A review of settings-based health promotion with applications to sports clubs

Health promotion expectations and perceptions of sport club participants

To develop health promotion (HP) in sports clubs (SCs), stakeholders need to know the HP expectations of sports participants. However, the literature does not provide information on these aspects, which exacerbates the difficulty for SCs to provide an environment, activities and organization that promote health and to play the role entrusted to them in the integration of vulnerable populations. To fill this gap, this study explores the HP expectations and perceptions of sports participants, with a particular focus on ethnocultural characteristics, and documents participants' understanding of HP. A descriptive qualitative study comprising semi-structured interviews was carried out with 22 French and Quebec sports participants. Because they have little experience with HP in their SC, participants do not seem to have many expectations of their SC in terms of HP. Nevertheless, they felt that SCs can play an important role in health and suggested several themes and types of action, such as seminars on nutrition, activities outside the SC to develop cohesion or health monitoring. Sports participants from ethnocultural minorities seem to appreciate the programs designed to integrate them. There is a predominantly physical conception of health and the contribution of SCs to health, and the relationship between the types of health determinants (economic, environmental, organizational and social) and health is not clear. This study shows that the idea of a health-promoting SC appeals to SC participants, but this approach has not yet taken root in this setting or in society as a whole.

Health promotion at higher educational institutions a clarion call for action in India

This article introduces the concept of a health-promoting university (HPU) in an Indian context. The importance of health promotion through a 'settings-based' approach that focuses on India's needs is outlined. We highlight the aims and objectives of a HPU and the mechanisms to evaluate its impact. We call for action by stakeholders to develop a HPU project consistent with public health issues, including health development and sustainability. Furthermore, this settings-based approach provides a template that can be replicated in other low- and middle-income countries.

Process evaluations of health-promotion interventions in sports settings: a systematic review

Sports settings have been identified as an ideal place to conduct complex multi-level health-promotion interventions, with the potential to engage a broad audience. Whilst the benefits of delivering health-promotion interventions in sports settings are well documented, such interventions' real-world implementation and success must be better understood. Process evaluations can be conducted to provide information related to an intervention's fidelity, replication, scaling, adoption, and the underlying mechanisms driving outcomes. This systematic review summarizes how process evaluations of health-promotion interventions are conducted in sports settings and highlight facilitators and barriers to health-promotion intervention delivery using narrative synthesis. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, searches included original peer-reviewed articles from inception-January 2023. We searched eight electronic databases: Academic Search Complete; MEDLINE, PsycARTICLES; PsycINFO; SPORTSDiscus with Full Text; MEDLINE; SCOPUS; Pub Med, and Pro Quest Central. Thirty-two studies were included. Findings suggest that most process evaluations of health-promotion interventions have acknowledged the inherent complexity of sports settings, and investigated factors that explain their intervention's success (e.g. trust building, engagement). However, poor use of process evaluation frameworks or guidelines resulted in wide variations of how process evaluations are conducted and reported, which made findings difficult to integrate and standardize with consistency. Accordingly, this review provides a guide on how future process evaluations can be conducted to improve health-promotion interventions' transparency, replicability and reliability in real-world settings.

Creating healthy food environments in recreation and sport settings using choice architecture: a scoping review

Recreation and sport settings (RSS) are ideal for health promotion, however, they often promote unhealthy eating. Choice architecture, a strategy to nudge consumers towards healthier options, has not been comprehensively reviewed in RSS and indicators for setting-based multi-level, multi-component healthy eating interventions in RSS are lacking. This scoping review aimed to generate healthy food environment indicators for RSS by reviewing peer-reviewed and grey literature evidence mapped onto an adapted choice architecture framework. One hundred thirty-two documents were included in a systematic search after screening. Data were extracted and coded, first, according to Canada's dietary guideline key messages, and were, second, mapped onto a choice architecture framework with eight nudging strategies (profile, portion, pricing, promotion, picks, priming, place and proximity) plus two multi-level factors (policy and people). We collated data to identify overarching guiding principles. We identified numerous indicators related to foods, water, sugary beverages, food marketing and sponsorship. There were four cross-cutting guiding principles: (i) healthy food and beverages are available, (ii) the pricing and placement of food and beverages favours healthy options, (iii) promotional messages related to food and beverages supports healthy eating and (iv) RSS are committed to supporting healthy eating and healthy food environments. The findings can be used to design nested, multipronged healthy food environment interventions. Future research is needed to test and systematically review the effectiveness of healthy eating interventions to identify the most promising indicators for setting-based health promotion in RSS.

Participation of university community members in Health Promoting University (HPU) initiatives

Background

Several universities around the world have adopted the settings approach to health to create a Health Promoting University (HPU) initiative. Health promoting initiatives are built on the values of health promotion, with participation being one of the most important. Despite the above, there is little information on how university community members participate in HPU initiatives. This study aims to describe the participation of university community members in HPU initiatives in universities around the world.

Methods

An online questionnaire was sent to representatives of universities that have implemented a HPU initiative. The questionnaire inquired about the level and nature of participation of university community members (students, professors, and administrative/technical staff) at different levels. Three levels of participation ranged from lower to higher levels were considered: (a) information delivery strategies; (b) consultation strategies and (c) involvement in design, planning and decision-making processes.

Results

At least the 50% of the universities implemented strategies so that all the members of the community could participate at all levels. Information delivery strategies were the most often used, with students being the main target group. Consultation strategies were aimed mainly at students and professors, whilst professors participated most actively in the design, planning and decision-making.

Conclusion

Different participation strategies are used in the HPU initiatives. Information delivery strategies, which represent the lowest level of participation, were the most often reported. Higher levels of participation were less used in the HPU initiatives. HPU initiatives should seek for strategies to provide more high-level participation to all university community members.

Health promoting sports federations: theoretical foundations and guidelines

Background

Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP).

Methods

A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework.

Results

Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club's intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP.

Conclusion

The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.

Older adults' and service providers' experiences of a settings-based health promotion initiative in English football

The study was undertaken to explore the experiences of older adults and service providers in a settings-based health promotion initiative in a football club. We conducted semi-structured interviews with 10 older adults attending an 'Extra Time Hub' (ETH) and two staff delivering the initiative. Our reflexive thematic analysis generated six themes. Findings revealed the brand of the sports club attracted some to join the ETH, but through partnerships with local agencies, the initiative was also successful in widening participation beyond older adults with an interest in football. Participants perceived that the ETH was beneficial for their mental health, helped them develop social connections, and promoted positive physical activity experiences. Moreover, the variety of pleasures derived from participation were also discussed. Our findings also illustrate the central role of staff in older adults' experiences of this form of health promotion. Overall, this study contributes to understandings of settings-based health promotion activities in sports clubs, and also demonstrates the potential for sports clubs to widen engagement with the local community through health promotion for older adults.

Function of Perceived Corporate Social Responsibility in Safety of Sports Activities and Home Aerobic Equipment in the Late Period of COVID-19

The pandemic has impacted various industries, including the sports industry. However, corporate social responsibility (CSR) can mitigate the adverse effects of the crisis and promote the sports industry. To analyze the effect of CSR, the study examined the impact of perceived corporate social responsibility on injury prevention expectation, injury risk perception, and health up-gradation with the mediation of sports safety measures. There are 259 sportsmen of local sports bodies provided the data through a self-administered survey. Data analysis was conducted through Smart-PLS and SEM techniques. The outcome of the analysis showed that perceived corporate social responsibility leads to injury prevention expectation, injury risk perception, and health up-gradation. Also, the study found that sports safety measure mediates the relationship between perceived corporate social responsibility and injury prevention expectation, between perceived corporate social responsibility and injury risk perception, and between perceived corporate social responsibility and health up-gradation among sportsmen of local sports bodies. The theoretical implications were presented related to the significance of CSR and sports safety measure and their impact on sportsmen injury prevention expectation, health, and risk perception. The practical implications were related to the management of local sports bodies and how they can induce CSR initiatives and programs. Some limitations related to sample size, incorporating other variables, examining the model in other contexts, and using different study designs, have also been mentioned in the study.

Experiences of Size Inclusive Physical Activity Settings Among Women With Larger Bodies

Purpose: Size inclusive physical activity settings may help mitigate the impact of physical activity-related weight stigma. In this interpretive description study, we aimed to understand how women with larger bodies experienced size inclusive physical activity settings. The study was informed by a settings-based approach to health promotion. Method: We interviewed nine women with larger bodies who participated in size inclusive physical activity and used an inductive approach to analyze the data. Findings: At the individual level, size inclusion was experienced as an enhancement of well-being, self-worth, and belonging. This was closely tied to the interpersonal level, whereby weight-neutral practices used by fitness instructors and lack of judgment from other exercisers contributed to experiences of size inclusion. At the organizational level, the organization's culture, marketing, programs, and physical spaces could enhance or limit inclusion and participation. However, weight stigma was prevalent in women's experiences outside the physical activity setting. Conclusion: We provide recommendations to improve size inclusion in physical activity settings.

Sports Training Health Analysis Algorithm Based on Heart Rhythm Feature Extraction and Convolutional Neural Network

Intelligent sports equipment and software have emerged in the field of sports as a result of the advancement of information technology, allowing professional athletes to collect and visually display the movement and physical signs of the human body to aid in the planning of sports strategies. Intuitive data, on the other hand, cannot assist ordinary people who lack professional knowledge in exercising correctly. As a result, in the field of intelligent sports and health, effective use of collected exercise and physical sign data to analyze the user's personal physical condition and generate reasonable exercise suggestions has emerged as a research direction. In humans, the heart sound signal is a biological signal. It can help people detect and monitor heart health problems by analyzing the characteristics of heart sound signals. The goal of this paper is to use heart sound to identify and analyze athletes' training health. It provides a revolutionary health analysis algorithm based on heart rhythm feature extraction and convolutional neural networks, which is based on exercise training. It greatly improves the accuracy of the recognition and prediction of the athlete's training health status.

The health promoting sports club model: an intervention planning framework

Researchers and policymakers acknowledge sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to provide SCs guidance to develop health promotion (HP) interventions. As implementation science insists on theoretically grounded interventions, the present work's objective was to provide SCs an evidence-driven intervention framework for planning, developing and implementing HP initiatives. Four iteratively sequenced steps were undertaken: (i) investigation of 'health promoting' indicators, (ii) adaptation of the HPSC concept to create the HPSC model, (iii) formulation of published evidence-driven guidelines into strategies and implementable intervention components (ICs) and (iv) merging the HPSC model with the ICs to create an intervention planning framework for SCs. First, researchers drafted five HPSC indicators. Second, they defined three SC levels (macro, meso and micro) and four health determinants (organizational, environmental, economic and social) to create an HPSC model. Third, researchers used published guidelines to develop 14 strategies with 55 ICs. Fourth, three workshops (one each with French master-level sport students, French sport and health professionals and Swedish sport and health professionals) had participants classify the ICs into the model. The HPSC model and intervention framework are starting points to plan, select and deliver interventions to increase SC HP. This planning framework is usable in several ways: (i) clubs can apply strategies to achieve specific goals, (ii) clubs can target specific levels with corresponding ICs and (iii) ICs can be used to address particular health determinants.

Multiple effects health economic evaluation of the Ahead of The Game Study for mental health promotion in sporting club communities

BACKGROUND

This study evaluates the Ahead Of The Game (AOTG) mental health promotion strategy for adolescent males relative to usual practice in team based sporting club community settings, allowing for joint incremental effects across 13 dimensions and 5 domains alongside intervention implementation costs.

METHODS

Analysis is undertaken between matched communities with difference in differences analysis of joint multiple pre-post effect changes alongside implementation costs employing radar plots in cost-disutility space. A robust bootstrapping method allowed including all observed change in effect data from 343 AOTG and 273 control arm participants across 13 effect dimensions.

RESULTS

Triangulation across joint evidence shows mean incremental effects favoured AOTG in all dimensions (10/13 significantly at 5% level) and in simple aggregation to each of five pre-specified 5 domains (each significant at < 1% level) and global measures (significant at 0.001% level), while mean AOTG implementation costs were conservatively estimated as $37.47 per participant.

CONCLUSION

The AOTG strategy was found to represent an effective mental health promotion strategy across all domains and globally with associated significant potential for downstream health system cost savings to offset against modest implementation costs. Evaluation methods extend conventional cost-effectiveness analysis to enable robust joint presentation and triangulation under uncertainty of multiple effect dimensions alongside costs.

TRIAL REGISTRATION

ANZCTR, ACTRN12617000709347 . Registered 17th May 2017.

Professional football clubs' involvement in health promotion in Spain: an audit of current practices

The implementation of effective community-based health interventions within Spanish football clubs has the potential to positively influence the public health agenda and enable the healthcare system in Spain to be more successful and sustainable. This paper aims to explore the involvement of Spanish football clubs in health promotion activities, their potential for future involvement and what that would require. A mixed methods explanatory sequential design, with a purposive sample of La Liga clubs. Data collection included online questionnaires and phone interviews. Quantitative methods enabled us to describe the number and types of programmes the clubs are currently involved in. Qualitative data was useful to further unpick the processes followed by the clubs in planning and developing health promotion programmes, while identifying any determinants to change. Seventeen clubs completed questionnaires and 11 participated in interviews. Clubs generally support inclusive programmes that target disadvantaged groups. Health-related programmes focus on healthy eating, physical activity and blood donation. Thematic analysis of interviews with 11 representatives of La Liga clubs resulted in three-key themes. These related to: (i) Diversity of programmes; (ii) (Lack of) evidence-based approaches to intervention design and evaluation and (iii) Contrasting views about a club's role in health promotion interventions. Spanish football clubs have potential to reach into communities that are currently underserved. However, there is limited infrastructure and understanding within the clubs to do this. Nevertheless, there is huge opportunity for organizations with public health responsibility in Spain to implement translational approaches within football-based settings.

Learn, Have Fun and Be Healthy! An Interview Study of Swedish Teenagers' Views of Participation in Club Sport

In Sweden, participation in club sport is a vital part of many children’s lives. Despite this, many stop in their teenage years, raising questions concerning if and in what ways club sport can provide health-promoting activities via longer, sustained participation. The aim of this cross-sectional study is to explore and discuss young people’s views of club sport from a health-promoting perspective. The analysis draws on three sets of qualitative data: results from focus groups interviews conducted in 2007 (n = 14) and in 2016 (n = 8) as well as 18 in-depth interviews conducted 2008. Antonovsy’s salutogenic theory and his sense of coherence (SOC) model inspired the analysis. Teenagers want to be a part of club sport because of a sense of enjoyment, learning, belonging and feeling healthy. Teenagers stop when sport becomes too serious, non-flexible, time-consuming and too competitive. The urge for flexibility and possibilities to make individual decisions were emphasised in 2016. The organisation of club sport, it seems, has not adapted to changes in society and a generation of teenagers’ health interests. Club sport has the potential to be a health-promoting arena, but the focus should be on changing the club sport environment, instead of a focus on changing young people.

Building Public Health Capacity through Organizational Change in the Sport System: A Multiple-Case Study within Australian Gymnastics

Sports clubs increasingly are settings for health promotion initiatives. This study explored organizational change processes and perceived facilitators and barriers relevant to implementing a health promotion initiative within gymnastics settings in New South Wales (NSW), Australia. A multiple-case design investigated the experiences of the state association (Gymnastics NSW) and five clubs from one region of NSW in a participatory Health-Promoting Gymnastics Clubs (HPGC) program. The program aimed to build the capacity of Gymnastics NSW to support affiliated clubs to become health-promoting settings. Interviews with organizational representatives explored their experiences of the program and identified factors that enabled or inhibited program adoption, implementation and sustainability. Facilitators and barriers identified included leadership and champions; organizational capacity and culture; priorities and timing; and characteristics of the HPGC framework. This multi-level, organizational change intervention demonstrated potential to create health-promoting gymnastics settings. Tailoring strategies in diverse club contexts required involvement of organizational leaders in program development and action planning. Despite positive impacts, pre-existing organizational culture inhibited integration of health promotion as a core value. Sustained organizational change may result from professional regulatory requirements (e.g., accreditation and affiliation), and policy directives and funding (for organizational change, not program delivery) from relevant government departments.

Can Health-Enhancing Sporting Programs in Sports Clubs Lead to a Settings-Based Approach? An Exploratory Qualitative Study

There is limited knowledge about how a settings-based approach can be best applied in a sports club setting. This qualitative exploratory study examined whether and how sporting programs focusing on individual behavior change (i.e., increasing physical activity levels of inactive people) and implemented on the micro-level of the sports club, can be a first step towards a settings-based approach (i.e., inclusion of the meso- and macro-level of the sports club). In addition, this study explored factors that influenced the inclusion of the meso- and macro-level of the sports club. Telephone interviews were conducted with representatives of sixteen sports clubs about program activities on all levels of the sports club. Thematic analyses were performed to explore stimulating and hindering factors. After multiple years, six sports clubs also had program activities on the meso-level and twelve sports clubs had activities on the macro-level. Program activities differed per level within a sports club and on the same level between sports clubs. Cultural and social factors influenced macro-level activities, while predominantly economic factors influenced meso-level activities. Based on these factors, sports clubs could develop, prioritize, and choose strategies that support them in developing a settings-based approach when increasing physical activity levels of inactive citizens.

Health Promoting Sports Club in Practice: A Controlled Evaluation of the GAA Healthy Club Project

Sport is a developing setting and a relevant system in health promotion but there are few examples of settings-based initiatives and systems thinking in sport. The Gaelic Athletic Association (GAA) Healthy Club Project (HCP) adopts a settings approach delivered through and by grassroots clubs who respond to local needs while working within a national support system. The aim of this evaluation was to assess and describe the health promotion impact and experience of the HCP. Healthy Clubs (n = 23) and Control Clubs (n = 10) completed a Healthy Club Questionnaire at the start and end of the 20-month HCP and Healthy Clubs took part in focus group discussions. Healthy Clubs, using the structures of the HCP, a commitment to health and community engagement, demonstrated a significant improvement in their overall orientation to health promotion, which was not apparent in Control Clubs. The health promotion message is pervading into many aspects of the GAA club apart from that which relates to the day to day business of coaching and providing physical activity for all. The HCP represents health promotion activity embedded within and across systems, with further development and evaluation recommended to measure delivery and impact at the individual level, organisational, and wider societal levels.

Conceptualizing the 'whole university' approach: an international qualitative study

Focusing on the conceptualization of a whole university approach, this paper reports on an international qualitative study that explored vice-chancellors' and network members' understanding of and commitment to Health Promoting Universities, examined perspectives on leadership and investigated the Okanagan Charter's potential to catalyse whole university leadership and change. A multi-method qualitative approach was used: semi-structured interviews and focus groups were conducted face-to-face with vice-chancellors (n = 12) and Health Promoting University co-ordinators who were members of the UK Healthy Universities Network (n = 8); telephone interviews were conducted with a mix of UK and non-UK Health Promoting University co-ordinators (n = 5) and two online questionnaires were distributed to non-UK network co-ordinators (n = 6) and non-UK Health Promoting University co-ordinators (n = 10). Through thematic analysis, a number of key themes emerged that build a new conceptualization of the whole university approach (see Figure 1): building a broad understanding and framing of health; developing a supportive ethos and culture; embedding health into the university and joining up areas of work; focusing on the whole population and facing challenges and seizing opportunities. The study elicited rich and wide-ranging views from multiple stakeholders from universities and networks across four continents, confirming Health Promoting Universities as a truly global movement. Looking ahead, there are clear opportunities and challenges. First, the media narrative of a student mental health 'crisis' has focused universities' attention on 'health', but from a single issue 'illness' perspective. This risks detracting from the whole system Health Promoting Universities approach. Second, even with the Okanagan Charter inspiring individuals and universities, there are still major challenges in translating the rhetoric of whole system approaches into meaningful action within large, complex and culturally diverse organizations.

Youth sport participation and physical activity in rural communities

Background

Physical activity, a high-frequency health behavior, varies by where children live, learn, and play. Children accumulate physical activity in adult-led in-school and out-of-school settings. Youth sport is a potential setting for physical activity, but there are differences in youth sport participation based on age, sex, and socioeconomic status. There is a gap in understanding demographic influences on youth sport participation and how these factors interact to influence physical activity. This study examines influences of grade, sex, and family income on youth sport participation and these factors and youth sport participation on moderate-to-vigorous physical activity of children in rural communities.

Methods

Children (n = 418 3rd–6th graders) living in two rural communities completed the online Youth Activity Profile as part of Wellscapes, a type 3 hybrid implementation-effectiveness community randomized trial. Mixed models with community as a random effect examined main effects and interactions of grade, sex, and family income on youth sport participation and these factors and youth sport participation on moderate-to-vigorous physical activity.

Results

About 80% of children engaged in youth sport, and full-pay lunch students were almost four times more likely to have youth sport participation than students with free/reduced lunch (OR = 3.91, 95% CI = 1.95, 7.8). Females and 6th graders (p < 0.05) had lower physical activity than comparison groups. Males with higher family income had greater physical activity; females with higher family income had less physical activity. For 6th graders, high family income had less effect on physical activity than similar 3rd-5th graders (p < 0.01).

Conclusions

While a fairly high percentage of children participate in youth sports, there are disparities in rural communities on youth sport participation and physical activity outcomes based on age, sex, and family income.

Promoting healthy eating in the community sport setting: a scoping review

Community sport organizations promote beneficial health outcomes such as social connection and physical activity, yet they can also facilitate the consumption of unhealthy food and beverages. To provide a foundation for future research and to inform intervention efforts in this context, this scoping review summarizes existing knowledge of the factors that contribute to unhealthy food and beverage consumption in the community sport setting and explores the interventions to promote healthier choices. Using a qualitative process aligned with the nature of our aims, 228 articles were initially identified and subjected to a systemized appraisal, resulting in 45 articles pertinent to the review. The findings identify that the two key factors contributing to unhealthy food choices are the limited availability of healthy options within the sport setting and the presence of unhealthy food and beverage sponsorship. These factors contribute to the normalization of unhealthy eating in this context and health promotion interventions have had limited success. Barriers to change primarily stem from the revenue implications of removing unhealthy food sponsors, lack of organizational capabilities and resources, and consumer preference for unhealthy options. Public health practitioners seeking to intervene in this setting should consider adopting practices used in other settings outside of the sport environment, including the use of technology, the role of peers and mentors and the co-production of impactful material. Community sport plays a vital role in delivering health benefits but must do more to stem its facilitation of a potentially unhealthy consumptive environment.

An investigation of the health-promoting practices of Australian universities

Workplace health promotion programmes (WHPPs) are more likely to succeed where design and implementation account for the influence of health's complex, systemic nature. Thus, a greater understanding of how frameworks developed to progress WHPPs are operationalized across different countries and industries is needed. This study investigates health concerns targeted in an underexplored setting-Australian universities, describing how diverse programmes are implemented to target different health issues and health risk factors. Content analysis is used to outline how Australian universities implement WHPPs to target diverse health concerns. Content from 497 website documents is collected and analysed using NVivo software. A framework for examining diverse WHPPs currently used in practice is developed. Based on this framework, it was evident that Australian universities emphasized initiatives targeting health issues focusing on 'mental health' and 'diabetes'. Regarding health risk factors, 'alcohol and other addictions', 'discrimination and harassment', and 'physical activity' were emphasized. Links between different health concerns targeted and corresponding WHPPs implemented, provide workplaces with a benchmark for designing and implementing programmes. University WHPPs targeted a diverse range of health concerns when enough legal and political motivations to do so existed. These findings about the motivations for improving employee health indicate a potential gap between health promotion benefits reported in literature and the appreciation for these benefits in practice.

Factors influencing the implementation of the Health Promoting University initiative: experiences of Ibero-American universities

The Health Promoting University (HPU) concept encourages universities to incorporate health into the university context. HPU initiatives exist worldwide, yet information on how universities translate the HPU concept into actions is scarce. This study aimed to identify the factors influencing the implementation of HPU initiatives in Ibero-American universities. Semi-structured interviews were held with seventeen representatives of universities in Ibero-America that had implemented an HPU initiative. All interviewees had been involved in the initiative and had occupied a position of responsibility for at least 1 year before the study. The interviews were carried out remotely, and the data were analyzed using an inductive approach. The main factors influencing the implementation of an HPU initiative were political support by the university authorities, coordination structure, funding, collaboration inside and outside university and participation of the university community. Among them, political support by the university authorities was considered the most important, although some initiatives succeeded without it and managed to obtain support during the implementation process. This study is one of the first to investigate the factors influencing the implementation of the HPU concept. A better understanding of these factors would enable universities to address them to develop the HPU initiative in the best possible conditions.

Capitalization of Health Promotion Initiatives within French Sports Clubs

The settings-based approach to health promotion within sports clubs is a growing field of research. Evidence of health promotion intervention effectiveness in scientific literature is scarce, and little is known about their implementation mechanisms. The present study explores how promising health promotion interventions in eight French sports clubs are developed, and how the health promoting sports club's intervention planning framework is applied. A method to collect Experiential Knowledge in health promotion was used, based on two iterative interviews to analyze intervention mechanisms and completed with document analysis. A deductive analysis using the health promoting sports club intervention planning framework was then undertaken. Among the 14 evidence-driven strategies, 13 were implemented in sports clubs (min = 9; max = 13). Policies were not targeted by any of the interventions. Key competencies of the managers of these health promotion interventions were identified: (1) having a deep understanding of the public and environment, (2) acquiring a high capacity to mobilize internal and external human resources, (3) possessing communication skills and (4) having an ability to write grant applications. By using evidence-driven strategies and intervention components, sports professionals can use this experiential knowledge to create successful and sustainable interventions.

Health Promotion Interventions in Sports Clubs: Can We Talk About a Setting-Based Approach? A Systematic Mapping Review

Many researchers and authorities have recognized the important role that sports clubs can play in public health. In spite of attempts to create a theoretical framework in the early 2000s, a thorough understanding of sports clubs as a setting for health promotion (HP) is lacking. Despite calls for more effective, sustainable, and theoretically grounded interventions, previous literature reviews have identified no controlled studies assessing HP interventions in sports clubs. This systematic mapping review details how the settings-based approach is applied through HP interventions in sports clubs and highlights facilitators and barriers for sports clubs to become health-promoting settings. In addition, the mapped facilitators and barriers have been used to reformulate previous guidelines of HP in sports clubs. Seven databases were searched for empirical research published between 1986 and 2017. Fifty-eight studies were included, principally coming from Australia and Europe, describing 33 unique interventions, which targeted mostly male participants in team sports. The settings-based approach was not yet applied in sports clubs, as more than half of the interventions implemented in sports club targeted only one level of the socio-ecological model, as well as focused only on study participants rather than the club overall. Based on empirical data, the analysis of facilitators and barriers helped develop revised guidelines for sports clubs to implement settings-based HP. This will be particularly useful when implementing HP initiatives to aid in the development of sports clubs working with a whole setting approach.

Promotion of healthy eating in clubs with junior teams in Australia: A cross-sectional study of club representatives and parents

ISSUES ADDRESSED

To: (i) describe the prevalence of policies and practices promoting healthy eating implemented by sports clubs with junior teams; (ii) examine differences in such practices across geographic and operational characteristics of clubs; and (iii) describe the attitudes of club representatives and parents regarding the acceptability of sports clubs implementing policies and practices to promote healthy eating.

METHODS

Cross-sectional telephone surveys of junior community football club management representatives and parents/carers of junior players were conducted in the states of New South Wales and Victoria, Australia in 2016.

RESULTS

Seventy-nine of the 89 club representatives approached to participate completed the telephone survey. All clubs (100%; 95% CI 96.2-100.0) reported recommending fruit or water be provided to players after games or at half-time, 24% (95% CI 14.4-33.7) reported promoting healthy food options through prominent positioning at point of sale and only 8% (95% CI 1.6-13.6) of clubs had a written healthy eating policy. There were no significant differences between the mean number of healthy eating policies and practices implemented by club socio-economic or geographic characteristics. Club representatives and parents/carers were supportive of clubs promoting healthy eating for junior players.

CONCLUSIONS

While there is strong support within sporting clubs with junior teams for policies and practices to promote healthy eating, their implementation is highly variable. SO WHAT?: A considerable opportunity remains for health promotion policy and practice improvement in clubs with junior teams, particularly regarding policies related to nutrition.

A qualitative investigation of the role of sport coaches in designing and delivering a complex community sport intervention for increasing physical activity and improving health

BACKGROUND

Community sport can potentially help to increase levels of physical activity and improve public health. Sport coaches have a role to play in designing and implementing community sport for health. To equip the community sport workforce with the knowledge and skills to design and deliver sport and empower inactive participants to take part, this study delivered a bespoke training package on public health and recruiting inactive people to community sport for sport coaches. We examined the views of sport coach participants about the training and their role in designing and delivering a complex community sport intervention for increasing physical activity and improving health.

METHODS

Semi-structured interviews were conducted with paid full-time sport coaches (n = 15) and community sport managers and commissioners (n = 15) with expertise in sport coaching. Interviews were conducted by a skilled interviewer with in-depth understanding of community sport and sport coach training, transcribed verbatim and analysed using thematic analysis.

RESULTS

Three key themes were identified showing how the role of sport coaches can be maximised in designing and delivering community sport for physical activity and health outcomes, and in empowering participants to take part. The themes were: (1) training sport coaches in understanding public health, (2) public involvement in community sport for health, and (3) building collaborations between community sport and public health sectors.

CONCLUSION

Training for sport coaches is required to develop understandings of public health and skills in targeting, recruiting and retaining inactive people to community sport. Public involvement in designing community sport is significant in empowering inactive people to take part. Ongoing knowledge exchange activities between the community sport and public health sector are also required in ensuring community sport can increase physical activity and improve public health.

The social and psychological health outcomes of team sport participation in adults: An integrative review of research

Aim: The aim of this article was to review the international scientific research literature about the social and psychological health outcomes associated with participation in team sport and to synthesise the key issues about team sport as a health-promoting activity. Methods: The methodological framework guiding the review process is the integrative research review. A search of 10 key electronic databases was conducted to identify both quantitative and qualitative studies addressing the social and/or psychological health outcomes from participation in a team sport. A total of 6,097 publications were identified and 17 studies met the inclusion criteria. Results: A wide range of different positive social, psychological, and psychosocial health outcomes associated with team sport participation were identified in the studies, with emotional social support, sense of belonging, higher self-esteem, social network, and social interaction being the most frequently reported health benefits. In addition, three key issues influencing the psychological and social health outcomes of team sport participation as a health-promoting activity were identified: (1) team sport versus individual sport, (2) competitive versus non-competitive structure, and (3) commitment and continuation. Conclusions: There is consistent evidence that participation in a team sport is associated with improved social and psychological health independent of the type of team sport, age, somatic, or mental health problems. The findings indicate that team sport could be more efficient in promoting health and ensuring exercise participation and continuation than individual sport. However, when utilising team sports for health purposes, precautions must be taken with regard to their inherent competitive nature.

Effectiveness of targeting the health promotion settings for non-communicable disease control in low/middle-income countries: systematic review protocol

INTRODUCTION

Settings-based approaches to health promotion, involving holistic and multidisciplinary methods, which integrate action across risk factors are important. Major advantage of focusing on these settings is the continuous and intensive contact with the participant. Despite the apparent advantages of addressing non-communicable diseases (NCDs) using targeted interventions for several developed country settings, a relative lack of evidence of effectiveness of such interventions in low/middle-income countries has led to poor allocation of resources towards these interventions. The focus is therefore on the settings rather than any one condition, and we therefore expect the findings to generalise to NCD prevention and control efforts. We intend to estimate the effectiveness of targeted interventions in low/middle-income countries.

METHODS AND ANALYSIS

We will search PubMed, Excerpta Medica Database, OVID, WHO Library and The Cochrane Library from the year 2000 to March 2018 without language restrictions. Study designs to be included will be randomised controlled trials. The primary outcome of effectiveness will be the percentage change in population having different behavioural risk factors. Subgroup analyses will be performed, and sensitivity analyses will be conducted to assess the robustness of the findings.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. The Institute Ethics Committee of the Post Graduate Institute of Medical Education and Research approved the doctoral research protocol under which this review is being done. Dissemination will be done by submitting scientific articles to academic peer-reviewed journals. We will present the results at relevant conferences and meetings.

STUDY DESIGN

Systematic review.

PROSPERO REGISTRATION NUMBER

CRD42016042647; Pre-results.

Leisure-time youth centres as health-promoting settings: Experiences from multicultural neighbourhoods in Sweden

AIMS

The aim of this paper is to advocate for the importance of meaningful leisure time for young people from a health-promotion perspective using experiences from two youth centres in multicultural neighbourhoods in Sweden.

METHODS

In this practice-based study, data were collected between 2012 and 2014 at two youth centres in multicultural, socially deprived suburbs in Sweden using surveys with 12- to 16-year-old adolescents ( n = 207), seven individual interviews with staff and three cooperation partners in the neighbourhoods, and six group interviews with adolescents (50% girls). Quantitative, qualitative and mixed methods were used for analysis.

RESULTS

As part of the youth centres' strategies, they are open and inclusive, foster supportive relationships, emphasise youth empowerment, and integrate family, school and community in their work. The youth centres are health-promoting settings with regard to four of the action areas in the Ottawa Charter: build healthy public policy, create supportive environments, strengthen community actions and develop personal skills.

CONCLUSIONS

There is a need for a variety and a combination of various structured and unstructured leisure-time activities because young people's background and life situation plays a role for their participation in leisure-time activities. We conclude that youth centres are well placed to be or to become health-promoting settings if the activities takes place in a structured environment.

Exploring strategies to improve the health promotion orientation of Flemish sports clubs

Sports clubs are increasingly recognized as an innovative setting for health promotion, as exemplified by the health promoting sports club concept. This study aims to assess the health promotion orientation of both youth sports clubs (YSC) and adult sports clubs (ASC) in Flanders and to identify the motives and barriers as reported by their representatives as a basis for proposing intervention strategies to improve the health promotion orientation in sports clubs. A total of 253 Flemish sports clubs, consisting of 156 YSC and of 97 ASC, completed the online questionnaire, covering club characteristics (e.g. finances, human resources), perceived motives and barriers for health promotion and the health promoting sports club index. Even though YSC were more health promoting than ASC, the results indicated that all sports clubs could improve their health promotion orientation. The most consistent predictors of health promotion orientation are perceived motives index for YSC and perceived lack of resources for ASC. Based on these results, interventions to enhance the health promoting orientation need to tackle the lack of resources such as lack of expertise regarding health promotion. Interventions aimed specifically at YSC should emphasize the direct benefits, for example by demonstrating how health promotion helps clubs to improve the provision of high quality sports participation and by awarding a health promotion quality label.

"The individual at the centre" - a grounded theory explaining how sport clubs retain young adults

PURPOSE

There is still a lack of knowledge regarding which social processes occur in sport clubs and what factors influence young adults to want to remain in a sport club context. Thus, the purpose of this study was to construct a grounded theory (GT) explaining how sport clubs can retain their young adults.

METHOD

The study uses an intersectional approach. In line with constructivist GT methodology, data from 14 focus-group interviews (27 coaches and 28 young adults) were collected and analysed using a constant comparative method.

RESULTS

The core category, "The individual at the centre of a community", summarizes a process, whereby the generated GT contains three main categories, namely (1) "Participation and influence", (2) "Social connectedness" and (3) "Good conditions".

CONCLUSIONS

The coaches put the individual at the centre of a community and pay attention to the needs and interests of all the young adults, regardless of their background, ambitions, and skills. However, while the idea of a moral imperative to provide for diversity was not directly absent in the discussions with both the coaches and young adults, most of the diversity approaches seemed to be based on ambition and skills, gender, age and sexuality.

Piecing the puzzle together: case studies of international research in health-promoting sports clubs

This paper seeks to review the current international health-promoting sports club (HPSC) research, drawing together findings based on case studies from various countries to illustrate the status of HPSCs. In addition, future challenges for HPSC research and implementation are considered. The review includes six case studies from five countries. In summary, there are two major research themes in this area, namely 'research into HPSC activity' and 'research into HPSC networks'. The first theme investigates the extent to which sports clubs and/or national sports organisations invest in health promotion (HP) - both in policy and practice. The latter theme is driven by an intention to widen the scope of HPSCs to reach novel internal actors, like parents, siblings, etc., and/or external non-sporting bodies, like communities, schools, etc. The future challenges for HPSC research require a better understanding of the motives, barriers and capacities of sports clubs and coaches. Sports organisations, clubs and coaches generally support the intent of the HPSC concept, but even with the best evidence- or theory-based HP programmes/guidelines/standards, nothing will happen in practice if the nature and capacities of sports clubs are not better acknowledged. Therefore, a call for embracing implementation science is finally made to enhance implementation.

The influence of a Healthy Welcoming Environment on participation in club sport by adolescent girls: a longitudinal study

Background

This study investigated the perceived influence of a Healthy Welcoming Environment (HWE) on participation in sports clubs among adolescent girls, and how these perceptions changed longitudinally. HWE was defined in terms of a set of health promotion policies advocated by a health promotion foundation as the basis of sport club health promotion practice to promote structural reform in state sporting organisations and their affiliated associations and clubs. These included sports injury prevention, smoke-free, responsible serving of alcohol, sun protection, healthy eating, and welcoming and inclusive environments.

Methods

Year 7 and 11 female students from metropolitan (n = 17) and non-metropolitan secondary schools (n = 14) in Australia were invited to participate in three annual surveys. These surveys collected information about current or past membership of a sports club and the influence of HWEs on their decision to participate (or not) in a sports club.

Results

Year 7 (n = 328; 74.5%) and Year 11 (n = 112; 25.5%) female students completed all three waves (19.6% response rate; 82.7 and 74.0% retention rate). Most agreed that characteristics of HWEs were a positive influence on their participation in sports clubs, except those relating to alcohol and Sunsmart. Welcoming factors had consistent high agreement among respondents. Alcohol and friendliness factors of the club were regarded as being positively influential by higher percentages of non-metropolitan than metropolitan respondents.

Conclusions

Welcoming factors were the most positive influences on decisions to participate in sports clubs. These factors may be important in reducing barriers to sport participation. Strategies supporting the social environment within sports clubs should be prioritised.

Adherence to and effects on physical function parameters of a community-based standardised exercise programme for overweight or obese patients carried out by local sports clubs

OBJECTIVES

To evaluate the adherence to a sports-club-based standardised real-life exercise programme for overweight or obese patients. The effects on physical function parameters, anthropometry and quality of life were also assessed.

STUDY DESIGN

Within this prospective cohort study data from patients in Austrian sports-club-based programmes were analysed.

METHODS

Sports-club-based programmes were held twice a week and carried out by local trainers. The target group was overweight or obese patients. Adherence was determined after 2 and 6 months, and physical function parameters were evaluated at baseline and after 2 months.

RESULTS

A total of 71 patients (age: 52.0; standard deviation [SD: 12.1] years; body mass index [BMI]: 37.3 [SD: 8.2] kg/m²) took part in the study. Within the first 2 months the adherence rate was 62%, while 20% (14/71) participated in ≥75% of all offered sessions. After 6 months, 49% (17/35) of the retained sample still participated regularly in an exercise class. At baseline, muscle strength represented only 70% of the age- and sex-specific reference values and could be increased in a range from +4.0% (1.3 [SD: 3.0] kg; muscular endurance for the pectoral muscles) to +22.5% (16.1 [SD: 17.5] kg) (muscular endurance for the lower limb muscles). Concerning endurance capacity, the heart rate for a constant submaximal workload decreased from 126.4 (SD: 21.7) beats per minute at baseline to 120.9 (SD: 21.1) after 2 months (P < 0.001).

CONCLUSIONS

Sports clubs, as a non-clinical setting, can offer attractive standardised exercise programmes for a minority of overweight or obese patients. Long term changes in life-style, that result in sufficient levels of health enhancing physical activity still remain a huge public health challenge.

Comparison of coaches' perceptions and officials guidance towards health promotion in French sport clubs: a mixed method study

Despite the call to improve health promotion (HP) in sport clubs in the existing literature, little is known about sport clubs' organizational capacity. Grounded within the setting-based framework, this study compares HP activities and guidance among 10 football clubs. At least three grassroots coaches from each club (n = 68) completed the Health Promoting Sports Clubs scale to assess their perceptions of HP; an official (n = 10) was interviewed about club's activities and official's guidance provided to coaches. A concurrent embedded design with quantitative results guiding the qualitative analysis was used. Despite no significant differences regarding coaches' perceptions of HP between the 10 sport clubs, except for the policy dimension, officials' interviews revealed some contradictions. Sport participation was recognized as automatically promoting HP, meaning that sport practice entails many benefits, without questioning the nature of the activities. HP was considered as a secondary aim in regard to sport performance, leading to the lack of written policies, partnerships and sporadic HP activities. Future interventions should consider: (i) the creation of required policy and long-term vision; (ii) the link between HP and sport performance; (iii) the rootedness of sport clubs within their community and (iv) guidelines towards HP from sport federations.

Are coaches' health promotion activities beneficial for sport participants? A multilevel analysis

OBJECTIVES

As major actors in sports activities, sports coaches can play a significant role in health education and contribute to the psychological well-being of young people. However, not all participants in sports activities experience sports positively, which reduces the potential benefits for health. The present study investigates if coaches' efforts to promote health increase young athletes' enjoyment, self-esteem and perceived health in daily life and decrease sport dropout.

DESIGN

To control for the variability between teams and between clubs, multilevel modeling was applied.

METHODS

A sample of 342 young football players completed questionnaires assessing their perceptions of coaches' Health Promotion (HP) activities, enjoyment of sports, dropout intentions, self-esteem and perceived health in daily life.

RESULTS

HP general score was positively related to enjoyment and perceived health as well as negatively dropout intentions. Players perceiving their coaches as promoting fair and play (Respect for oneself and others) scored higher on their perceptions of enjoyment in sport, self-esteem and self-reported health, and lower on dropout intentions. Moreover, players recognizing their coaches as encouraging their healthy lifestyle also reported higher perceptions of sport enjoyment, whereas player's perceived coaches' activities on substance use were associated with lower participants' enjoyment.

CONCLUSIONS

These results support the importance of developing HP in sports clubs. Especially, promoting respect of oneself and others seems to be the more beneficial to sport participants.

Physical activity levels during youth sport practice: does coach training or experience have an influence?

This study examined moderate-to-vigorous physical activity (MVPA) levels in youth during flag football practice and compared youth MVPA in practices led by trained or untrained, and by experienced or inexperienced, coaches. Boys (n = 111, mean age = 7.9 ± 1.2 years) from 14 recreation-level flag football teams wore an accelerometer during two practices. Each team's volunteer head coach reported prior training and coaching experience. Mixed-model team-adjusted means showed the proportion of practice time spent in sedentary (13 ± 1%), MVPA (34 ± 2%) and vigorous (12 ± 1%) activity. Practice contributed ~20 min of MVPA towards public health guidelines. There was no significant difference in percentage time spent in MVPA between teams with trained (mean = 33.3%, 95% CI = 29.4%, 37.2%) and untrained coaches (mean = 35.9%, 95% CI = 25.5%, 42.4%) or between experienced (mean = 34.1%, 95% CI = 30.2%, 38.0%) and inexperienced coaches (mean = 33.8, 95% CI = 27.9%, 39.7%). Although sport provides a setting for youth to accrue MVPA, two-thirds of practice was spent sedentarily or in light activity. Participation in a coach training programme was not associated with higher MVPA. Further research is needed to inform volunteer coach training programmes that provide coaches with skills necessary to increase the percentage of practice time spent in MVPA.

Creating a supportive environment among youth football players

Purpose

– The health promoting benefits of sport participation are under-utilized and should be further developed, particularly at the grassroots level. The purpose of this paper is to examine how grassroots coaches in youth football perceive their coaching practices after participating in a community-based coach education program aimed at optimizing their experiences in youth sport, namely the Empowering Coaching™ training program, based on self-determination theory (SDT) and achievement goal theory (AGT). It compares French and Norwegian coaches to suggest whether the principles of the Empowering Coaching™ training program can be applied successfully in the two countries.

Design/methodology/approach

– The Empowering Coaching™ training program is a six hour workshop and was delivered at the beginning of the 2011 football season. At the end of the season, the grassroots coaches’ reflections on their coaching practices were examined through a qualitative approach with in-depth interviews of 18 coaches in France and Norway, applying a hybrid analyses and comparing country-wise.

Findings

– All coaches expressed the intention to embrace the philosophy of the program, and to apply several of the strategies they had learnt during the workshop. The coaches perceived that the program supported their efforts to develop and implement strategies to stimulate intrinsic motivation, enjoyment and long-term participation among the players. There were some differences between coaches from France and Norway (e.g. rules and involvement), but the similarities were more evident, supporting the universality of applying SDT in the youth sport setting.

Social implications

– The findings are encouraging for sport as a health promoting setting and for the development of the personal skills in grassroot coaches, as they imply that coaches who feel competent in how to structure practices and matches that provide the players with positive sport experiences are likely to enable players to feel supported and motivated.

Originality/value

– This study explores qualitatively the impact of an intervention based on SDT and AGT, focussing on football coaches’ reflections on their coaching practices.

Health promotion activities of sports clubs and coaches, and health and health behaviours in youth participating in sports clubs: the Health Promoting Sports Club study

Introduction

Sports clubs form a potential setting for health promotion, but the research is limited. The aim of the Health Promoting Sports Club (HPSC) study was to elucidate the current health promotion activities of youth sports clubs and coaches, and to investigate the health behaviours and health status of youth participating in sports clubs compared to non-participants.

Methods and analysis

The study design employs cross-sectional multilevel and multimethod research with aspirations to a prospective cohort study in the next phase. The setting-based variables at sports clubs and coaching levels, and health behaviour variables at the individual level, are investigated using surveys; and total levels of physical activity are assessed using objective accelerometer measurements. Health status variables will be measured by preparticipation screening. The health promotion activity of sports clubs (n=154) is evaluated by club officials (n=313) and coaches (n=281). Coaches and young athletes aged 14–16 (n=759) years evaluate the coaches’ health promotion activity. The survey of the adolescents’ health behaviours consist of two data sets—the first is on their health behaviours and the second is on musculoskeletal complaints and injuries. Data are collected via sports clubs (759 participants) and schools 1650 (665 participants and 983 non-participants). 591 (418 athletes and 173 non-athletes) youth, have already participated in preparticipation screening. Screening consists of detailed personal medical history, electrocardiography, flow-volume spirometry, basic laboratory analyses and health status screening, including posture, muscle balance, and static and dynamic postural control tests, conducted by sports and exercise medicine specialists.

Ethics and dissemination

The HPSC study is carried out conforming with the declaration of Helsinki. Ethical approval was received from the Ethics Committee of Health Care District of Central Finland. The HPSC study is close-to-practice, which generates foundations for development work within youth sports clubs.

The contribution of sport participation to overall health enhancing physical activity levels in Australia: a population-based study

Background

The contribution of sport to overall health-enhancing leisure-time physical activity (HELPA) in adults is not well understood. The aim was to examine this in a national sample of Australians aged 15+ years, and to extend this examination to other ostensibly sport-associated activities.

Methods

The 2010 Exercise, Recreation and Sport Survey (ERASS) was conducted by telephone interview in four quarterly waves. Data from this survey were analysed to categorise leisure-time physical activity (LTPA) as HELPA or non-HELPA, and to categorise HELPA activities and sessions of HELPA activity by setting and frequency. The contribution of sport to HELPA was estimated, both directly through activities and settings classified as sport per se, and indirectly through other fitness activities ostensibly related to preparation for sport and enhancement of sport performance.

Results

Of 21,602 respondents, 82 % reported some LTPA in the 12 months prior to the survey. In aggregate, respondents reported 37,020 activity types in the previous 12 months, of which 94 % were HELPA. Of HELPA activities, 71 % were non-organised, 11 % were organised but not sport club-based, and 18 % were sport club-based. Of all sport activities, 52 % were HELPA. Of sport HELPA, 33 % was sport club-based and 78 % was undertaken ≥12 times/year. Sport club members were significantly more likely to have participated in running, but significantly less likely to have participated in walking or aerobics/fitness training, than non-club members.

Conclusions

Club sport participation contributes considerably to LTPA at health enhancing levels. Health promotion policies, and more specifically physical activity policies, should emphasize the role of sport in enhancing health. Sport policy should recognise the health-promoting role of community-based sport in addition to the current predominant focus on elite pathways.

Sports clubs as settings for health promotion: fundamentals and an overview to research

This paper explores the efficacy and value of sports clubs as a setting for health promotion. Sports clubs for children and adolescents are the primary focus of the paper, and the aims are two-fold.

AIMS

Firstly, the paper aims to review the basis for and elements of the health promoting sports club (HPSC) concept. Secondly, the aim is to overview the international evolution of the HPSC concept and its usefulness in the research. The settings-based health promotion approach forms the basis for the HPSC concept and it is introduced first. Thereafter, both obligating and prospecting factors, to justify the importance for sports clubs to address health promotion, are expressed. Major prospecting factors relate to the facts that sports club activities reach a lot of children and adolescents, and that its educational nature is informal due to voluntary participation. The paper also presents multilevel structure of sports clubs, as well as the determinants affecting the settings-based work. The research concerning health promotion in sports-related settings is evolving worldwide, and Nordic countries are in the front line of this new-wave of settings-based health promotion. Indeed, it has been claimed that, for the settings approach to assimilate to current societal challenges, there is a need to widen the reach of the approach to non-traditional, non-institutional settings, like sports clubs.

Unintended effects in settings-based health promotion

The settings-based approach to health promotion (HP) employs a social ecological (SE) framework to integrate HP into the usual activities of the setting and to increase the setting’s support for healthy choices. The SE approach calls for systems thinking to account for the inextricable relationship between people, their behaviour and their environment. Knowledge about a setting can be used to mobilise people to participate in HP, to optimise success by taking into account the local context, and to anticipate and avoid barriers to success. In other words, the SE approach aims to help HP reach its goals for better health, established in concert with community needs and wishes. Yet, the focus on HP goals may detract attention from how intervention may have unanticipated, and even untoward effects on the setting. There is much evidence from classical ecological research that well-meaning interventions have unintended effects. Biology is so tuned to the possibility that the study of unintended effects is integral to the field. There is some evidence – but much less - that HP also has unexpected, deleterious effects. The evidence is limited because of neglect; the subject of unintended effects is only of peripheral interest in HP. This is a call for a more robust SE approach, in which frameworks used to guide settings-based HP are augmented so as to be concerned with planned effects, and also unplanned effects. What can be done to more responsibly monitor, document and report the full panoply of our effects, including detecting and preventing untoward effects?