[Capabilities for Physical Activity in Older People: Development and Testing of a Measurement Tool]

INTRODUCTION

Based on Sen's capability approach, this study addresses the operationalization of capabilities for leading an active lifestyle. By assessing capabilities, processes of change can be mapped and the development of interventions to promote physical activity in different population groups, e. g., older adults, can be supported. However, no standardized German-language instrument for measuring physical activity-related capabilities is available to date.

METHODS

Building on an exploratory interview study (Sauter et al., 2019) that identified relevant physical activity-related capabilities in older adults, a standardized questionnaire with 41 items was designed. Two different question formulations were designed to query perceived capabilities for physical activity. The "think-aloud" method was conducted to validate the instrument. This involved recording all verbal comments made by participants while completing the questionnaire and conducting supplementary interviews for comprehensibility and applicability. The sample included 16 older adults (w=9, MW=66.3 years).

RESULTS

Overall, respondents rated the instrument's usability and comprehensibility as good. For the questioning of perceived capabilities, the formulation "I have the possibility to..." was favored instead of "I perceive my personal opportunities as…". Difficulties in understanding and ambiguities were found in a few items. Thus, further changes were made to specify these questions with regard to unclear terms such as "walking paths".

CONCLUSION

The questionnaire seems to be suitable to asses perceived capabilities for leading an active lifestyle in older adults. The final questionnaire is available in English and in German. Further research is needed to test the applicability of the instrument in other population groups and verify objectivity, reliability and validity.

Development and reliability testing of an audit toolbox for the assessment of the physical activity friendliness of urban and rural environments in Germany

Background

According to socio-ecological theories, physical activity behaviors are linked to the physical and social neighborhood environment. Reliable and contextually adapted instruments are needed to assess environmental characteristics related to physical activity. This work aims to develop an audit toolbox adapted to the German context, to urban and rural settings, for different population groups, and different types of physical activity; and to evaluate its inter-rater reliability.

Methods

We conducted a systematic literature search to collect existing audit tools and to identify the latest evidence of environmental factors influencing physical activity in general, as well as in German populations. The results guided the construction of a category system for the toolbox. Items were assigned to the categories based on their relevance to physical activity and to the German context as well as their comprehensibility. We piloted the toolbox in different urban and rural areas (100 street segments, 15 parks, and 21 playgrounds) and calculated inter-rater reliability by Cohen's Kappa.

Results

The audit toolbox comprises a basic streetscape audit with seven categories (land use and destinations, traffic safety, pedestrian infrastructure, cycling infrastructure, attractiveness, social environment, and subjective assessment), as well as supplementary tools for children and adolescents, seniors and people with impaired mobility, parks and public open spaces, playgrounds, and rural areas. 76 % of all included items had moderate, substantial, or almost perfect inter-rater reliability (κ > 0.4).

Conclusions

The audit toolbox is an innovative and reliable instrument for the assessment of the physical activity friendliness of urban and rural environments in Germany.

Toward the economic evaluation of participatory approaches in health promotion: lessons from four German physical activity promotion projects

Health promotion increasingly employs participatory approaches, but the question arises whether the likely higher costs of participation also translate into greater benefits. This article takes a first step toward a full health economic evaluation by comprehensively reporting the costs of a specific participatory approach, Cooperative Planning, in a German research consortium to promote physical activity. We conducted a costing analysis of Cooperative Planning at 22 sites across six settings. Project teams used a custom template to record resource use. We calculated average costs per meeting, site and setting using the opportunity costs approach, and obtained feedback from participating researchers. A total of 144 planning meetings with an average of nine participants were conducted. Costs per meeting varied significantly across settings. Differences were mostly attributable to varying meeting duration, preparation time and numbers of participants. Across settings, human resources accounted for roughly 95% of the costs. Implementing researchers reported challenges regarding the logic and methods of the health economic analysis. A participatory approach to physical activity promotion may cause substantially varying costs in different settings despite similar cost structures. However, their value for money could turn out comparably favorable if (and only if) the expected benefits is indeed forthcoming. Despite some challenges implementing the costing exercise into the logistics of ongoing participatory projects, this analysis may pave the way toward a full health economic evaluation, and the template may be useful to future participatory health promotion projects.

[The first steps after a proximal femoral fracture : Sensor-based mobility exploration in geriatric trauma patients]

BACKGROUND

Sensor-based monitoring allows continuous observations of patient mobilization after proximal femoral fractures. A wrist-worn motion tracker allows long-term observation that is low in interruption and constraints for subjects.

OBJECTIVE

Description of steps development after hip fracture surgery on a specialized geriatric trauma ward and beyond.

MATERIAL AND METHODS

In the explorative long-term field research study, an applicable motion tracker observed steps per day of 20 patients (80% female, mean age 85.2 years ± 7.86 years) for 10 weeks. Weekly mean values (days 1-7, 8-14 etc.) of steps per day formed the database for descriptive analysis (mean, SD, min, max, median).

RESULTS

During observation weeks (ow) a positive development of steps took place. A mean increase factor of 1.285 (±0.351) occurred from ow 1 (M = 353.57 ± 310.15) to ow 10 (M = 2482.07 ± 1374.12). The highest increase by a factor of 1.8 could be reported from ow 2 (M = 556.27 ± 478.11) to ow 3 (M = 1024.86 ± 921.24) as well as from ow 6 (M = 1268.21 ± 880.47) to 7 (M = 2367.14 ± 1680.08). A slight decrease of steps occurred from ow 4 (M = 1208.27 ± 1210.45) to ow 5 (0.99-fold) and from ow 9 (M = 2689.98 ± 2339.71) to 10 (0.92-fold). High ranges and standard deviations in relation to the mean occurred constantly. The presence of several step development groups could be presumed.

CONCLUSION

Motion tracker and the variable steps per day can represent the ability to walk within an everyday environment, with a possible underestimation of < 10%. Differences regarding observation lengths and disruptions occurred. Cluster analysis should detect group attributes of different courses of development in subsequent studies.

The capability approach as a bridging framework across health promotion settings: theoretical and empirical considerations

Health promotion research has increasingly called for transdisciplinary approaches. Such calls ask for bridging frameworks that define comprehensive sets of health determinants and appropriately conceptualize the roles of population groups as well as other relevant actor groups in the co-production of health. This article aims to present the seminal capability approach by Sen and Nussbaum as a potentially suitable framework for such bridging endeavors to guide health promotion research. It highlights domains of the capability approach that appear to be particularly relevant to bridging diverse disciplines and settings. Such domains particularly refer to the agency of decisive actor groups (population groups, professionals, policymakers and researchers) as well as to the differentiation of personal, social and environmental conversion factors that disciplines define within their specific epistemologies and ontologies. The article uses empirical examples from a German research consortium that aimed to promote physical activity in five different settings while fostering cooperation and conceptual alignment between several academic disciplines and sub-disciplines to highlight benefits and challenges of using the capability approach as a bridging framework for transdisciplinary health promotion. We conclude that the capability approach might serve as bridging framework to guide future transdisciplinary research if partners involved continuously exchange to develop a shared understanding of the issues to be researched.

Measuring capabilities in health and physical activity promotion: a systematic review

BACKGROUND

The capability approach by Amartya Sen and Martha Nussbaum has gained increasing attention in the field of public health. As it combines individual, social and structural factors and shifts the focus of attention from the actual behavior towards available options for health behaviors that people can actually choose from, it may help advance our understanding of complex health issues.

OBJECTIVES

The aim of this article is to identify and describe tools available to measure capabilities within the context of health, with a specific focus on capabilities for health-enhancing physical activity.

METHOD

We conducted a systematic literature review using 11 databases covering scientific journal articles published in English or German between the years 2000 and 2020 with a focus on capabilities for health or physical activity.

RESULTS

We found a total of 51 articles meeting our inclusion criteria. Four articles measured capabilities using qualitative methods, one combined qualitative and quantitative methods, while the rest used quantitative methods. We identified a total 11 different capability questionnaires, all showing moderate to good validity/reliability. Only one questionnaire and one interview-based tool specifically dealt with capabilities for health enhancing physical activity.

CONCLUSION

Although we were able to identify measurement tools for capabilities in health, this review has shown that there is no generic tool available for the measurement across all population- and age-groups, and tools focusing on physical activity are scarce. However, our results can be used as guide for future projects that aim at measuring capabilities.