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Wilderink L, Visscher A, Bakker I, Schuit AJ, Seidell JC, Renders CM. Mechanisms and contextual factors related to key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A realist evaluation perspective. PLoS One 2023; 18:e0284903. [PMID: 37195985 DOI: 10.1371/journal.pone.0284903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/11/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Reducing health inequalities is a challenge for policymakers and civil society. A multisectoral and multilevel approach is most promising to reduce those inequalities. Previous research showed what key elements of Zwolle Healthy City, an integrated community-based approach aimed at reducing socioeconomic health inequalities, are. To fully understand approaches that are complex and context dependent, questions as 'how does the intervention work' and 'in what context does it work' are just as important as 'what works'. The current study aimed to identify mechanisms and contextual factors associated with the key elements of Zwolle Healthy City, using a realist evaluation perspective. METHODS Transcripts of semi-structured interviews with a wide range of local professionals were used (n = 29). Following realist evaluation logic in the analysis of this primary data, context-mechanism-outcome configurations were identified and thereafter discussed with experts (n = 5). RESULTS How mechanisms (M) in certain contexts (C) were of influence on the key elements (O) of the Zwolle Healthy City approach are described. For example, how, in the context of the responsible aldermen embracing the approach (C), regular meetings with the aldermen (M) increased support for the approach among involved professionals (O). Or, how, in the context of available financial resources (C), assigning a program manager (M) contributed positively to coordination and communication (O). All 36 context-mechanism-outcome configurations can be found in the repository. CONCLUSION This study showed what mechanisms and contextual factors are associated with the key elements of Zwolle Healthy City. By applying realist evaluation logic in the analysis of primary qualitative data we were able to disentangle the complexity of processes of this whole system approach and show this complexity in a structured manner. Also, by describing the context in which the Zwolle Healthy City approach is implemented, we contribute to the transferability of this approach across different contexts.
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Affiliation(s)
- Lisa Wilderink
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Annemijn Visscher
- Research Department of the Municipal Public Health Service Organization Flevoland, Lelystad, The Netherlands
| | - Ingrid Bakker
- Department of Healthy Society, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Albertine J Schuit
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carry M Renders
- Department of Health Sciences, Faculty of Sciences, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Kobes A, Kretschmer T, Timmerman MC. Prevalence of overweight among Dutch primary school children living in JOGG and non-JOGG areas. PLoS One 2021; 16:e0261406. [PMID: 34919583 PMCID: PMC8682899 DOI: 10.1371/journal.pone.0261406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background One of the most influential integrated approaches towards reducing childhood obesity is EPODE, a program that has been translated to over 20 different countries worldwide. Aim The goal of this study was to explore how JOGG–the Dutch EPODE adaptation–might reduce overweight prevalence among children. Methods To compare whether overweight prevalence was different in JOGG areas vs. non-JOGG areas, in long-term JOGG areas vs. short-term JOGG areas, and in low SES JOGG areas vs. middle/high SES JOGG areas, secondary anthropometric and personal data of 209,565 Dutch children were mapped onto publicly available JOGG data. Results Findings showed that overweight prevalence decreased from 25.17% to 16.08% in JOGG-areas, and from 32.31% to 18.43% in long-term JOGG areas. However, when taking into account SES, the decrease in prevalence was mainly visible in low SES long-term JOGG areas. Conclusion JOGG appeared to be successful in targeting areas where overweight was most prevalent. Low SES areas that had implemented JOGG for a longer period of time, i.e., six years, appeared to be successful in decreasing overweight prevalence.
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Affiliation(s)
- Annita Kobes
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Tina Kretschmer
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | - Margaretha C. Timmerman
- Faculty of Behavioural and Social Sciences, Department of Pedagogical and Educational Sciences, University of Groningen, Groningen, The Netherlands
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Drewnowski A, Caballero B, Das JK, French J, Prentice AM, Fries LR, van Koperen TM, Klassen-Wigger P, Rolls BJ. Novel public-private partnerships to address the double burden of malnutrition. Nutr Rev 2018; 76:805-821. [PMID: 30203056 PMCID: PMC6236421 DOI: 10.1093/nutrit/nuy035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Public–private partnerships are an effective way to address the global double burden of malnutrition. While public–private partnerships operate in multiple forms, their leadership usually falls to governments, public health agencies, or nongovernmental organizations, with the private sector taking a subordinate role. The rapid ascent of social media and mass communications worldwide has provided a disruptive technology for new nutrition intervention programs. A new model, provisionally called private–public engagement, takes advantage of social media, mass media, and integrated social marketing to reach parents, families, and communities directly. These new private–public engagement initiatives need to be managed in ways suggested for public–private partnerships by the World Health Organization, especially if the private sector is in the lead. Once the rationale for engagement is defined, there is a need to mobilize resources, establish in-country partnerships and codes of conduct, and provide a plan for monitoring, evaluation, and accountability. Provided here is an example consistent with the private–public engagement approach, ie, the United for Healthier Kids program, which has been aimed at families with children aged less than 12 years. Materials to inspire behavioral change and promote healthier diets and lifestyle were disseminated in a number of countries through both digital and physical channels, often in partnership with local or regional governments. A description of this program, along with strategies to promote transparency and communication among stakeholders, serves to provide guidance for the development of future effective private–public engagements.
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Affiliation(s)
- Adam Drewnowski
- Center for Public Health Nutrition, University of Washington, Seattle, Washington, USA
| | - Benjamin Caballero
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jai K Das
- Division of Woman and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jeff French
- Brighton Business School, Brighton University, Brighton, United Kingdom.,Strategic Social Marketing Ltd, Concord, Hampshire, United Kingdom
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Keneba, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lisa R Fries
- Corporate Nutrition, Health and Wellness Unit, Nestlé, Vevey, Switzerland.,Behavioral Science Group, Nestlé Research Center, Lausanne, Switzerland
| | | | - Petra Klassen-Wigger
- Corporate Nutrition, Health and Wellness Unit, Nestlé, Vevey, Switzerland.,Nutrition, Health and Wellness Unit, Nestlé Research Center, Lausanne, Switzerland
| | - Barbara J Rolls
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
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Mantziki K, Renders CM, Westerman MJ, Mayer J, Borys JM, Seidell JC. Tools for a systematic appraisal of integrated community-based approaches to prevent childhood obesity. BMC Public Health 2018; 18:189. [PMID: 29378550 PMCID: PMC5789618 DOI: 10.1186/s12889-018-5042-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/05/2018] [Indexed: 01/04/2023] Open
Abstract
Background Evaluation and monitoring methods are often unable to identify crucial elements of success or failure of integrated community-wide approaches aiming to tackle childhood overweight and obesity, yet difficult to determine in complex programmes. Therefore, we aimed to systematically appraise strengths and weaknesses of such programmes and to assess the usefulness of the appraisal tools used. Methods To identify strengths and weaknesses of the integrated community-based approaches two tools were used: the Good Practice Appraisal tool for obesity prevention programmes, projects, initiatives and intervention (GPAT), a self-administered questionnaire developed by the WHO; and the OPEN tool, a structured list of questions based on the EPODE theory, to assist face-to-face interviews with the principle programme coordinators. The strengths and weaknesses of these tools were assessed with regard to practicalities, quality of acquired data and the appraisal process, criteria and scoring. Results Several strengths and weaknesses were identified in all the assessed integrated community-based approaches, different for each of them. The GPAT provided information mostly on intervention elements whereas through the OPEN tool information on both the programme and intervention levels were acquired. Conclusion Large variability between integrated community-wide approaches preventing childhood obesity in the European region was identified and therefore each of them has different needs. Both tools used in combination seem to facilitate comprehensive assessment of integrated community-wide approaches in a systematic manner, which is rarely conducted. Nonetheless, the tools should be improved in line to their limitations as recommended in this manuscript. Electronic supplementary material The online version of this article (10.1186/s12889-018-5042-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- K Mantziki
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands.
| | - C M Renders
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - M J Westerman
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
| | - J Mayer
- EPODE International Network, 109-111 Rue Royale, 1000, Brussels, Belgium
| | - J M Borys
- EPODE International Network, 109-111 Rue Royale, 1000, Brussels, Belgium
| | - J C Seidell
- Department of Health Sciences, VU University of Amsterdam, De Boelelaan 1085, 1081HV, Amsterdam, The Netherlands
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Dynamics of Implementation and Maintenance of Organizational Health Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080917. [PMID: 28809807 PMCID: PMC5580620 DOI: 10.3390/ijerph14080917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 07/26/2017] [Accepted: 08/11/2017] [Indexed: 12/22/2022]
Abstract
In this study, we present case studies to explore the dynamics of implementation and maintenance of health interventions. We analyze how specific interventions are built and eroded, how the building and erosion mechanisms are interconnected, and why we can see significantly different erosion rates across otherwise similar organizations. We use multiple comparative obesity prevention case studies to provide empirical information on the mechanisms of interest, and use qualitative systems modeling to integrate our evolving understanding into an internally consistent and transparent theory of the phenomenon. Our preliminary results identify reinforcing feedback mechanisms, including design of organizational processes, motivation of stakeholders, and communication among stakeholders, which influence implementation and maintenance of intervention components. Over time, these feedback mechanisms may drive a wedge between otherwise similar organizations, leading to distinct configurations of implementation and maintenance processes.
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van der Kleij RMJJ, Crone MR, Reis R, Paulussen TGWM. Critical stakeholder determinants to the implementation of intersectoral community approaches targeting childhood obesity. HEALTH EDUCATION RESEARCH 2016; 31:697-715. [PMID: 27923861 DOI: 10.1093/her/cyw047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/23/2016] [Indexed: 06/06/2023]
Abstract
Several intersectoral community approaches targeting childhood obesity (IACOs) have been launched in the Netherlands. Translation of these approaches into practice is however arduous and implementation. We therefore studied the implementation of five IACOs in the Netherlands for one-and-a-half years. IACO implementation was evaluated via an adapted version of the MIDI questionnaire, consisting of 18 theory-based constructs. A response rate of 62% was obtained. A hierarchical multivariate linear regression model was used to analyse our data; the final regression model predicted 65% of the variance in adherence. Higher levels of self-efficacy, being an implementer embedded in community B, and having more than 1 year of experience with IACO implementation were associated with higher degrees of adherence. Formal ratification of implementation by management and being prescribed a higher number of activities were related to lower degrees of adherence. We advise that, when designing implementation strategies, emphasis should be placed on the enhancement of professionals' self-efficacy, limitation of the number of activities prescribed and allocation of sufficient time to get acquainted and experienced with IACO implementation. Longitudinal studies are needed to further evaluate interaction between and change within critical determinants while progressing through the innovation process.
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Affiliation(s)
- R M J J van der Kleij
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - M R Crone
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
| | - R Reis
- Public Health and Primary Care, Leiden University Medical Center, 2300 RC Leiden, The Netherlands
- Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
- The Children s Institute, School of Child and Adolescent Health, University of Cape Town, South Africa
| | - T G W M Paulussen
- Research Group Lifestyle, Netherlands Organisation for Applied Scientific Research, ZL, 2316 Leiden, The Netherlands
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