Critical success factors for physical activity promotion through community partnerships

An integrative perspective on interorganizational multilevel healthcare networks: a systematic literature review

BACKGROUND

Interorganizational networks in healthcare do not always attain their goals. Existing models outline the factors that could explain poor network performance: governance; structure; and the alignment of professional, organizational and network levels. However, these models are very generic and assume a functional approach. We investigate available empirical knowledge on how network structure and governance relate to each other and to network performance in a multilevel context, to get deeper insight, supported with empirics, of why networks (fail to) achieve their goals.

METHOD

A systematic literature review based on a search of Web of Science, Business Source Complete and PubMed was executed in May 2021 and repeated in January 2022. Full papers were included if they were written in English and reported empirical data in a healthcare interorganizational setting. Included papers were coded for the topics of governance, structure, performance and multilevel networks. Papers from the scientific fields of management, administration and healthcare were compared. Document citation and bibliographic coupling networks were visualized using Vosviewer, and network measures were calculated with UCINET.

RESULTS

Overall, 184 papers were included in the review, most of which were from healthcare journals. Research in healthcare journals is primarily interested in the quality of care, while research in management and administration journals tend to focus on efficiency and financial aspects. Cross-citation is limited across different fields. Networks with a brokered form of governance are the most prevalent. Network performance is mostly measured at the community level. Only a few studies employed a multilevel perspective, and interaction effects were not usually measured between levels.

CONCLUSIONS

Research on healthcare networks is fragmented across different scientific fields. The current review revealed a range of positive, negative and mixed effects and points to the need for more empirical research to identify the underlying reasons for these outcomes. Hardly any empirical research is available on the effects of different network structures and governance modes on healthcare network performance at different levels. We find a need for more empirical research to study healthcare networks at multiple levels while acknowledging hybrid governance models that may apply across different levels.

Interorganizational Networks in Physical Activity Promotion: A Systematic Review

Public health challenges such as physical inactivity are multiplex and cannot be effectively addressed by single organizations or sectors. For this reason, public health policies have to involve various sectors and foster partnerships among organizations. Social network analysis (SNA) provides a methodological toolkit that enables the investigation of relationships between organizations to reveal information about the structure and cooperation within networks. This systematic review provides an overview of studies utilizing SNA to analyze the structure of networks that promote physical activity, including the structural set-up, types, and conditions of cooperation, the existence or absence of key actors, the characteristics of organizations working together, and potential barriers limiting collaboration. In total, eight eligible studies were identified. To evaluate the quality of these studies, a quality assessment tool for SNA was created. Relevant aspects from each study were systematically outlined using a data extraction template developed for network studies. The studies reported low to moderate density scores with many ties not being realized. Organizations tend to work side by side than as real partners, whereas organizations of the same type are more strongly connected. Most of the studies identified governmental health organizations as key players in their networks. Network maturity influences network outcomes. Shared goals and geographic proximity are potential facilitators for network development. For future research, more sophisticated methods and longitudinal studies are required to describe how networks, with the aim of promoting physical activity, develop and change to identify predicting factors for an effective network structure.

Communication as a Strategy to Promote Sports and Health Activities Designed for Adolescents

Physical activity reduces the risk of developing noncommunicable diseases and improves quality of life, providing health benefits for present and future generations. This is especially relevant for adolescents. Educational institutions are promoters of healthy habits through the organisation of different activities such as extracurricular sports programmes. These activities increase the rates of sports practice among adolescents. The literature shows that the perceived quality of sports and health services is an antecedent of users' behavioural intentions. The aim of this paper is to find out whether communication from educational/sports organisations influences adolescents' intentions to continue engaging in physical activity. A total of 1080 students participated, with a mean age of 13.76 ± 1.39 years, 34.1% of whom were girls. Tests were conducted to verify the validity and reliability of the model that relates communication with value, satisfaction, and future intentions. Tests were conducted to verify the validity (average variance extracted was between 0.754 and 0.583) and reliability (composite reliability was between 0.925 and 0.813) of the model that relates communication with value, satisfaction, and future intentions. Confirmatory analyses and factor invariance tests were performed. The results revealed that communication is an antecedent of value, satisfaction, and future intentions. In conclusion, communication is a good strategy to consolidate sporting habits in both male and female adolescents.

A Systematic Review of Key Factors in the Effectiveness of Multisector Alliances in the Public Health Domain

Objective:

The purpose of this systematic literature review is to assess the factors associated with synergistic multisector alliances in the public health domain.

Data Source:

Articles in PubMed, CINAHL, Scopus, and Google Scholar between March 2009 and February 2019 were searched.

Study Inclusion and Exclusion Criteria:

Included alliances had a public health and behavioral focus, were from the public or private sector, and were multipartner and multisector, and from high-income countries. Public health research alliances were included, but clinical research alliances were excluded.

Data Extraction:

Data extraction included alliance description, alliance domain, country, single or multiple alliances, and the sectors included in the alliance. Two theoretical frameworks were used in data extraction.

Data Synthesis:

Data were coded according to 28 factors representing antecedents, management, and evaluation (Parent and Harvey model) and 3 output-specific factors (Bergen model).

Results:

A final 24 papers were included, of which 58% contained synergistic alliances. While almost all factors reportedly enabled synergy, some factors were more frequently associated with synergistic alliances, including clear purpose and positive coordination, information sharing, and evaluation of project outcomes. Complexity within some factors was also reported.

Conclusion:

The theoretical models were supported by the data. Public health alliances would likely benefit from incorporating factors identified as beneficial for synergy and from carefully considering the management of complex factors.

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

This study describes a Pyrenean cross-cultural structure called Centre for the Promotion of Physical Activity and Health (CAPAS-City) that was created to promote physical activity (PA) in Huesca (Spain) and Tarbes (France). The main aim of this centre is to lead the way in the design, implementation, and evaluation of multilevel PA interventions to improve their efficacy and sustainability inside the city. CAPAS-City responds to the main challenges related to multilevel PA interventions, through six guiding principles: (1) promoting sustainability, (2) playing a leadership role, (3) promoting multisectoral partnerships, (4) using evidence-based strategies, (5) promoting integrated knowledge translation, and (6) using a participatory research approach. Five multilevel PA interventions were designed in both cities by CAPAS-City with these principles in mind. Through the example of the Annual MOT Test adapted to bikes, we also illustrate one practical application of the use of these principles, following the Social-Ecological approach, in which the main agents of influence are involved at different levels to encourage cycling. According to the promising results found in this study, CAPAS-City appears to be a structure that is able to respond to the main needs and challenges of multilevel interventions to increase PA levels in the whole population of both cities.

Partnerships between an At-Risk Youth CrossFit Program and Local Community Organizations: Focusing on the Antecedents to Partnership Development

A large body of research has established that sport intervention programs can have social, emotional and health benefits for at-risk youth. While research has focused on the positive outcomes associated with these programs, little attention has been given to program inputs. It is recognized that community partnerships can help intervention programs achieve their goals. Yet, how are such partnerships formed and what can help to promote the successful formation of partnerships? This paper provides a detailed account of the partnership implementation process undertaken to develop and deliver a health promotion physical activity program for at-risk youth through the medium of CrossFit in a low socioeconomic area in a rural community in the southeastern United States. Developing successful partnerships serves as a valuable component to help organizations obtain resources and skills needed to initiate and continue programs for underserved populations. The scholars identify and explain how critical success factors such as personal contact, partnership complementarity and fit and the promotion of high levels of commitment and trust, serve as important starting points for developing and maintaining strong community partnerships.

What makes intersectoral partnerships for health promotion work? A review of the international literature

A Health in All Policies approach requires creating and sustaining intersectoral partnerships for promoting population health. This scoping review of the international literature on partnership functioning provides a narrative synthesis of findings related to processes that support and inhibit health promotion partnership functioning. Searching a range of databases, the review includes 26 studies employing quantitative (n = 8), qualitative (n = 10) and mixed method (n = 8) designs examining partnership processes published from January 2007 to June 2015. Using the Bergen Model of Collaborative Functioning as a theoretical framework for analyzing the findings, nine core elements were identified that constitute positive partnership processes that can inform best practices: (i) develop a shared mission aligned to the partners’ individual or institutional goals; (ii) include a broad range of participation from diverse partners and a balance of human and financial resources; (iii) incorporate leadership that inspires trust, confidence and inclusiveness; (iv) monitor how communication is perceived by partners and adjust accordingly; (v) balance formal and informal roles/structures depending upon mission; (vi) build trust between partners from the beginning and for the duration of the partnership; (vii) ensure balance between maintenance and production activities; (viii) consider the impact of political, economic, cultural, social and organizational contexts; and (ix) evaluate partnerships for continuous improvement. Future research is needed to examine the relationship between these processes and how they impact the longer-term outcomes of intersectoral partnerships.

Health in All local Policies: Lessons learned on intersectoral collaboration in a community-based health promotion network in Denmark

Health promotion increasingly involves collaboration with civil society organisations and the private sector rather than being implemented exclusively by public sector stakeholders. Health in All Policies (HiAP) is an approach that promotes health in policy-making across public sectors. This study explored intersectoral integration and collaboration for health promotion at a local community level through a qualitative single case study of a local community network in Denmark: the Husum Health Network. The paper describes and discusses strengths, weaknesses, and challenges of HiAP-inspired local efforts to build alliances and supportive environments for health within an inter-organisational community-based network. The data were generated from participant observations made at 11 meetings and events organised by the network partners and nine qualitative, semi-structured interviews with Husum Health Network partners conducted from August 2014 to February 2015. The data were analysed using a theoretical framework introduced by Axelsson and Axelsson (2006) to characterise aspects of integration and differentiation between organisations. With high levels of structural and functional differentiation between the partners, the network provided an opportunity to exercise inter-organisational integration at the local level. Integration was fostered by knowledge sharing, face-to-face interaction, and communal events. However, the loose structure of the network was a challenge to its sustainability and achievement. We argue that Health in All local Policies is a meaningful concept in the context of local community development only when referring to the polices and strategies of all stakeholder organisations involved in decision-making and agenda setting, and not just local government institutions.

Promoting integration within the public health domain of physical activity promotion

Purpose

The purpose of this paper is to report and critically reflect on the methodological processes involved in a formal attempt to promote health and social integration in the rarely reported public health domain of physical activity promotion.

Design/methodology/approach

A quality improvement (QI) methodology was deployed, comprising three elements: a diagnostic tool that assessed strategic and practice positions; a half-day workshop that brought senior leaders together for to reflect this evidence; and a structured process that sought to generate proposals for future integrated action. A mixed-method evaluative approach was used, capturing insights of the integration processes via quantitative and qualitative data collection pre-event, in-event, immediate post-event and at six-month follow-up.

Findings

Insights suggested that despite some critical concerns, this QI process can be considered as robust, offering pointers to elements required to successfully promote integration in this domain, including the significance of leadership, the preparatory contribution of a diagnostic tool and position paper, the opportunities for active exchange and planning within a workshop situation and the initiation of a process of integrated work via tangible “pledges”.

Originality/value

The paper offers originality in two respects. Generally, it describes and reflects on the relationship between theoretical and empirical dimensions of a model of integration promotion. Specifically, in offering an account of integrative public health work across health service, local authority and third sector partners, it addressed an area that has received relatively limited prior attention.

Capacity building through cross-sector partnerships: a multiple case study of a sport program in disadvantaged communities in Belgium

Background

Recent research has illustrated the need for cross-sector partnerships to tackle multidimensional problems such as health inequalities and sport and physical activity promotion. Capacity building is based on partnerships and has demonstrated effectiveness in tackling these multidimensional problems. This study aims to explain how cross-sector partnerships build capacity at the practitioner, organisational and partnership levels. The subject of this study is a community sport program (CSP) that aims to increase sport participation rates and physical activity levels.

Methods

The study examined multiple cases in four disadvantaged communities in Antwerp, Belgium where the CSP was implemented. Forty-four face-to-face interviews were held with leaders from sport, social, health, culture and youth organisations that collaborated with the CSP.

Results

Thirteen elements of cross-sector partnerships were identified as critical to building capacity at each of the different levels. These include: process evaluation, trust, mutuality, policy support, partner complementarity and fit, diversity of activities and period of collaboration-time. Trust in turn was fostered by a longer period of collaboration-time, better personal contact, clearer coordination and an external focus. Policy support was developed by support of partners and establishing clear metrics of success.

Conclusion

Insight into the key elements of cross-sector partnerships that build capacity is given and several practical recommendations are suggested for practitioners and policy makers.