Project SoL—A Community-Based, Multi-Component Health Promotion Intervention to Improve Eating Habits and Physical Activity among Danish Families with Young Children. Part 1: Intervention Development and Implementation

Abstract

Project SoL was implemented over a period of four years from 2012–2015 with the aim to promote healthy eating and physical activity among families with children aged 3–8 years, living in selected communities in two Danish municipalities. This was done by applying the supersetting approach to implement complex multi-component interventions in a participatory, coordinated, and integrated manner in childcare centres, schools, and supermarkets in three local communities, as well as in local media during a 19-month period in the Regional Municipality of Bornholm, which served as the intervention site. The matching municipality of Odsherred served as a control site based on its similarity to Bornholm regarding several socio-demographic and health indicators. The present paper describes the design of Project SoL as well as the processes of developing and implementing its complex interventions. Moreover, the theoretical and conceptual framework of the project is described together with its organisational structure, concrete activities, and sustainability measures. The paper discusses some of the key lessons learned related to participatory development and the implementation of a multi-component intervention. The paper concludes that coordinated and integrated health promotion activities that are implemented together with multiple stakeholders and across multiple settings in the local community are much more powerful than individual activities carried out in single settings. The supersetting approach was a useful conceptual framework for developing and implementing a complex multi-component health promotion intervention and for fostering ownership and sustainability of the intervention in the local community. The research and evaluation approach of the project is described in a separate paper (Part 2).

Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity

“…Complementary interventions may address different groups within a target population. For example, in the SoL intervention, different components addressed children (school), adults (supermarkets) and policymakers (local action groups) [33]. Getting different groups involved in an intervention means that there will be enhanced opportunities for social support [33].…”

Nudging in Public Health Lifestyle Interventions: A Systematic Literature Review and Metasynthesis

“…There were, for example, three examples from Denmark (15, 18, 27). However, a project like “Project SoL” (a Danish intervention, spanning the years 2012–2015), which employed structural changes in environments to promote healthy behaviors, did not turn up in our search, suggesting reticence to embrace “nudging” in the Danish context (Toft et al., 2018), where terms such as a setting approach or complex interventions are often used instead. The apparent scarcity of nudging initiatives in Denmark may well reflect a cultural emphasis on informed choice and self-determination in the Danish health context (Hoyer, 2010), attitudes that were evident, for example, in criticisms of perceived manipulation in a Danish screening campaign (Damhus et al., 2018; Jørgensen et al., 2009).…”

Centre for the Promotion of Physical Activity and Health (CAPAS-City): A Pyrenean Cross-Cultural Structure to Lead the Way in the Design, Implementation, and Evaluation of Multilevel Physical Activity Interventions

“…The Social-Ecological Model is a comprehensive public health approach that recognizes multiple levels of influence of PA behaviour [30], while the SDT is a macro-theory of motivation that assumes that the satisfaction of autonomy, competence, and relatedness affects people’s motivation and, consequently, PA behaviour [38]. Previous systematic reviews and meta-analysis showed that SDT is the social-cognitive theory that explained the greatest amount of variance in PA (i.e., 37%) [39] and has been shown effective in increasing PA levels in a wide range of populations [40]. CAPAS-City is based on evidence-based knowledge and research expertise [40], using strategies that have already been effective in improving PA and other health-related behaviours in multiple settings (e.g., schools, community, etc.)…”

“…Previous systematic reviews and meta-analysis showed that SDT is the social-cognitive theory that explained the greatest amount of variance in PA (i.e., 37%) [39] and has been shown effective in increasing PA levels in a wide range of populations [40]. CAPAS-City is based on evidence-based knowledge and research expertise [40], using strategies that have already been effective in improving PA and other health-related behaviours in multiple settings (e.g., schools, community, etc.) [40,41,42,43].…”