[show abstract][hide abstract] ABSTRACT: BACKGROUND: A multi-level theoretical framework of physical activity (PA) promotion that addresses supportive environments, PA behavior, community action and PA promoting policies is related to research and development in an international comparative study. METHODS: Most-different and most-similar case selection was applied to data from eight EU Member States. Data from semi-structured key informant qualitative interviews, focus group interviews with experts and policy-makers, as well as document analysis were linked to corresponding Eurobarometer data. RESULTS AND DISCUSSION: The framework on the interplay of environment, PA behavior, community action and policies appears to be working across most different countries. Comprehensive systems of PA infrastructures are interlinked with relatively high levels of PA prevalence. These countries implement comprehensive national policies on PA promotion and show a positive perception of related local governments' engagement. Less comprehensive systems of infrastructures interplay with lower levels of PA prevalence, less community action and fewer policies. Differences between similar cases are linked to country-specific contexts. CONCLUSIONS: Framework application and comparative analysis indicates how to relate theory to empirical research and complex data sets. In-depth analysis of country-specific contexts and longitudinal observation on changes within and between countries might advise on how to integrate the framework into intervention research.
Journal of Physical Activity and Health 05/2013; · 1.95 Impact Factor
[show abstract][hide abstract] ABSTRACT: The BIG approach aims at promoting physical activity and health among socially disadvantaged women. BIG has been developed and sustainably implemented in Erlangen/Bavaria. Subsequently, it has been transferred to other communities and states in Germany. Crucial factors for sustainability and transfer in BIG are (1) lifestyle and policy analysis, (2) assets approach, (3) empowerment of target group, (4) enabling of policy-makers and professionals.
Das Gesundheitswesen 04/2013; · 0.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article outlines a theoretical framework for an interactive, research-driven approach to building policy capacities in health promotion. First, it illustrates how two important issues in the recent public health debate, capacity building and linking scientific knowledge to policy action, are connected to each other theoretically. It then introduces an international study on an interactive approach to capacity building in health promotion policy. The approach combines the ADEPT model of policy capacities with a co-operative planning process to foster the exchange of knowledge between policy-makers and researchers, thus improving intra- and inter-organizational capacities. A regional-level physical activity promotion project involving governmental and public-law institutions, NGOs and university researchers serves as a case study to illustrate the potential of the approach for capacity building. Analysis and comparison with a similar local-level project indicate that the approach provides an effective means of linking scientific knowledge to policy action and to planning concrete measures for capacity building in health promotion, but that it requires sufficiently long timelines and adequate resources to achieve adequate implementation and sustainability.
Health Promotion International 03/2013; · 1.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Despite the recent rapid development of policies to counteract physical inactivity (PI), only a small number of systematic analyses on the evolution of these policies exists. In this article we analyze how PI, as a public health issue, "translates" into a policy-making issue. First, we discuss why PI has become an increasingly important public health issue during the last two decades. We then follow Guy Peters and conceptualize PI as a "policy problem" that has the potential to be linked to policy instruments and policy impact. Analysis indicates that PI is a policy problem that i) is chronic in nature; ii) involves a high degree of political complexity; iii) can be disaggregated into smaller scales; iv) is addressed through interventions that can be difficult to "sell" to the public when their benefits are not highly divisible; v) cannot be solved by government spending alone; vi) must be addressed through a broad scope of activities; and vii) involves interdependencies among both multiple sectors and levels of government.We conclude that the new perspective on PI proposed in this article might be useful and important for i) describing and mapping policies to counteract PI in different contexts; ii) evaluating whether or not existing policy instruments are appropriate to the policy problem of PI, and iii) explaining the factors and processes that underlie policy development and implementation. More research is warranted in all these areas. In particular, we propose to focus on comparative analyses of how the problem of PI is defined and tackled in different contexts, and on the identification of truly effective policy instruments that are designed to "solve" the PI policy problem.
Health Research Policy and Systems 01/2013; 11(1):9. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: Enabling is a concept central to health promotion. It is perceived as a mechanism that can help people gain control over determinants of health. Little is known, however, about enabling among policy-makers and professionals. This case study investigates enabling among policy-makers and professionals who engaged in a specific participatory approach, cooperative planning. We define 'enabling' as creating action situations that allow policy-makers and professionals to (i) build individual capacities for health promotion and to (ii) apply these capacities to concrete organizational and political action at the institutional level. This case study followed policy-makers and professionals as they participated in a local physical activity promotion action research project in Germany. We conducted a secondary analysis of qualitative data gathered in that project (2005-2011). Methods included participant observation, document analysis, focus groups and qualitative interviews. All data were revisited for the case study and analyzed using qualitative content analysis. Findings include examples of enabling among policy-makers and professionals related to the cooperative planning process. Individual capacities were developed in perceived project roles, interactions with target groups and decision-making procedures. Findings also demonstrated municipal policy changes. Access to physical activity infrastructures improved, and an intersectoral job position was funded to support physical activity promotion among target group participants. Findings were analyzed using a model that links cooperative planning with a framework on policy change from a political science perspective. We conclude that cooperative planning might be a pathway to negotiated agreements that foster systematic enabling and health-promoting policy change.
Health Promotion International 09/2012; · 1.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Purpose of the study was to test a theoretical model to assess and develop policies for the promotion of physical activity among older people as part of an international intervention study.
248 semi-standardized interviews with policy-makers were conducted in 15 European nations. The questionnaire assessed policy-makers' perceptions of organizational goals, resources, obligations, as well as organizational, political and public opportunities in the area of physical activity promotion among older people. In order to develop policies, workshops with policy-makers were conducted. Workshop outputs and outcomes were assessed for four nations nine months after the workshops.
Policy assessment: Results of the policy assessment were diverse across nations and policy sectors. For example, organizational goals regarding actions for physical activity promotion were perceived as being most favorably by the sports sector. Organizational obligations for the development of such policies were perceived as being most favorably by the health sector. Policy development: The workshops resulted in different outputs: a national intersectoral action plan (United Kingdom), a national alliance (Sweden), an integrated policy (the Netherlands), and a continuing dialogue (Germany).
Theory-driven policy assessment and policy-maker workshops might be an important means of scientific engagement in policy development for health promotion.
Health Research Policy and Systems 04/2012; 10:14. · 1.38 Impact Factor
[show abstract][hide abstract] ABSTRACT: This article proposes to shift the focus of our view on evidence-based policy towards a comprehensive "policy orientation". While previous contributions on policy making in public health have already recognised that the evidence-based medicine paradigm is inappropriate for the specificities of the policy context, they still have primarily dealt with evidence of the policy content, i. e. with research to inform policy makers about "what works" in public health (e. g. evidence-based interventions on health determinants). However, they have widely neglected issues pertaining to the policy process, i. e. knowledge concerning "what works" in policy making (e. g. key determinants of policy development and policy implementation in order to build policy capacities and to improve policy outcomes). A broader perspective including the policy process will allow us to contextualise theory and research in a way more appropriate to the process of policy making and will help improve approaches of applied science and knowledge translation in public health. We will illustrate the differences be-tween a content orientation and a policy process orientation in public health by reviewing previous discourses on 3 closely related topics: (1) the production of evidence for policy making, (2) the conditions for the utilisation of evidence in policy making, and (3) the translation of evidence into policy making. We conclude that future public health theory and research, while continuing to broaden the evidence base on health determinants and health interventions, should increasingly focus on research concerning processes of public health policy development and implementation, building frameworks, developing methodologies, and conducting the necessary empirical research.
Das Gesundheitswesen 04/2012; 74(4):224-8. · 0.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: Many questionnaires for measuring physical activity (PA) exist. This complicates the comparison of outcomes.
In 8 European countries, PA was measured in random samples of 600 persons, using the IPAQ as a 'bridge' to historical sets of country-specific questions. We assume that a unidimensional scale of PA ability exists on which items and respondents can be placed, irrespective of country, culture, background factors, or measurement instrument. Response Conversion (RC) based on Item Response Theory (IRT) was used to estimate such a common PA scale, to compare PA levels between countries, and to create a conversion key. Comparisons were made with Eurobarometer (IPAQ) data.
Appropriateness of IRT was supported by the existence of a strong first dimension established by principal component analysis. The IRT analysis resulted in 1 common PA scale with a reasonable fit and face validity. However, evidence for cultural bias (Differential Item Functioning, DIF) was found in all IPAQ items. This result made actual comparison between countries difficult.
Response Conversion can improve comparability in the field of PA. RC needs common items that are culturally unbiased. Wide-scale use of RC awaits measures that are more culturally invariant (such as international accelerometer data).
Journal of Physical Activity and Health 01/2012; 9(1):29-38. · 1.95 Impact Factor
[show abstract][hide abstract] ABSTRACT: The article describes existing recommendations and prevalences of physical activity. In addition, different intervention strategies for the promotion of physical activity on the population level and evidence for their effectiveness are discussed. Intervention strategies are categorized in individually adapted approaches, community-based approaches, mass media campaigns, approaches as part of health service delivery, and policy and environmental approaches. Reviews indicate evidence for the effectiveness of individually adapted approaches for physical activity promotion. However, these approaches might not be well suited to reach certain subgroups of populations. For community-based approaches and for mass media campaigns, at this point, conflicting evidence exists. Interventions as part of health service delivery seem to mostly result in short-term effects regarding physical activity. For policy and environmental approaches, reviews indicate effectiveness.
[show abstract][hide abstract] ABSTRACT: The recent debate in public health about the "inequality paradox" mirrors a long-standing dispute between proponents of structuralist approaches and advocates of action theory. Both views are genuine perspectives of health promotion, but so far they have not been adequately linked by health promotion theory. Using Anthony Giddens's concepts of structure and agency seems promising, but his theory has a number of shortcomings that need to be amended if it is to be applied successfully to health promotion. After briefly assessing Giddens's theory of structuration, this paper proposes to add to it both the concept of structural change as proposed by William Sewell and the policy dimension as described by Elinor Ostrom in her distinction between "operational" and "collective choice" level. On this basis, a multi-level model of the interaction of structure and agency in health promotion is proposed. This model is then connected to central claims of the Ottawa Charter, i.e. "build healthy public policy", "create supportive environments", "strengthen community actions", and "develop personal skills". A case study from a local-level health promotion project in Germany is used to illustrate the explanatory power of the model, showing how interaction between structure and agency on the operational and on the collective choice level led to the establishment of women-only hours at the municipal indoor swimming pool as well as to increased physical activity levels and improved general self-efficacy among members of the target group.
Social Science [?] Medicine 07/2011; 73(7):953-9. · 2.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Movement as Investment for Health (Bewegung als Investition in Gesundheit or BIG) was a multidimensional research study in participatory physical activity promotion among socially disadvantaged women in a deprived neighbourhood in Erlangen, Germany. It aimed at making full use of health-promoting effects of movement and developing integrated evaluation through approaches from different disciplines. We defined the target population through national health survey data, and determined important intervention and evaluation dimensions through meta-analyses. A co-operative planning group of women, researchers, policy-makers, and local experts made decisions on the most appropriate procedures. Integrated evaluation in participatory approaches is promising. It calls for context-specific evaluation, requires adaptation of existing approaches or even development of its own evidence base.
[show abstract][hide abstract] ABSTRACT: Die Verbesserung von Bewegungsverhältnissen ist ein Kernziel des Gesundheitssports. Sowohl sportwissenschaftliche Konzeptualisierungen
als auch praktische Leitlinien der Sportverbände und Krankenkassen beziehen sich explizit auf dieses Konstrukt. Es gibt jedoch
bisher weder ein theoretisch fundiertes Konzept der Bewegungsverhältnisse noch eine systematische Operationalisierung des
Konzepts für die Praxis.
Der Beitrag dient vor diesem Hintergrund zunächst der begrifflichen Präzisierung des Terminus Bewegungsverhältnisse. Dabei wird in Abgrenzung zum Begriff Setting die Bedeutung der Mehrdimensionalität des Begriffs Verhältnisse im Rahmen des Konzepts der Gesundheitsförderung herausgestellt. Gleichzeitig wird über die interdependente Betrachtung von
Verhältnissen und Verhalten die Anschlussfähigkeit des vorliegenden Konzepts für soziologische und politikwissenschaftliche
Im zweiten Teil wird am Beispiel eines Projekts aus der bewegungsbezogenen Gesundheitsförderung die analytische Erklärungskraft
des vorliegenden Konzepts der Bewegungsverhältnisse in der Interventionspraxis veranschaulicht. Der Schwerpunkt dieser Betrachtung
bezieht sich auf einen Ansatz zum strukturellen Wandel, d.h. der Möglichkeit der Veränderung von Bewegungsverhältnissen.
Improving environments for physical activity is a fundamental goal of health sports. Both considerations in sport science
as well as practical guidelines by sport associations and sickness funds build upon that. However, currently there is neither
a theory-based concept nor a systematic operationalisation of that concept.
In the first part, this article therefore aims to define and conceptualise the term “environments for physical activity”.
It refers to the term “setting” to underline the multidimensionality of environments with regard to physical activity as part
of health promotion. The article indicates potential links of the concept to theories of sociology and political science by
looking at the interdependency of structure (Verhältnisse) and agency (Verhalten).
The second part of the article analyses a case study from physical activity promotion to demonstrate the explanatory power
of the concept to intervention practice. The focus of the analysis is on an approach to structural change, i.e. the potential
of changing environments for physical activity.
KeywordsHealth sports–Environments for physical activity–Setting–Conceptualisation–BIG Project
[show abstract][hide abstract] ABSTRACT: There is a growing interest among health promotion researchers to better understand and influence the policy process. However, at this point in time, theoretical concepts enabling researchers to do so are still rare and underused, suggesting a need for new, easy-to-use concepts to explain successes or failures of health promotion policies. This article presents the ADEPT (Analysis of Determinants of Policy Impact) approach, which aims to explain and influence policy development and policy impact implementation with four determinants: goals, obligations, resources and opportunities. ADEPT provides a detailed operationalization for both quantitative and qualitative use. An empirical test of the ADEPT model using a quantitative survey of 719 policy-makers from four health promotion policy fields and six European nations indicated that both policy outputs and policy outcomes are influenced by the four determinants. The approach has, in the meantime, been successfully utilized to analyze and initiate policy development in a number of health promotion projects. Despite a number of limitations, ADEPT provides an easy-to-use, theory-based and parsimonious tool for understanding and influencing policy processes in health promotion. Moreover, as it identifies potential 'levers of influence' and can easily be connected to existing methods of community development or capacity building, it is a particularly powerful tool for policy development.
Health Promotion International 12/2010; 26(3):322-9. · 1.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: This study explored the differences in individual empowerment outcomes of a group of socially disadvantaged women participating in physical activity promotion. The outcomes observed were assessed in the context of the women's mode of participation and the structural organizational and community level changes, which took place during the implementation of the program.
Fifteen semi-structured qualitative interviews were conducted and analyzed using qualitative content analysis. Two groups of women participated in the interviews--those involved in the whole process of planning, implementation and evaluation of the program and those who took part in the program activities.
Individual empowerment outcomes were achieved for all those interviewed, although those participating in the planning, implementation and evaluation of the program achieved the greatest. A number of organizational and community level processes were also identified that supported the individual empowerment of those taking part.
This study supports the use of multilevel empowerment approaches to health as they help to identify the ideal characteristics that organizations and communities should possess and the potential structural changes required to support individual empowerment.
International Journal of Public Health 11/2010; 56(5):465-73. · 1.99 Impact Factor
[show abstract][hide abstract] ABSTRACT: Models explaining the engagement of organizations in different policy sectors in health promotion policy implementation often utilize retrospective data. The current study attempted to model determinants of organizational readiness (goals, resources, obligation, opportunities) in supporting health policy implementation prospectively. Twenty qualitative interviews with representatives of organizations from different policy sectors, levels of government and organizational legal entities were conducted at the beginning of a project for the promotion of physical activity among women in difficult life situations. Organizational support in developing, implementing and disseminating the project was documented over 36 months. Results indicated that in most organizations, determinants were not favorable for health promotion policy action for physical activity among women in difficult life situations. Six organizations did not report any favorable determinant, and two organizations reported four. The other 12 organizations reported positive results for some of the determinants. Project work received support from 6 out of the 20 organizations. A case study of three organizations indicated that engagement or disengagement of organizations in health promotion policy actions might be partly explained by the theoretical model. The prospective assessment of organizational readiness in implementing health promotion policy is highly relevant for health promotion. Considering the proposed theoretical framework may aid in advancing our understanding of factors that are related to organizational engagement in health promotion actions.
Health Promotion International 07/2009; 24(3):243-51. · 1.94 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is accumulating evidence from animal and epidemiologic studies that physical exercise is neuroprotective in healthy animals and humans and can prevent cognitive decline in chronic neurodegenerative processes like Alzheimer's dementia. However, data from well-designed interventional, randomized non-pharmacologic trials is lacking in contrast to other areas of medicine like prevention of hypertension, diabetes or the antipsychotic-associated metabolic syndrome. The demonstration of a potential positive effect of physical exercise on preventing dementia using a controlled study design would represent a significant progress in the prevention of dementia and public health, especially as long as other treatments for dementia prevention are lacking.