of the PG-SGA. All five dimensions were in the preplanning range (3.5– 4.5). Resources was lowest (3.5 ± 0.9; range 3.0– 4.0), and Knowledge of efforts was highest (4.5 ± 1.9; range 2.0– 7.0); the scores of the remaining dimensions clustered around ~4.0. No dimension score exceeded the preplanning stage. Conclusion: Readiness to implement the PG-SGA was uniformly low (ie, at preplanning stage) across CRM dimensions, with resources most limited and awareness of existing efforts highest, yet still in the preplanning stage. Recommendations are directed to hospital leadership/clinical leaders and to interprofessional nutrition teams, with targeted training for all professionals involved in nutritional care to enable progression toward implementation.

Community-based approaches are promising to promote physical activity in old age. The community readiness (CR) model offers a structured approach to assess community capacities to address a certain health topic before and after implementing an intervention. The objective of this study is to assess whether community-based capacity building for physical activity among the elderly has a lasting effect on CR. Four communities (two sub-urban and two urban) in Northwestern Germany were randomly assigned to either intervention or control group. CR was assessed at three time points (2015, 2018 and 2020) by interviewing local key informants (n = 129). Community capacity building was carried out in the two intervention communities after baseline assessment and included the development and implementation of a local physical activity action plan for elderly. Overall CR scores were calculated and random effects regression analysis was performed to analyze group-by-time interaction. At baseline, the overall CR score was 4.62 (standard deviation (SD) = 0.51) indicating that communities were in the preplanning stage of CR. CR scores in the intervention communities did not significantly increase at follow-up assessments compared to control communities [2018: 4.82, coefficient −0.03, 95% confidence interval (CI) (−0.80; 0.73); 2020: 4.54, coefficient 0.19, 95% CI: (−0.59; 0.97)]. The process evaluation indicated several factors facilitating a successful cooperation with community stakeholders. These included building on existing networks, using a structured approach for developing and implementing a local physical activity action plan for older adults, providing financial support for implementing activities and linking activities to existing community events.

Objective: Communities are important settings for health promotion and prevention. The community readiness assessment offers a structured approach to assess resources and opportunities to tackle a health problem within a community. The assessment relies on semi-structured interviews with key informants from the communities. A number of 4–6 key informant interviews are recommended in the literature. However, it is unclear whether this is sufficient to obtain a valid representation of the respective community. This study analysed whether increasing the number of key informants from 4–6 to 12–15 alters the results of the community readiness assessment. Results: A total of 55 community readiness interviews were carried out in 4 communities. Overall, the community readiness scores showed little variation after having interviewed 10 key informants in a community. However, even after completing 10 interviews in a community, key informants were still able to identify up to 6 new information items regarding community efforts for physical activity promotion among the elderly, contact and communication channel for informing or approaching the target group, or barriers to participation.

Zusammenfassung: Das 2015 verabschiedete Präventionsgesetz sieht eine Stärkung settingbasierter Präventionsansätze vor. Ziel der vorliegenden Arbeit ist die Vorstellung des Community Readiness-Modells als ein Instrument zur Bedarfsermittlung und Verbesserung gesundheitsförderlicher Strukturen im Setting Kommune am Beispiel Bewegungsförderung im Alter im Rahmen des Forschungsprojekts Ready to Change. Community Readiness steht dabei für kommunale Handlungsbereitschaft. Die Bedarfsermittlung im Rahmen der Modell-Umsetzung erfolgt als Community Readiness-Assessment, bei dem an Themen der Gesundheitsförderung und Prävention angepasste Leitfaden-gestützte Interviews mit Schlüsselpersonen in Kommunen geführt werden. Als Ergebnis wird für die Kommunen ein Stadium der Handlungsbereitschaft identifiziert, aus dementsprechend zu ergreifende Public Health-Maßnahmen abgeleitet werden. In unserem Beispiel wurde das Modell an das Thema Bewegungsförderung im Alter im kommunalen Setting angepasst. Ein Assessment wurde im Jahr 2015 in 23 Kommunen im Nordwesten Deutschlands durchgeführt. Für die Ergebnisdarstellung des Assessments werden beispielhaft Darstellungen wie Spinnweb-Diagramme und geographische Verteilungen präsentiert. Mit dem Community Readiness-Ansatz liegt ein Modell vor, mit dem eine systematische Bestandsaufnahme und Verbesserung lokaler Strukturen und Ressourcen der Gesundheitsförderung umgesetzt werden kann. Unsere Projekterfahrungen zeigen, dass sich das Vorgehen im Community Readiness-Modell gut umsetzen lässt. Wesentliche Vorteile dieses Ansatzes liegen in der Systematik des Vorgehens und in der lokalen Stärken- und Schwächenanalyse als Voraussetzung für kommunenspezifische Interventionen.

Background: A sufficient amount of regular moderate physical activity (PA), at least 2.5 h of moderate to vigorous PA per week as recommended by the WHO, is one of the most important lifestyle factors for maintaining good health in old age. However, less than one in four older adults (65 years or older) in Germany meets this recommendation for PA. Although previous research has found several factors related to participation in PA programmes, little is known about how these factors simultaneously affect participation decisions of older adults and how PA programmes can accommodate these dynamics. Taking an everyday life perspective, this study aimed to identify multidimensional types of PA behaviour among older adults.Methods: In this qualitative study, 25 episodic interviews were conducted with participants and non-participants (ratio 1:3) of a structured PA intervention for older adults (65 years or older). Direct and indirect recruitment methods (e.g. pick up, gatekeeper) were used in different municipalities in Northwest Germany. The interviews were analysed according to the Grounded Theory methodology and a typology of PA participation behaviour was derived from the responses of the interviewees.Results: Four types of PA participation behaviour were identified based on different activity goals and time management preferences: ‘Health designer’, ‘Flexible function-oriented type’, ‘Comparison and competition type’ and ‘Fun and wellness-oriented type’. The results indicate that the structured PA intervention was better able to reach the health designer and the competitive type but was less successful in accommodating the function- or wellness-oriented type.Conclusions: In order to improve older adults’ participation in PA, preventive offers should take various activity goals and the desire for flexible time management in everyday life into account. The typology of PA participation behaviour contributes to a better understanding of the target group and can thus help to improve the development, communication and implementation of tailored PA interventions.

Reducing social inequalities in health and health determinants, including physical activity (PA), is a major challenge for public health. PA-promoting interventions are increasingly implemented. Little is known, however, about the impact of these interventions on social inequalities. For prioritizing interventions most likely to be effective in reducing inequalities, studies of PA interventions need to conduct equity impact assessments. The aim of this article is to describe the development of a logic model framework for equity impact assessments of interventions to promote PA. The framework was developed within the prevention research network AEQUIPA—Physical activity and health equity: primary prevention for healthy ageing, informed by an equity-focused systematic review, expert interviews, exploratory literature searches, and joint discussions within the network. The framework comprises a general equity-focused logic model to be adapted to specific interventions. The intervention-specific equity-focused logic models illustrate the key elements relevant for assessing social inequalities in study participation, compliance with and acceptance of interventions, as well as the efficacy of interventions. Future work within AEQUIPA will reveal which key elements are most critical for the interventions’ equity impacts. Equity impact assessments are beneficial for prioritizing interventions most likely to be effective in reducing health inequalities.

Communities can play an important role in delivering public health programs to older adults, but they differ in the provision of local structures and resources. The community readiness (CR) approach applies a stage model of change to the community level and analyzes structures and the degree of willingness to take action on a health issue. This study compared the CR regarding the promotion of physical activity as part of healthy ageing for older adults among urban and rural communities in North-West Germany. A cross-sectional CR assessment with key respondents in 23 municipalities (11 urban and 12 rural communities) was conducted using a semi-structured interview. Interviews were scored across the five CR dimensions and global CR score was calculated (scores between 1 = no awareness and 9 = professionalization). Wilcoxon rank-sum test and hierarchical regression models were used to compare urban and rural communities. In total, 118 interviews were conducted (response rate 69.8%). On average, the communities showed moderate CR scores (4.9 ± 0.3; Range: 4.3–5.4; preplanning or preparation phase). The global CR score was slightly higher in rural than in urban communities (regression coefficient = 0.29, 95% confidence interval (CI): −0.02–0.59). The rural communities showed significantly higher CR scores in the ‘Knowledge of efforts’ dimension (0.70, 95% CI: 0.26–1.14) and in the ‘Knowledge of the issue’ (0.37, 95% CI: 0.04–0.70). Rural communities display a slightly higher CR level than urban communities. In the next step, targeted capacity building activities will be initiated among communities with low CR levels.

Community-based interventions to promote physical activity (PA) among older adults are of high interest in health promotion since they promise to be effective strategies to reach this population group. Community capacity building, that is, the local promotion of knowledge, skills, commitment, structures, and leadership, is among the recommended core strategies. However, little guidance is provided on how to achieve a high degree of community capacity. This study aims to identify practical strategies to enhance community capacities for PA promotion among older adults (50 years or older) and to evaluate their success. A literature review was conducted using scientific databases (PsycInfo and Web of Sciences) and grey literature (national and international project databases), and 14 studies (16 articles) were identified. Five groups of capacity building strategies emerged from the literature: (1) building community coalitions and networks, (2) training of professionals, (3) training of laypersons, (4) strengthening competence and awareness in the target population, and (5) allocation of financial resources. All studies used more than one strategy. Coalition building and strengthening competence and awareness were most frequently used. Feasibility and acceptability of the capacity building strategies were demonstrated. However, intervention effects on PA behavior and other relevant outcomes were inconsistent. The one study that systematically compared different capacity building approaches did not find any evidence for beneficial effects of intensified capacity building. More rigorous research evaluating the efficacy of specific strategies to enhance community capacities for PA promotion is needed.

In einer Online-Befragung, an der 18 Expertinnen und Experten teilnahmen, wurden Empfehlungen für Wissenschaft und Praxis zur Verbesserung des Zugangs zu den Zielgruppen zur Diskussion gestellt, die im Rahmen des KNP-Projektes entwickelt worden sind. Für die Umsetzung der Empfehlungen sind eine verstärkte Zusammenarbeit von Wissenschaft und Praxis besonders wichtig, aber auch Materialien/Qualifizierung, Vereinheitlichung von Methoden und nicht zuletzt finanzielle Mittel, vor allem auch für die Durchführung von Evaluationsstudien. In an online survey, in which 18 experts participated, recommendations for research and practice to improve access to target groups were discussed. The recommendations were developed within the context of the KNP project. For the implementation of the recommendations, not only is an increased cooperation between science and practice particularly important, but also materials and training as well as standardization of methods. Furthermore, financial resources, especially for conducting evaluation studies are needed.

Injection drug use (IDU) and IDU‐related infectious diseases such as hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are highly prevalent among prisoners worldwide. However, little is known about the prevalence of IDUs, HCV/HIV and the availability of respective treatment options in German prisons. Data provided by prison physicians of 31 prisons, representing 14,537 inmates, were included in this analysis. The proportion of IDUs among all prisoners was 21.9%. Substitution treatment was available in three out of four prisons (74.2%). Overall, 1137 substitution treatments were provided annually with a wide range of treatment aims. The prevalence rate was 14.3% for HCV and 1.2% for HIV. Around 5.5% of all HCV‐infected prisoners were in antiviral treatment annually, 86.5% of all HIV‐positive inmates in antiretroviral HIV‐treatment. Generally, substitution treatment, and HCV and HIV testing and treatment are available. However, due to abstinence‐orientated treatment aims, substitution treatment is rarely available as maintenance treatment, and HCV/HIV‐treatment is mainly provided for patients with an existing treatment before imprisonment. The inconsistent data quality necessitates changes in prison‐related policy to improve surveillance and to generate aggregated data in German prisons. The selection process in this analysis might lead to overestimating the provision of substitution and antiviral HCV‐treatment.