How community sport programs may improve the health of vulnerable population groups: a program theory

Abstract

Background: Groups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called 'community sports', to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting. Methods: We developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations. Results: The health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics. Conclusions: The program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.

Understanding Trustful Relationships between Community Health Workers and Vulnerable Citizens during the COVID-19 Pandemic: A Realist Evaluation

“…A MRT is a program theory, developed at a mid-level range of abstraction, i.e., a theory concrete enough to test yet generalizable to different contexts. This program theory clarifies why, how, and in which circumstances CHWs can build trustful relationships with vulnerable clients (referring to mechanisms and influencing context factors of improved psychosocial health outcomes) [ 32 ]. This MRT can be tested and refined through further studies.…”

Evaluation of a program targeting sports coaches as deliverers of health-promoting messages to at-risk youth: Assessing feasibility using a realist-informed approach

“…A pre-developed program theory was used as the foundation for this study [34]. This theory has been further tested and refined in other SFD contexts [35]. It represents the effects of SFD programs on health outcomes in at-risk populations through mechanisms of experiential learning among participants and incremental responsibility taking and reflexivity.…”

“…This overall finding has great importance. One of the key change mechanisms of improved health among at-risk youth using sports as a lever is their observation and learning through what is respected by others and in particular with regards to what the coaches are doing [34,35]. This process of 'vicarious learning' is most profoundly described in the Social Cognitive Theory (SCT) of Bandura [39].…”

“…The outputs of previous studies resulted in the development of a program theory and its further refinement by clarifying why, how, and when community sport can promote health, in terms of the mechanisms and context factors of improved health outcomes of at-risk youth. These results are described elsewhere [34,35], and a training program was developed for community coaches based on the insights of the program theory [31]. A brief overview of this training program is needed to enable the interpretation of the current study, and it is, therefore, described below.…”

An Intersectional Analysis of the Recruitment and Participation of Second-Generation African Canadian Adolescent Girls in a Community Basketball Program in Ottawa, Canada

“…Community-based sport. According to Van der Veken et al (2020), community sport provide particular benefits to people and groups in socially disadvantaged conditions. The possibilities that community sport offers in the way of providing socially disadvantaged people access to sport that is otherwise inaccessible (such as private club sports) can increase opportunities for participation (Rosso & McGrath, 2017).…”