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Silva CS, Godinho C, Encantado J, Rodrigues B, Carraça EV, Teixeira PJ, Silva MN. Implementation determinants of physical activity interventions in primary health care settings using the TICD framework: a systematic review. BMC Health Serv Res 2023; 23:1082. [PMID: 37821932 PMCID: PMC10568782 DOI: 10.1186/s12913-023-09881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 08/07/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Translation into practice of effective physical activity interventions in primary care is difficult, due to a complex interaction of implementation determinants. We aimed to identify implementation barriers and facilitators of four primary care interventions: physical activity assessment, counselling, prescription, and referral. METHODS A systematic review of qualitative, quantitative and mixed-methods studies published since 2016 was conducted. The "Tailored Implementation for Chronic Diseases" (TICD) framework was adapted to extract and synthesize barriers and facilitators. RESULTS Sixty-two studies met the inclusion criteria. Barriers (n = 56) and facilitators (n = 55) were identified across seven domains, related to characteristics of the intervention, individual factors of the implementers and receivers, organizational factors, and political and social determinants. The five most frequently reported determinants were: professionals' knowledge and skills; intervention feasibility/compatibility with primary health care routine; interventions' cost and financial incentives; tools and materials; and professionals' cognitions and attitudes. "Social, political and legal factors" domain was the least reported. Physical activity counselling, prescription, and referral were influenced by determinants belonging to all the seven domains. CONCLUSION The implementation of physical activity interventions in primary care is influenced by a broader range of determinants. Barriers and facilitators related with health professionals, intervention characteristics, and available resources were the most frequently reported. A deep understanding of the local context, with particularly emphasis on these determinants, should be considered when preparing an intervention implementation, in order to contribute for designing tailored implementation strategies and optimize the interventions' effectiveness.
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Affiliation(s)
- Catarina Santos Silva
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal.
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal.
| | - Cristina Godinho
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisboa, Portugal
| | - Jorge Encantado
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Bruno Rodrigues
- CIAFEL, Faculdade de Desporto da Universidade Do Porto, Porto, Portugal
| | - Eliana V Carraça
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
| | - Pedro J Teixeira
- CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Marlene Nunes Silva
- Programa Nacional Para a Promoção da Atividade Física, Direção-Geral da Saúde, Lisboa, Portugal
- CIDEFES, Centro de Investigação em Desporto, Educação Física, Exercício e Saúde, Universidade Lusófona, Lisboa, Portugal
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O'Grady M, Barrett E, Broderick J, Connolly D. The role of intermediaries in connecting community-dwelling adults to local physical activity and exercise: A scoping review protocol. HRB Open Res 2022; 5:29. [PMID: 35655716 PMCID: PMC9130757 DOI: 10.12688/hrbopenres.13523.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Physical inactivity is a major global issue affecting health. Promoting, supporting and encouraging physical activity amongst community-dwelling adults is essential. An intermediary is a clinical or non-clinical professional based in primary care, community or voluntary settings. They support individuals referred to them to connect with appropriate community services with the goal of improving health and wellbeing. This may be a promising method to establish a connection to local physical activity and exercise; however the process has been poorly described to date. Objective: The objectives of this scoping review will be to identify and summarise the literature describing the process of connecting community-dwelling adults to an intermediary, the characteristics of these adults, the processes (role, practice and procedure) of an intermediary in connecting these adults to local physical activity and exercise opportunities, and to map these processes of connection to outcomes. Methods: This scoping review will be conducted in accordance with the scoping review methodology of the Joanna Briggs Institute. A comprehensive search strategy will identify relevant studies in Embase, Medline, Web of Science and CINAHL, along with a structured grey literature search. Studies which describe an intermediary connecting community-dwelling adults (aged ≥18 years) to local physical activity and exercise will be included. Data will be charted and narratively summarised. Intermediary processes will be mapped to outcomes related to physical activity, and the PAGER (patterns, advances, gaps, evidence for practice and research recommendations) framework will be used to identify evidence gaps and research recommendations. Conclusions: This scoping review will be the first to describe the process of an intermediary connecting community dwelling adults to local physical activity and exercise. This review will identify, map and summarise the existing research on the processes and outcomes. The results will also identify any evidence gaps and will guide future research.
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Affiliation(s)
- Megan O'Grady
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Emer Barrett
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
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3
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O'Grady M, Barrett E, Broderick J, Connolly D. The role of intermediaries in connecting community-dwelling adults to local physical activity and sport: A scoping review protocol. HRB Open Res 2022; 5:29. [DOI: 10.12688/hrbopenres.13523.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Physical inactivity is a major global issue affecting health. Promoting, supporting and encouraging physical activity amongst community-dwelling adults is essential, especially in primary care services where the majority of healthcare contacts take place. An intermediary, a professional who supports individuals to connect with appropriate community and voluntary services with the goal of improving health and wellbeing, may be a promising method to establish a connection to local physical activity; however the process has been poorly described to date. Objective: The objective of this scoping review will be to identify and summarise the literature describing the process of connecting community-dwelling adults to an intermediary, the processes (role, practice and procedure) of an intermediary in connecting these adults to local physical activity and sport opportunities, and to map these processes of connection to outcomes. Methods: This scoping review will be conducted in accordance with the scoping review methodology of the Joanna Briggs Institute. A comprehensive search strategy will identify relevant studies in Embase, Medline, Web of Science and CINAHL, along with a structured grey literature search. Studies which describe an intermediary connecting community-dwelling adults (aged ≥18 years) to a local physical activity and/or sport opportunity or other similar resource will be included. Data will be charted and narratively summarised. Intermediary processes will be mapped to outcomes related to physical activity, and the PAGER (patterns, advances, gaps, evidence for practice and research recommendations) framework will be used to identify evidence gaps and research recommendations. Conclusions: This scoping review will be the first to describe the process of an intermediary connecting community dwelling adults to local physical activity. This review will identify, map and summarise the existing research on the processes and outcomes. The results will also identify any evidence gaps and will guide future research.
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van Bijsterveld SC, Barten JA, Molenaar EALM, Bleijenberg N, de Wit NJ, Veenhof C. Psychometric evaluation of the Decision Support Tool for Functional Independence in community-dwelling older people. JOURNAL OF POPULATION AGEING 2022; 16:1-23. [PMID: 35368880 PMCID: PMC8960690 DOI: 10.1007/s12062-022-09361-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/11/2022] [Indexed: 11/06/2022]
Abstract
Background The aging population is increasingly faced with daily life limitations, threatening their Functional Independence (FI). These limitations extend different life domains and require a broad range of community-care professionals to be addressed. The Decision Support Tool for Functional Independence (DST-FI) facilitates community-care professionals in providing uncontradictory recommendations regarding the maintenance of FI in community-dwelling older people. The current study aims to determine the validity and reliability of the DST-FI. Methods Sixty community-care professionals completed a twofold assessment. To assess construct validity, participants were asked to assign predefined recommendations to fifty cases of older people to maintain their level of FI. Hypotheses were tested regarding the expected recommendations per case. Content validity was assessed by questions on relevance, comprehensiveness, and comprehensibility of the current set of recommendations. Twelve participants repeated the assessment after two weeks to enable both within- and between rater reliability properties, expressed by an Intraclass Correlation Coefficient. Results Seven out of eight predefined hypotheses confirmed expectations, indicating high construct validity. As the recommendations were indicated 'relevant' and 'complete', content validity was high as well. Agreement between raters was poor to moderate while agreement within raters was moderate to excellent, resulting in moderate overall reliability. CONCLUSION The DST-FI suggests high validity and moderate reliability properties when used in a population of community-dwelling older people. The tool could facilitate community-care professionals in their task to preserve FI in older people. Future research should focus on psychometric properties like feasibility, acceptability, and developing and piloting strategies for implementation in community-care.
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Affiliation(s)
- S. C. van Bijsterveld
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - J. A. Barten
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - E. A. L. M. Molenaar
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - N. Bleijenberg
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
- Research Group Proactive Care in Older People, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
| | - N. J. de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - C. Veenhof
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Research Group Innovation of Human Movement Care, Research Centre for Healthy and Sustainable Living, Utrecht University of Applied Sciences, Utrecht, The Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, The Netherlands
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Bolster EAM, van Gessel C, Welten M, Hermsen S, van der Lugt R, Kotte E, van Essen A, Bloemen MAT. Using a Co-design Approach to Create Tools to Facilitate Physical Activity in Children With Physical Disabilities. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:707612. [PMID: 36188842 PMCID: PMC9397745 DOI: 10.3389/fresc.2021.707612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022]
Abstract
Introduction: There is a lack of effective interventions available for Pediatric Physical Therapists (PPTs) to promote a physically active lifestyle in children with physical disabilities. Participatory design methods (co-design) may be helpful in generating insights and developing intervention prototypes for facilitating a physically active lifestyle in children with physical disabilities (6–12 years). Materials and methods: A multidisciplinary development team of designers, developers, and researchers engaged in a co-design process–together with parents, PPTs, and other relevant stakeholders (such as the Dutch Association of PPTs and care sports connectors). In this design process, the team developed prototypes for interventions during three co-creation sessions, four one-week design sprint, living-lab testing and two triangulation sessions. All available co-design data was structured and analyzed by three researchers independently resulting in themes for facilitating physical activity. Results: The data rendered two specific outcomes, (1) knowledge cards containing the insights collected during the co-design process, and (2) eleven intervention prototypes. Based on the generated insights, the following factors seem important when facilitating a physically active lifestyle: a) stimulating self-efficacy; b) stimulating autonomy; c) focusing on possibilities; d) focusing on the needs of the individual child; e) collaborating with stakeholders; f) connecting with a child's environment; and g) meaningful goal setting. Conclusion: This study shows how a co-design process can be successfully applied to generate insights and develop interventions in pediatric rehabilitation. The designed prototypes facilitate the incorporation of behavioral change techniques into pediatric rehabilitation and offer new opportunities to facilitate a physically active lifestyle in children with physical disabilities by PPTs. While promising, further studies should examine the feasibility and effectivity of these prototypes.
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Affiliation(s)
- Eline A. M. Bolster
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, Netherlands
- *Correspondence: Eline A. M. Bolster
| | - Christa van Gessel
- Co-design Research Group, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Maxime Welten
- Research Group Participation and Urban Development, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Sander Hermsen
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, Netherlands
- OnePlanet Research Center, Imec the Netherlands, Wageningen, Netherlands
| | - Remko van der Lugt
- Co-design Research Group, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | | | - Anita van Essen
- Co-design Research Group, Utrecht University of Applied Sciences, Utrecht, Netherlands
| | - Manon A. T. Bloemen
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, Netherlands
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Law RJ, Langley J, Hall B, Burton C, Hiscock J, Williams L, Morrison V, Lemmey AB, Lovell-Smith C, Gallanders J, Cooney J, Williams NH. Promoting physical activity and physical function in people with long-term conditions in primary care: the Function First realist synthesis with co-design. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
As people age and accumulate long-term conditions, their physical activity and physical function declines, resulting in disability and loss of independence. Primary care is well placed to empower individuals and communities to reduce this decline; however, the best approach is uncertain.
Objectives
To develop a programme theory to explain the mechanisms through which interventions improve physical activity and physical function in people with long-term conditions in different primary care contexts, and to co-design a prototype intervention.
Data sources
Systematic literature searches of relevant databases with forwards and backwards citation tracking, grey literature searches and further purposive searches were conducted. Qualitative data were collected through workshops and interviews.
Design
Realist evidence synthesis and co-design for primary care service innovation.
Setting
Primary care in Wales and England.
Participants
Stakeholders included people with long-term conditions, primary care professionals, people working in relevant community roles and researchers.
Methods
The realist evidence synthesis combined evidence from varied sources of literature with the views, experiences and ideas of stakeholders. The resulting context, mechanism and outcome statements informed three co-design workshops and a knowledge mobilisation workshop for primary care service innovation.
Results
Five context, mechanism and outcome statements were developed. (1) Improving physical activity and function is not prioritised in primary care (context). If the practice team culture is aligned to the elements of physical literacy (mechanism), then physical activity promotion will become routine and embedded in usual care (outcome). (2) Physical activity promotion is inconsistent and unco-ordinated (context). If specific resources are allocated to physical activity promotion (in combination with a supportive practice culture) (mechanism), then this will improve opportunities to change behaviour (outcome). (3) People with long-term conditions have varying levels of physical function and physical activity, varying attitudes to physical activity and differing access to local resources that enable physical activity (context). If physical activity promotion is adapted to individual needs, preferences and local resources (mechanism), then this will facilitate a sustained improvement in physical activity (outcome). (4) Many primary care practice staff lack the knowledge and confidence to promote physical activity (context). If staff develop an improved sense of capability through education and training (mechanism), then they will increase their engagement with physical activity promotion (outcome). (5) If a programme is credible with patients and professionals (context), then trust and confidence in the programme will develop (mechanism) and more patients and professionals will engage with the programme (outcome). A prototype multicomponent intervention was developed. This consisted of resources to nurture a culture of physical literacy, materials to develop the role of a credible professional who can promote physical activity using a directory of local opportunities and resources to assist with individual behaviour change.
Limitations
Realist synthesis and co-design is about what works in which contexts, so these resources and practice implications will need to be modified for different primary care contexts.
Conclusions
We developed a programme theory to explain how physical activity could be promoted in primary care in people with long-term conditions, which informed a prototype intervention.
Future work
A future research programme could further develop the prototype multicomponent intervention and assess its acceptability in practice alongside existing schemes before it is tested in a feasibility study to inform a future randomised controlled trial.
Study registration
This study is registered as PROSPERO CRD42018103027.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 16. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Beth Hall
- Library and Archives Services, Bangor University, Bangor, UK
| | - Christopher Burton
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Lynne Williams
- School of Health Sciences, Bangor University, Bangor, UK
| | - Val Morrison
- School of Psychology, Bangor University, Bangor, UK
| | - Andrew B Lemmey
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | | | | | - Jennifer Cooney
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, UK
| | - Nefyn H Williams
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Smit E, Leenaars K, Wagemakers A, van der Velden K, Molleman G. How to recruit inactive residents for lifestyle interventions: participants' characteristics based on various recruitment strategies. Health Promot Int 2021; 36:989-999. [PMID: 33270846 PMCID: PMC8521843 DOI: 10.1093/heapro/daaa134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.
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Affiliation(s)
- Eva Smit
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Karlijn Leenaars
- Department of Healthy Living, RIVM,
Bilthoven, P.O Box 1, 3720 BA, The Netherlands
| | - Annemarie Wagemakers
- Social Sciences, Group Health & Society,
Wageningen University, Wageningen, P.O. Box 8130, 6700 EW,
The Netherlands
| | - Koos van der Velden
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
| | - Gerard Molleman
- Department of Primary and Community Care, Radboud
University Medical Center, Radboud Institute for Health Sciences,
Nijmegen, P.O. Box 9101 6500 HB. The
Netherlands
- Research Department, GGD Gelderland
Zuid, Nijmegen, P.O. Box 1120, 6501 BC, The
Netherlands
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Smit E, Leenaars KEF, Wagemakers A, van der Velden K, Molleman GRM. Perceptions of Care Sport Connectors' Tasks for Strengthening the Connection Between Primary Care, Sports and Physical Activity: A Delphi Study. Int J Integr Care 2020; 20:13. [PMID: 32292311 PMCID: PMC7147677 DOI: 10.5334/ijic.4789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/09/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Care sport connectors stimulate physical activity and facilitate collaboration between the primary care and physical activity sectors in the Netherlands. To strengthen intersectoral collaboration between the primary care and sports sectors, it is necessary to study which tasks a care sport connector must fulfil according to their own and other professionals' perceptions. METHODS A Delphi study was conducted with 182 professionals from the primary care, public health and physical activity sectors. Rounds 1 and 2 included questions about task perception, willingness to collaborate and expectations of care sport connectors. Rounds 3 and 4 were used to reach consensus. RESULTS All professions acknowledged physical activity promotion tasks, but they are not all willing to collaborate. They expect a broad range of roles from care sport connectors: informative, executive, guiding and intermediate. Care sport connectors reached consensus on two roles: informative and intermediate. DISCUSSION Care sport connectors have an important role in strengthening intersectoral collaboration. All the professions acknowledged a task concerning physical activity promotion and accepted a broker role. Thus, a public health mind-set seems to be present to some extent. However, challenges remain, such as the lack of willingness to collaborate among primary care professionals and sports policies not (yet) supporting intersectoral collaboration.
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Affiliation(s)
- Eva Smit
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboudumc, Nijmegen, NL
| | | | - Annemarie Wagemakers
- Health and Society Group, Department of Social Sciences, Wageningen University & Research, Wageningen, NL
| | - Koos van der Velden
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboudumc, Nijmegen, NL
| | - Gerard R. M. Molleman
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboudumc, Nijmegen, NL
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Wagemakers A, Mulderij LS, Verkooijen KT, Groenewoud S, Koelen MA. Care-physical activity initiatives in the neighbourhood: study protocol for mixed-methods research on participation, effective elements, impact, and funding methods. BMC Public Health 2018; 18:812. [PMID: 29954365 PMCID: PMC6025726 DOI: 10.1186/s12889-018-5715-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the Netherlands, people with a low socioeconomic status (SES) live approximately 6 years less and are less engaged in physical activity (PA) than high SES citizens. This contributes to the persistent health inequalities between low and high SES citizens. Care-PA initiatives are deemed effective for stimulating PA and improving health and participation among peoples with a low SES. In those initiatives, multiple sectors (e.g. sports, health insurers, municipalities) collaborate to connect primary care and PA at neighbourhood level. This study focuses on two Dutch municipalities that aim to invest in Health in All Policies (HiAP) and care-PA initiatives to improve the health of people with low SES. The aim is to gain insight into (1) the short-term (3 months) and long-term (1 year) outcomes of participating in care-PA initiatives for low SES citizens in terms of health, quality of life, and societal participation, (2) the effective elements that contribute to these outcomes, (3) the direct and perceived societal costs and benefits of care-PA initiatives, and (4) alternative ways to fund integrated care, prevention, and care-PA initiatives at neighbourhood level. METHODS The study will be built on a mixed-methods design guided by action research to continuously facilitate participatory processes and practical solutions. To assess outcomes, body measurements and questionnaires will be used as part of a pre-test/post-test design. Focus groups and interviews will be conducted to gain an in-depth understanding of outcomes and action elements. Action elements will be explored by using multiple tools: concept mapping, the logic model, and capacity mapping. Direct and perceived societal costs will be measured by administrative data from healthcare insurers (before-after design) and the effectiveness arena. An alternative funding model will be identified based on literature study, expert meetings, and municipal workshops. DISCUSSION Initiatives addressing multiple factors at different levels in an integral way are a challenge for evaluation. Multi-methods and tools are required, and data need to be interpreted comprehensively in order to contribute to a contextual insight into what works and why in relation to HiAP and care-PA initiatives.
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Affiliation(s)
- Annemarie Wagemakers
- Health and Society, Department of Social Sciences, Wageningen University, PO. Box 8130, 6700 EW, Wageningen, The Netherlands.
| | - Lisanne S Mulderij
- Health and Society, Department of Social Sciences, Wageningen University, PO. Box 8130, 6700 EW, Wageningen, The Netherlands
| | - Kirsten T Verkooijen
- Health and Society, Department of Social Sciences, Wageningen University, PO. Box 8130, 6700 EW, Wageningen, The Netherlands
| | - Stef Groenewoud
- Institute for Quality in Health Care (IQ Healthcare), RadboudUMC Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Maria A Koelen
- Health and Society, Department of Social Sciences, Wageningen University, PO. Box 8130, 6700 EW, Wageningen, The Netherlands
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10
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Leenaars KEF, Smit E, Wagemakers A, Molleman GRM, Koelen MA. Exploring the impact of the care sport connector in the Netherlands. BMC Public Health 2017; 17:813. [PMID: 29037216 PMCID: PMC5644127 DOI: 10.1186/s12889-017-4830-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 10/06/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Regular physical activity (PA) is deemed to contribute to the primary and secondary prevention of several chronic diseases, like diabetes mellitus, cancer, cardiovascular diseases, and osteoporosis. In 2012, Care Sport Connectors (CSC), to whom a broker has been ascribed, were introduced in the Netherlands to stimulate PA and guide primary care patients towards local sport facilities. The aim of this study was to explore which structural embedding is the most promising for CSCs' work. METHODS In three rounds of interviews, 13 CSCs were followed for 2 years in their work. In these interviews, a network survey was used to identify organisations in the CSCs' network, whether they collaborated with these organisations, and the role of the organisations in the connection. Data from the network survey were analysed using the RE-AIM framework and disaggregated into how CSCs were structurally embedded (Type A: only PA sector; Type B: different sectors; Type C: partnership). A related samples Wilcoxon signed rank test was performed to study how the CSCs' network developed between 2014 and 2016. RESULTS All CSCs established a connection between the primary care and the PA sector in which the average number of organisations with which CSCs collaborated increased significantly between 2014 (8.3) and 2016 (19.8) (p = 0.002). However, differences were identified in the way CSCs were structurally embedded and in the way they established the connection. Type A CSCs established the connection mostly around their own activities, supported PA organisations with their activities, and collaborated with primary care and welfare professionals around their own activities. Type B and Type C CSCs established the connection by organising, supporting, and implementing different kinds of activities targeting different kinds of audiences, and collaborated mostly with primary care professionals around the referral of professionals' patients. CONCLUSIONS The results of this study suggest that adopting an integral approach (Type B and C) for the structural embedding of the CSC is more promising for reaching the desired outcomes. Whether CSCs really improve the target groups' PA level and health needs to be further studied. TRIAL REGISTRATION Dutch Trial Register NTR4986 . Registered 14 December 2014.
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Affiliation(s)
- Karlijn E. F. Leenaars
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, 6700 EW Wageningen, The Netherlands
| | - Eva Smit
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Annemarie Wagemakers
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, 6700 EW Wageningen, The Netherlands
| | - Gerard R. M. Molleman
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Maria A. Koelen
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, P.O. Box 8130, 6700 EW Wageningen, The Netherlands
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Health Brokers: How Can They Help Deal with the Wickedness of Public Health Problems? BIOMED RESEARCH INTERNATIONAL 2017. [PMID: 28626753 PMCID: PMC5463123 DOI: 10.1155/2017/1979153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The role of health broker is a relatively new one in public health. Health brokers aim to create support for efforts to optimise health promotion in complex or even “wicked” public health contexts by facilitating intersectoral collaborations and by exchanging knowledge with different stakeholders. The current study aimed to explore the role of health brokers, by examining the motivational, contextual, and behaviour-related factors they have to deal with. Methods Fifteen professionals from various backgrounds and from various policy and practice organisations were recruited for a semistructured interview. To structure the interviews, we developed the “Health Broker Wheel” (HBW), a framework we then specified with more details derived from the interviews. Results We identified seven primary types of behaviour that health brokers need to engage in: recognizing opportunities, agenda setting, implementing, network formation, intersectoral collaboration, adaptive managing, and leadership. Determinants of health brokers' behaviours were identified and categorised as capability, opportunities, motivation, and local or national contextual factors. Conclusion The health brokers' role can be seen as an operational approach and is visualised in the HBW. This framework can assist further research to monitor and evaluate this role, and health promotion practitioners can use it as a tool to implement the health brokers' role and to facilitate intersectoral collaboration.
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