BackgroundIn the Netherlands, people with a low socioeconomic status (SES) live approximately 6 years less and are less engaged in physical activity (PA) than high SES citizens. This contributes to the persistent health inequalities between low and high SES citizens. Care–PA initiatives are deemed effective for stimulating PA and improving health and participation among peoples with a low SES. In those initiatives, multiple sectors (e.g. sports, health insurers, municipalities) collaborate to connect primary care and PA at neighbourhood level.This study focuses on two Dutch municipalities that aim to invest in Health in All Policies (HiAP) and care–PA initiatives to improve the health of people with low SES. The aim is to gain insight into (1) the short-term (3 months) and long-term (1 year) outcomes of participating in care–PA initiatives for low SES citizens in terms of health, quality of life, and societal participation, (2) the effective elements that contribute to these outcomes, (3) the direct and perceived societal costs and benefits of care–PA initiatives, and (4) alternative ways to fund integrated care, prevention, and care–PA initiatives at neighbourhood level.MethodsThe study will be built on a mixed-methods design guided by action research to continuously facilitate participatory processes and practical solutions. To assess outcomes, body measurements and questionnaires will be used as part of a pre-test/post-test design. Focus groups and interviews will be conducted to gain an in-depth understanding of outcomes and action elements. Action elements will be explored by using multiple tools: concept mapping, the logic model, and capacity mapping. Direct and perceived societal costs will be measured by administrative data from healthcare insurers (before-after design) and the effectiveness arena. An alternative funding model will be identified based on literature study, expert meetings, and municipal workshops.DiscussionInitiatives addressing multiple factors at different levels in an integral way are a challenge for evaluation. Multi-methods and tools are required, and data need to be interpreted comprehensively in order to contribute to a contextual insight into what works and why in relation to HiAP and care–PA initiatives.
The complex nature of Sport for Development (SfD) programmes makes impact evaluation challenging. Realist evaluation has been proposed as a new, theory-driven approach to evaluate complex programmes. The present study aimed to explore the value of conducting realist interviews to gain improved insight into the mechanisms and outcomes of three SfD programmes in the Netherlands: a programme that promotes sports participation among socially vulnerable youth; a combined lifestyle intervention for adults of low social economic status; and a sports-based programme for marginalised adults. In addition, the study aimed to investigate the applicability of a conceptual model from the field of social enterprise (Roy, Baker, & Kerr, 2017) as the preliminary programme theory for those interviews. First, for each programme, a realist interview was conducted with one researcher as the key informant. Thereafter, the findings from and experiences with the individual realist interviews were discussed among the informants in a group meeting. The results revealed that the conceptual model functioned well as preliminary programme theory for the SfD programmes. The realist interviews contributed to theoretical awareness and trustworthiness. Importantly, the interviews highlighted knowledge gaps and generated ideas for programme improvement. Hence, the realist interview technique is recommended as a methodological tool to generate, validate, and improve programme theory in the field of SfD. This study had, however, an explorative character, and more research is needed to confirm and generalize the findings and to learn how a greater number of stakeholders might contribute to this type of realist evaluation.
Sinds januari 2019 worden de zorggerelateerde onderdelen van een Gecombineerde Leefstijlinterventie (GLI), zoals de leefstijlcoach of de diëtist, vergoed vanuit de basisverzekering. Voorwaarde is dat mensen een gewichtsgerelateerd gezondheidsrisico hebben, dat ze zijn doorverwezen door een huisarts, dat het om een door het RIVM erkende GLI gaat en dat de zorggroep een contract heeft met de zorgverzekeraar (zie het Spectrum-artikel van Aldien Poll, verderop in dit nummer). De huidige erkende GLI's (CooL, Slimmer en Beweeg-Kuur) zijn echter niet specifiek ontwikkeld voor mensen met een lage sociaaleconomische status (SES). Doordat zorg-en beweegaanbieders vanwege de vergoeding alleen erkende GLI's aanbieden, krijgen andere GLI's weinig of geen kans zich (verder) te ontwikkelen. De vraag is hoe we tot een systeem komen waarin dit wel mogelijk blijft.
SamenvattingMensen met een lage sociaaleconomische status (SES) zijn minder gezond en hebben vaker overgewicht en obesitas dan mensen met een hoge SES. Gecombineerde leefstijlinterventies (GLI’s) kunnen worden ingezet voor de aanpak van overgewicht en obesitas. Het is echter niet duidelijk welke elementen van de GLI effectief zijn voor mensen met een lage SES. Het doel van dit onderzoek was daarom om de werkzame elementen van X‑Fittt 2.0, een GLI voor mensen met een lage SES, te bepalen. Negen professionals en één deelnemer van X‑Fittt 2.0 namen deel aan een concept mapping (CM)-proces om de werkzame elementen van X‑Fittt 2.0 in kaart te brengen. CM bestaat uit zes stappen: voorbereiden, brainstormen, clusteren, scoren, analyseren en discussiëren en interpreteren. Dit proces resulteerde in 72 werkzame elementen, ingedeeld in negen clusters, gericht op monitoring (12), interne (7) en externe (4) samenwerking, structuur en begeleiding (10), afspraken met deelnemers (5), beweegaanbod in de eerste twaalf weken (10), de beweegomgeving (10), wervingsstrategieën (5) en randvoorwaarden voor X‑Fittt 2.0 (9). Deze resultaten bieden een waardevolle eerste verkenning van de werkzame elementen van GLI’s voor mensen met een lage SES.
X‑Fittt 2.0 is a two-year combined lifestyle intervention (CLI) for people with a low socioeconomic status (SES), which starts with 12 weeks of intensive guidance, followed by a follow-up trajectory. In the first 12 weeks, participants receive three weekly sports sessions (two in a group with a sports coach, one individually), dietary advice and monitoring by a dietician, and four hours of coaching by a lifestyle coach to work on personal goals. The follow-up trajectory consists of a total of six hours of lifestyle coaching to encourage behavioural maintenance. The aim of this study was to gain insight into the experiences of participants with X‑Fittt 2.0. Therefore, 17 group discussions after 12 weeks (n = 71) and individual interviews after 1–2 years (n = 68) were held and thematically analysed. This resulted in five themes: ‘goals of the participant’, ‘programme content’, ‘accessibility of the programme’, ‘group dynamics’ and ‘guidance’. Most participants participated because of their health. They considered the programme accessible because the atmosphere in the sports centre was pleasant and X‑Fittt 2.0 was offered free of charge. The majority of participants liked the fact that the programme was offered in a group ‘with people like them’, referring to people who are overweight, because they did not have to be ashamed of themselves, which motivated them. The participants were especially satisfied with the guidance from the lifestyle coach and sports coach. However, they would have expected more guidance from the dietician. Overall, most participants were satisfied with the programme, but many also indicated that the first 12 weeks were too short to achieve sustainable behavioural change. Furthermore, quite a few participants indicated to have stopped sports after the first 12 weeks, because they could not afford to continue. The insights obtained can be used to better adapt (existing) CLIs to people with low SES.
Health inequalities still exist between people with a low socioeconomic status (SES) and people with a high SES. Combined lifestyle interventions (CLIs) could benefit the health of people with a low SES. However, it is unclear which CLI elements are effective for this group. Therefore, this study aimed to determine the effective elements X‑Fittt 2.0, a CLI for people with a low SES. Nine professionals and one participant of X‑Fittt 2.0 participated in a concept mapping (CM) process to develop an overview of the effective elements of X‑Fittt 2.0. CM consists of six steps: preparing, brainstorming, clustering, scoring, analysing, and discussing and interpreting. This process resulted in 72 effective elements, grouped in nine clusters, focused on monitoring (12), internal (7) and external (4) collaborations, structure and guidance (10), agreements with participants (5), sports options in the first 12 weeks (10), the sports environment (10), recruitment strategies (5) and the preconditions for X‑Fittt 2.0 (9). These results provide a valuable first overview of effective elements of CLIs for people with a low SES.
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