Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups

Herens, M.C.; Wagemakers, Annemarie; Vaandrager, L.; Ophem, Johan van; Koelen, M.A.

doi:10.1177/0163278716652940

Cited by 36 publications

(46 citation statements)

References 62 publications

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“…Thus, this measure was considered inappropriate for this context. Instead, the narrative timeline technique was used at the end of the first and second year of implementation to evaluate activities implemented in that particular school year and to discuss perceived highlights and perceived failures during implementation with the working groups [29]. Participants concluded with a discussion about "what to do next".…”

Section: Timeline Sessionsmentioning

confidence: 99%

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Verjans-Janssen

Gerards

Verhees

et al. 2020

IJERPH

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School health promotion is advocated. Implementation studies on school health promotion are less often conducted as effectiveness studies and are mainly conducted conventionally by assessing fidelity of “one size fits all” interventions. However, interventions that allow for local adaptation are more appropriate and require a different evaluation approach. We evaluated a mutual adaptation physical activity and nutrition intervention implemented in eight primary schools located in low socioeconomic neighborhoods in the Netherlands, namely the KEIGAAF intervention. A qualitative, multiple-case study design was used to evaluate implementation and contextual factors affecting implementation. We used several qualitative data collection tools and applied inductive content analysis for coding the transcribed data. Codes were linked to the domains of the Consolidated Framework for Implementation Research. NVivo was used to support data analysis. The implementation process varied greatly across schools. This was due to the high level of bottom-up design of the intervention and differing contextual factors influencing implementation, such as differing starting situations. The mutual adaptation between top-down and bottom-up influences was a key element of the intervention. Feedback loops and the health promotion advisors played a crucial role by navigating between top-down and bottom-up. Implementing a mutual adaptation intervention is time-consuming but feasible.

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Section: Timeline Sessionsmentioning

confidence: 99%

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Verjans-Janssen

Gerards

Verhees

et al. 2020

IJERPH

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“…The impacts on the different levels will be integrated and related to the action principles using realist synthesis [81] in the data analysis, facilitating the identification of the contextual factors and program mechanisms determining the outcomes (or impacts). These context–mechanism–outcome (CMO) configurations [18] will provide insights into the overall impacts in relation to the action principles.…”

Section: Methodsmentioning

confidence: 99%

Study protocol: evaluation of a community health promotion program in a socioeconomically deprived city district in the Netherlands using mixed methods and guided by action research

2019

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BackgroundVoorstad on the Move (VoM) is a community health promotion program implemented in a socioeconomically deprived city district in the Netherlands. Based on exploration of the health situation, concurrent views on health promotion, and insights from literature, VoM is grounded in a social-ecological perspective and puts three action principles center core: citizens’ participation, intersectoral collaboration, and a health supportive environment. VoM aims to improve the health of inhabitants, mostly low socioeconomic status (SES) families, and to realize changes in the social and physical environment. This current research, as part of the wider VoM project, aims to study the impacts and action principles of VoM. The main research questions concern the inhabitants’ perceptions on health and health supportive environments, the perceived benefits of citizen participation in terms of health literacy and empowerment, and the factors and mechanisms that contribute to citizen participation and intersectoral collaboration.MethodsThe study has a mixed methods design, including process evaluation and monitoring, and combines qualitative and quantitative data. Research activities include literature study, in-depth interviews, focus group discussions, concept and capacity mapping, document analysis, and health survey data. A prominent strategy is action research, which aims to involve all stakeholders, capturing the different perspectives of citizens and professionals, and engaging low SES groups. The principle of triangulation is continuously applied to optimize the reliability of this study, using multiple methods and multiple sources. Internal validity is enhanced by triangulation of methods and resources. Other verification techniques will also be used, such as expert consultation.DiscussionThe design of the study, with a strong focus on action research, facilitates the involvement of all stakeholders and contributes to the development of capacities, learning, and empowerment, and thus contributes to health. The VoM program is innovative because it adopts an open approach in which activities evolve from citizens’ needs, with a focus on action elements. This study will unravel the mechanisms of the action elements at community level, thereby helping to find ways to reduce health inequities. The findings will further elucidate what works and why it works for low SES groups.

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“…For instance, the analysis of qualitative data from interview transcripts may be based on coding in terms of ‘outcomes as observed by respondents,’ ‘context conditions’, and ‘underlying mechanisms – or effective elements – in the actual programme.’ The final research output from realist synthesis is not a statement of effect size, as the same programme will have different effects in different contexts, but a refinement of the programme theory. Previous use of realist synthesis in the project Communities on the Move provided a rich and detailed understanding of mechanisms at programme level [ 76 ].…”

Section: Methodsmentioning

confidence: 99%

Care–physical activity initiatives in the neighbourhood: study protocol for mixed-methods research on participation, effective elements, impact, and funding methods

et al. 2018

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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.

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Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups

Cited by 36 publications

References 62 publications

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Implementation of KEIGAAF in Primary Schools: A Mutual Adaptation Physical Activity and Nutrition Intervention

Study protocol: evaluation of a community health promotion program in a socioeconomically deprived city district in the Netherlands using mixed methods and guided by action research

Care–physical activity initiatives in the neighbourhood: study protocol for mixed-methods research on participation, effective elements, impact, and funding methods

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