BackgroundIn adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors).MethodsThe intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance).ResultsPHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a “healthy route” (Reach). The proportion of patients with at least one cardiovascular risk factor who were “sufficiently active” increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance).ConclusionsIn the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.
Introducción: La pandemia ha provocado una crisis sanitaria, económica y social. En Cataluña, en la primera ola, la comunidad se organizó de forma ágil para dar respuesta a las necesidades emergentes. El objetivo del estudio fue identificar y caracterizar redes comunitarias existentes o emergentes en Cataluña con el fin de visibilizarlas y establecer sinergias.
Métodos: Estudio transversal. Fase 1: identificación de iniciativas a través de cuestionario ad hoc enviado a población en general mediante internet y redes sociales. Fase 2: encuesta semiestructurada a redes identificadas para caracterizarlas y evaluar su grado de coordinación local. Análisis descriptivo.
Resultados: Fase 1: 303 respuestas que identifican 100 iniciativas de 96 municipios catalanes. Un 74% fueron creadas en pandemia y atendían a múltiples problemáticas: soledad, salud mental, alimentación, preparación/reparto de elementos de protección de la salud. Dirigidas principalmente a personas mayores y con diversidad funcional. Un 43% eran iniciativas ciudadanas. Fase 2: participan 32 redes (tasa de respuesta: 32%), un 60% se coordinaban con servicios sociales y consejos municipales. Dificultaba la coordinación: falta de recursos y elevada burocracia; la facilitaban: existencia de estructuras de coordinación previas a la pandemia. El 70% tenía voluntad de continuar ofreciendo servicios tras la pandemia.
Discusión: Se recomienda el trabajo en red a nivel local de Atención Primaria y entidades municipales con las redes comunitarias, vinculando sus acciones a las existentes, con el fin de facilitar la implementación, continuidad y fortalecimiento de la salud comunitaria.
Palabras clave: participación comunitaria, salud comunitaria, COVID-19, redes comunitarias.
Background
Non-communicable diseases (NCDs) account for 71% of deaths worldwide and individual behaviours such as sedentariness play an important role on their development and management. However, the detrimental effect of daily sitting on multiple NCDs has rarely been studied. This study sought (i) to investigate the association between sitting time and main NCDs and multimorbidity in the population of Catalonia and (ii) to explore the effect of physical activity as a modifier of the associations between sitting time and health outcomes.
Methods
Cross-sectional data from the 2016 National Health Survey of Catalonia were analyzed, and multivariable logistic regression, adjusting for socio-demographics and individual risk factors (tobacco and alcohol consumption, diet, hyperlipidaemia, hypertension, body mass index) was used to estimated odds ratios (ORs) and 95% confidence intervals (CIs) of the association between sitting time and NCDs.
Results
A total of 3320 people ≥15 years old were included in the study. Sitting more than 5 h/day was associated with a higher risk of cardiovascular disease (OR 1.90, 95% CI: 1.21–2.97), respiratory disease (OR 1.61, 95% CI: 1.13–2.30) and multimorbidity (OR 2.80, 95% CI: 1.53–5.15). Sitting more than 3 h/day was also associated with a higher risk of multimorbidity (OR 2.26, 95% CI: 1.23–4.16). Physical activity did not modify the associations between sitting time and any of the outcomes.
Conclusions
Daily sitting time might be an independent risk factor for some NCDs, such as cardiovascular disease, respiratory disease and multimorbidity, independently of the level risk of physical inactivity.
Background
Physical inactivity is one of the most important risk factors in modern society. Primary Health Care (PHC) interventions have been shown to be effective to increase physical activity (PA). This work evaluates the Catalan Physical Activity, Sport and Health Plan (PAFES) .
Methods
Nested case–control design with risk-set matching based on a retrospective cohort of 22 450 physically inactive people registered between 2010 and 2018 in the Catalan electronic medical record (EMR). Confounder adjusted conditional logistic regression was used to estimate the probability that participants who had received PA advice became active between 2010 and 2018 compared to those who did not receive it.
Results
A lower probability to become active [odds ratio (OR) = 0.11, 95% confidence interval (CI) 0.10–0.13] was found for those people who had received PA advice only once. However, the probability to become active increased for people who had received advice two or more times (two times: OR = 1.43, 95% CI 1.32–1.55). A dose–response relationship was observed.
Conclusions
This is the first study evaluating a PA promotion real-life intervention in PHC using a large cohort based on data from an EMR with more than 2 years of follow-up.
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