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Smit E, Leenaars KEF, Wagemakers MAE, Bakker EJ, van der Velden J, Molleman GRM. Do participants in a physical activity program from a Care Sport Connector become healthier? An explorative study from the Netherlands. PLoS One 2023; 18:e0287913. [PMID: 38096146 PMCID: PMC10721037 DOI: 10.1371/journal.pone.0287913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Care Sport Connectors (CSCs) have been appointed to create a connection between the primary care and physical activity (PA) sectors to stimulate residents who are inactive to become more physically active to gain health benefits. The objective of this explorative study was to find out whether CSCs achieve these goals by testing the hypothesis that more residents become physically active, and score higher for health-related fitness and health-related quality of life. METHOD We conducted a longitudinal study design whereby participants (n = 402) were measured at three time points: at the start of their PA program (T0); after 6 months (T1); and after 1 year (T2). Participants conducted a fitness test to measure their health-related physical fitness and filled in questionnaires to assess PA level (PA-, Fit-, Combi-, and sport norm), health-related quality of life, motivation for PA, and personal information. We used a multi-level analysis to test whether outcomes of participants differ over time. Participants who dropped out and maintainers were compared with a chi-square test and a one-way ANOVA. RESULTS This study showed that one-third of the participants dropped out (n = 139). Participants who dropped out were, compared with maintainers, less physically active (P = 0.004) and were more often reached in bigger municipalities, by an integral approach. More participants meet the PA norm (P = 0.007) and sport norm (P<0.001) at T2 then at T0. Scores in health-related physical fitness and quality of life were significant but not a meaningful gain in health-related fitness. CONCLUSION More residents become physically active and participate in sport because they took part in a PA programs or activity organized by a CSC. Lifestyle interventions should be offered with a higher frequency, intensity, and focus on behavior change. It is necessary to invest in combined lifestyle interventions offered by a collaboration of primary care, welfare, and PA professionals.
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Affiliation(s)
- E. Smit
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - K. E. F. Leenaars
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, Wageningen, The Netherlands
| | - M. A. E. Wagemakers
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, Wageningen, The Netherlands
| | - E. J. Bakker
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, Wageningen, The Netherlands
| | - J. van der Velden
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G. R. M. Molleman
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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de Jong M, Tijhuis Y, Koelen M, Wagemakers A. Intersectoral collaboration in a Dutch community health promotion programme: building a coalition and networks. Health Promot Int 2023; 38:daab207. [PMID: 34999774 PMCID: PMC10405043 DOI: 10.1093/heapro/daab207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. A health broker role is recognized as being helpful in connecting the coalition with the broader network, and participatory action research (PAR) is deemed supportive because it facilitates evaluation, reflection, learning and action. However, there is a lack of insight into how processes that affect collaboration develop over time. Therefore, this study aimed to provide insights into the coalition's processes that facilitate building and maintaining intersectoral collaboration within a HPP coalition and network and how these processes contribute to the coalition's ambitions. As part of PAR, the coalition members used the coordinated action checklist (CAC) and composed network analysis (CNA) in 2018 and 2019. The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on pro-gress and future planning. Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership and the importance of visibility and trust leading to investment in continuation. The combined research instruments and group sessions supported discussion and reflection, sharing visions and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.
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Affiliation(s)
- Marja de Jong
- GGD IJsselland, Zeven Alleetjes 1, 8011 CV Zwolle, The Netherlands
| | - Yvon Tijhuis
- GGD IJsselland, Zeven Alleetjes 1, 8011 CV Zwolle, The Netherlands
| | - Maria Koelen
- Health and Society, Wageningen University and Research, PO Box 8130, 6700 EW Wageningen, The Netherlands
| | - Annemarie Wagemakers
- Health and Society, Wageningen University and Research, PO Box 8130, 6700 EW Wageningen, The Netherlands
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de Jong MAJG, Wink G, Koelen MA, Wagemakers A. Unravelling mechanisms underlying the action principles of a community-based health promotion programme: a realist evaluation. Arch Public Health 2023; 81:9. [PMID: 36653819 PMCID: PMC9850519 DOI: 10.1186/s13690-023-01027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Since 1986, WHO has advised that applying action principles such as citizen participation and intersectoral collaboration leads to better health. However, less is known about the workability of these principles and how they trigger specific outcomes in interaction with the context. A critical realist perspective was applied to get a better understanding of what worked, and why it worked, in the context of a Dutch community-based health promotion programme (CBHPP). The aim of the study was to unravel the mechanisms underlying the action principles and find combinations of contextual factors and mechanisms that trigger outcomes in a CBHPP. METHODS In this single case study, a critical realist methodology was followed. Qualitative data used in this study originated from multiple sources and methods to ensure validity. They include evaluation sessions with coalition members (n = 6) and individual interviews (n = 6); group sessions with community workers (n = 1), a health broker (n = 1), and citizens (n = 12); and seven semi-annual progress reports and minutes of the coalition meetings. The collected data were then compared with the programme theory through a heuristic process of constructing, exploring, and refining context-mechanism-outcome configurations. RESULTS The programme initiated a variety of new activities that differed in content, intensity, duration, and number of participants, organised and implemented together with citizens. The most prominent mechanism underlying both action principles were programme-related, namely, patience, personal contact, contribution of budget, and the programme coordinator's leadership. Another important mechanism was creating visibility, which resulted in the involvement of the municipality and a budget to sustain the programme. CONCLUSION In this case study, personal contact, patience, perseverance, participatory action research activities, and visibility were found to be the most notable mechanisms underlying the citizen participation and intersectoral collaboration action principles. As the principle-based approach added value to the existing context and introduced most of the mechanisms that triggered the outcomes, it is recommended to include citizen participation and intersectoral collaboration not only as action principles but explicitly as targets in a CBHPP.
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Affiliation(s)
- Marja A. J. G. de Jong
- GGD IJsselland (Municipal Health Service), Zwolle, the Netherlands ,grid.4818.50000 0001 0791 5666Wageningen University and Research, chair Health and Society, Wageningen, the Netherlands
| | - Gerda Wink
- grid.10417.330000 0004 0444 9382Department of Primary and Community Care, Radboud University Medical Centre, AMPHI Academic Collaborative Centre, Nijmegen, the Netherlands
| | - Maria A. Koelen
- grid.4818.50000 0001 0791 5666Wageningen University and Research, chair Health and Society, Wageningen, the Netherlands
| | - Annemarie Wagemakers
- grid.4818.50000 0001 0791 5666Wageningen University and Research, chair Health and Society, Wageningen, the Netherlands
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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
- Corresponding author: E-mail:
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Leenaars KEF, Smit E, Wagemakers A, Molleman GRM, Koelen MA. The role of the care sport connector in the Netherlands. Health Promot Int 2018; 33:422-435. [PMID: 28011656 DOI: 10.1093/heapro/daw097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction To stimulate physical activity and guide primary care patients towards local sport facilities, Care Sport Connectors (CSC), to whom a broker role has been ascribed, were introduced in 2012 in the Netherlands. The aim of this study was to explore CSCs' role in connecting the primary care sector and the PA sector. Method Fifteen CSCs were selected to participate in this study and were followed in their work of connecting both sectors. Over the course of one year, three rounds of interviews were held with these CSCs on the topics of their role and the connection between the primary care and the PA sector. Both top-down and bottom-up codes were used to analyse the interviews. Results CSCs fulfilled three roles: 1) broker, 2) referral, 3) organiser. The extent to which CSCs fulfilled these roles was influenced by the way municipalities implemented the CSC funding. CSCs set up two forms of collaboration structures: 1) project basis and 2) referral scheme. CSCs perceived the following barriers to connecting the primary care and the PA sector: lack of knowledge and time, primary care professionals' own interests, and lack of suitable sport activities for the target group. Conclusion The CSC role seems to hold the promise of improving collaboration between the primary care and the PA sector, especially, because the roles that CSCs perceive themselves as having seem to be directed at eliminating barriers in this connection. Future research is needed to study whether CSCs are capable of establishing a connection over time.
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Affiliation(s)
- K E F Leenaars
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, EW Wageningen, The Netherlands
| | - E Smit
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical Center, Nijmegen, The Netherlands
| | - A Wagemakers
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, EW Wageningen, The Netherlands
| | - G R M Molleman
- Academic Collaborative Centre AMPHI, Primary Health Care, Radboud university medical Center, Nijmegen, The Netherlands
| | - M A Koelen
- Department of Social Sciences, Health and Society Group, Wageningen University & Research Centre, EW Wageningen, The Netherlands
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Leenaars KEF, Florisson AME, Smit E, Wagemakers A, Molleman GRM, Koelen MA. The connection between the primary care and the physical activity sector: professionals' perceptions. BMC Public Health 2016; 16:1001. [PMID: 27655426 PMCID: PMC5031288 DOI: 10.1186/s12889-016-3665-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To stimulate physical activity (PA) and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC), to whom a broker role has been ascribed, were introduced in 2012 in the Netherlands. The aim of this study is to assess perceptions of primary care, welfare, and sport professionals towards the CSC role and the connection between the primary care and the PA sector. METHODS Nine focus groups were held with primary care, welfare and sport professionals within the CSC network. In these focus groups the CSC role and the connection between the sectors were discussed. Both top-down and bottom-up codes were used to analyse the focus groups. RESULTS Professionals ascribed three roles to the CSC: 1) broker role, 2) referral, 3) facilitator. Professionals were enthusiastic about how the current connection was established. However, barriers relating to their own sector were currently hindering the connection: primary care professionals' lack of time, money and knowledge, and the lack of suitable PA activities and instructors for the target group. CONCLUSIONS This study provides further insight into the CSC role and the connection between the sectors from the point of view of primary care, welfare, and sport professionals. Professionals found the CSC role promising, but barriers are currently hindering the collaboration between both sectors. More time for the CSC and changes in the way the primary care and PA sector are organized seem to be necessary to overcome the identified barriers and to make a success of the connection. TRIAL REGISTRATION Dutch Trial register NTR4986 . Registered 14 December 2014.
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Affiliation(s)
- Karlijn E F Leenaars
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, EW, Wageningen, The Netherlands.
| | - Annemiek M E Florisson
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, 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
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, 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
- Wageningen University & Research Centre, Department of Social Sciences, Health and Society Group, P.O. Box 8130, EW, Wageningen, The Netherlands
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