Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity

Abstract

Background This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. Methods Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. Results Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). Conclusions These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies.

Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework

“…A PEN review concluded that the political context, sociocultural context and socioeconomic context (resources) are particularly important for the implementation domain. 30 PEN studies on the implementation of the European School Fruit and Vegetable schemes in European countries pointed towards similar characteristics: economic resources and governance structure (both the legal and political aspects) at the macro (national) level and the sociocultural context at the meso (school) level. 31 Studies in which the Food-Epi framework was applied to assess and benchmark the level of implementation of food environmental policies in different European countries 32 and Europe 33 came across an illustrative example of the role of the legal context: what was legally possible in different countries in terms of, for instance, food reformulation depended on European as well as national jurisdiction.…”

Avaliação do Programa de Promoção da Alimentação Adequada e Saudável na Atenção Primária: pesquisa de métodos mistos

“…Por outro lado, um ponto forte desse estudo foi avaliar um Programa que trabalha a alimentação adequada e saudável a partir de uma perspectiva sistêmica, pautada na integração das múltiplas dimensões que envolve as práticas ali-mentares, incluindo seus significados social, afetivo, cultural, e relativos à sustentabilidade, uma vez que os alimentos são mais do que nutrientes 34 . Tal aspecto corrobora a perspectiva de que os contextos socioculturais, econômicos e políticos precisam ser considerados na formulação de programas de PAAS 35 . Outra importante fortaleza dessa pesquisa é a avaliação da implantação do Programa por meio da pesquisa de Métodos Mistos, o que possibilita um maior aprofundamento ao contemplar abordagens quantitativa e qualitativa.…”

Lifestyle, Type of Work, and Temporary Disability: An Incidence Study of the Working Population

“…Some authors highlight that PA intervention strategies may target/address social aspects such as economic level, environment, and access to health and social services [ 30 , 31 ]. Therefore, it is essential to consider those aspects and study vulnerable workers’ needs, designing safe and healthy spaces in the workplace [ 32 ], as well as strong and supportive policies that help overcome those barriers [ 33 , 34 ].…”

“…The implications of these results turn out to be essential as a starting point to develop effective PA and diet interventions in the workplace. Due to a change in lifestyle patterns, an integrative assessment is needed where the structure of Total Worker Health is implemented [ 38 ], taking into consideration individual circumstances, and overcoming bias when integrating this approach into the workplace setting [ 32 , 39 ].…”