Pilot study of a health promotion intervention in sports clubs

Sports clubs (SCs) are an ideal setting for promoting health. However existing health promotion (HP) interventions in SCs mainly target a single health behavior and men who do sports, and evaluations of such interventions provides little information about their deployment. To overcome these limitations, the PROSCeSS intervention was co-constructed based on the theoretical model of the health-promoting SC and multi-level, multi-determinant health strategies. The aim of this pilot study was to evaluate the deployment of the PROSCeSS intervention and identify the factors influencing its deployment. A qualitative study, using recordings of meetings, email and telephone exchanges, and interviews with project leaders of fourteen SC, was carried out. Although a low number of SCs had completed the intervention, they all considered that they have a role to play in helping their members maintain good health. Their ability to develop HP activities and to implement the intervention was influenced by the resources available, the support they received from their sports federation, and the ability of each project leader to get involved in the intervention. The SCs that deployed the intervention implemented several strategies enabling them to integrate health into the organizational, social, economic, and environmental habits of the SCs and to develop new HP activities, such as adapted sports activity sessions and activities to teach members about first aid, nutrition, and good practices for warming up. This study highlights the importance of understanding the specificities of the contexts in which HP interventions are deployed. Having led to a reworking of the intervention steps and the development of an appropriate evaluation design, it also highlights the essential role of pilot studies in the development and evaluation of interventions.

A health promoting sports club framework: strategies from the field

The application of the settings-based approach to sports clubs requires a context-specific framework to develop and operationalize health promotion interventions. Incorporating top-down and bottom-up perspectives into interventions increases their efficiency, success and sustainability. In 2020, the health promoting sports club (HPSC) model and intervention framework were created, including strategies and intervention components. A subsequent concept mapping study generated 35 statements from sports club stakeholders highlighting their needs when developing health promotion initiatives. This commentary integrates the concept mapping results into the HPSC model and intervention framework. The process added new sports club levels, updated existing and developed new intervention components, then classified them into the framework. The revised HPSC model has seven levels while the revised intervention framework includes 13 strategies and 69 intervention components. This revised HPSC framework provides sports club stakeholders, public health experts and researchers a means to develop and implement targeted health promotion interventions.

Implementation of the GAA 'healthy clubs project' in Ireland: a qualitative study using the Consolidated Framework for Implementation Research

The sports clubs' role in promoting health has been acknowledged by policy makers and researchers, but there is little evidence on how sports clubs implement health-related interventions. The present article investigates the Gaelic Athletic Association Healthy Club Project (HCP) implementation process (mechanisms, barriers, leverages) over a 10-year timeframe. A case study design helped to produce and compare a data synthesis for five clubs involved since 2013. A qualitative iterative data collection, including document analysis was conducted through 20 focus groups with Healthy Club Officers, coaches, participants and members. The Consolidated Framework for Implementation Research was used in the deductive analysis process, conducted by the first author. Results have shown the success of the HCP in placing health promotion on the agenda of sports clubs leading to informal policy for health promotion, even if activities and recognition are directed toward and coming from the community. This study also underlines the virtuous cycle of the settings-based approach in enhancing membership and volunteer recognition through health promotion actions, and the importance of social good and corporate social activities for sports clubs. Nevertheless, the HCP still relies on limited human resources, is not recognized by competitive oriented adult playing members. and acknowledged as a resource by some coaches, limiting its rootedness in the core business of sports clubs. Future research should empower the HCP community to focus on organizational changes and develop outcomes for individuals, for the club as a whole as well as for the local community.

Using a socioecological approach to explore healthy lifestyle in elite sport: a qualitative study of French athletes', coaches', and managers' perspectives

Elite athletes are continually subjected to a range of constraints specific to high performance, and these can have a negative impact on their health. Although many studies have explored the individual factors related to risky behaviours and disorders in elite sport contexts, few have focused on health promotion. Consequently, the interpersonal, institutional, and policy factors of the health-related behaviours of elite athletes are still poorly explored. Based on the socioecological model, this study aimed to identify the factors involved in the health-related lifestyle of elite athletes. Semi-structured interviews were conducted with 45 participants: athletes (N = 32), their coaches (N = 6) and the managers of elite sport centres (N = 7). Both deductive and inductive thematic analyses were performed. Our results highlight the views of the actors. Regarding intrapersonal factors, resilience qualities and health literacy appeared as key factors in influencing the health-related lifestyle of elite athletes. At the interpersonal level, parents and coaches emerged as the main sources of educational support. Regarding institutional factors, the health policies of the elite sport centres were key factors in supporting the athletes' healthy lifestyle. These results encourage the development of health promotion programs at different levels of intervention.

Capitalization of experience of physical activity resumption programs: Lessons learned for adherence and post-program referral

The benefits of physical activity (PA) in managing chronic diseases are largely demonstrated. To encourage a sustainable PA practice for inactive patients with chronic diseases, France has recently implemented PA resumption programs, in which patients can participate with a medical prescription but which are time-limited. In the literature, the effectiveness of those exercise referral schemes to foster sustainable PA practice is still mixed. The present study aims at capitalizing the experience of eight resumption programs to understand what makes the programs work, adherence mechanisms and the post-program referral scheme. Questionnaires and semi-structured interviews informed those intervention mechanisms analysed using thematic analysis. This study provides insights into expertize in patient management among these programs, currently due to key findings as the employment of adapted PA teachers, their training and the use of mechanisms for program adherence (practice conditions, emphasize progress and feelings generated by exercise, the relational and social aspect of practice). Other key findings are a lack of clarity in program objectives which is an area of improvement, and a broad diversity of referral (transmitting contact details, contacting the club, intervention of a third-party association or physical presence) that need further exploration.

A RE-AIM framework analysis of a sports club health promotion MOOC: the PROSCeSS MOOC

Acquisition of health promotion (HP) skills and knowledge is essential for interventions development in this field. In sports clubs (SC), little HP training exists even though it was requested by SC actors. In response, the PROSCeSS (PROmotion de la Santé au sein du Clubs SportifS) MOOC (Massive Open Online Course) was developed to support actors of HP in the SC in the development of HP interventions. The present study evaluates the MOOC's effectiveness and learning process. The RE-AIM framework, measuring reach, effectiveness, adoption, implementation and maintenance was used to structure this study. Surveys were sent before and after the MOOC to the 2814 learners. Among the 502 (18%) respondents to the pre-survey, 80% reported belonging to a SC as a coach (35%) or manager (25%). The 14% of pre-survey respondents who completed the post-survey increased their HP knowledge score by 42% and their confidence to implement HP actions by 6%. Results present the strategies considered most important and feasible by the learners and the main barriers to the implementation of HP actions in the SC. This study shows that MOOC appears to be an appealing (93% of learners were satisfied) and effective solution (as long as it is followed) to develop HP knowledge and skills of SC actors in HP, meeting their needs and constraints. Although improvements should be made (especially in terms of promoting adoption), this type of educational format should be encouraged to support the HP potential of SC.

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.

Health promoting sports clubs: from theory to intervention

INTRODUCTION

Beyond the contribution of sports clubs to physical activity, an important health determinant, sports clubs can embrace the settings-based approach to health promotion, acting as health promoting sports clubs (HPSC). Limited research links the HPSC concept with evidence-driven strategies to provide guidance to develop HPSC interventions.

METHODS

An intervention building a research system of the development of an HPSC intervention will be presented, including seven different studies, from literature review to intervention co-construction and evaluation. The different steps and their results will be presented as lessons learnt for settings-based intervention development.

RESULTS

First, the evidence base showed a poorly defined HPSC concept, but 14 evidence-driven strategies. Second, concept mapping identified 35 sports clubs needs in regard to HPSC. Third, the HPSC model and intervention framework were designed using a participative research approach. Fourth, a measurement tool for HPSC was validated psychometrically. Fifth, capitalization of experience from eight exemplar HPSC projects was realized to test the intervention theory. Sixth, program co-construction was realized by involving sports club actors. Seventh, intervention evaluation was built by the research team.

DISCUSSION

This HPSC intervention development is an example of building a health promotion program, implicating different types of stakeholders, and provide a HPSC theoretical model, HPSC intervention strategies, a program and toolkit, for sports clubs to implement health promotion and fully endorse their role in the community.

Perceptions of barriers to and facilitators of physical activity in adults with cystic fibrosis

BACKGROUND

Physical activity (PA) is a proven therapeutic tool to increase the quality of life and life expectancy in people with cystic fibrosis (pwCF). Despite this, the PA level of pwCF is lower than recommended.

OBJECTIVES

This study was conducted to identify the barriers to and facilitators of PA in adults with CF with heterogeneous severity.

METHODS

Twenty adults with CF (mean age = 33.3±11.7 years, mean FEV1% = 50.55±20.4%) were recruited from two specialized centers and interviewed about the factors that limit and facilitate their PA. The collected data were transcribed, coded and analyzed using deductive and inductive methods.

RESULTS

Barriers and facilitators were classified into physical, psychological and environmental dimensions. The main barriers were fatigue, breathing difficulties, lack of available facilities, negative perceptions of PA and perceived health risks. The most important facilitators were respiratory benefits, well-being, and social support.

CONCLUSION

Although some barriers and facilitators were similar to those found in children with CF or adults from other vulnerable populations, others were specific to adults with CF, such as the risk of cross-contamination and transplant preparation. The comprehensive study of the barriers and facilitators in adults will enhance PA counseling for pwCF and help improve their compliance with PA recommendations.

Development of a health-promoting sports club’s intervention in France applying participatory action research

The recognition of sports clubs (SC) as health-promoting settings is increasing, as well as the number of health promotion (HP) interventions implemented in this setting. However, minimal understanding of their development process and the persistent gap between theoretical knowledge and real-life practice is a major limitation to their implementation. This article describes a participatory research approach, implicating 29 stakeholders in sports and HP (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations and 8 representatives from SC), leading to the co-construction of a health-promoting SC intervention. Stakeholders were mobilized through four stages: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (iv) beta-testing of a massive open online course (MOOC). A qualitative analysis was carried out on data collected through notetaking, recordings, transcripts, email exchanges and produced documents. This work led to the development of an HP intervention, including an MOOC, as well as a seven-step SC-tailored program. The convergence of theoretical knowledge and contextual real-life practice made it possible to respond to the specific needs and implementation problems encountered by SC actors and to develop acceptable strategies and tools.

Development of the Health Promoting Sports Club - National Audit Tool

Background

Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This manuscript outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods

A 5-step process was undertaken by an international project team: (1) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (2) a thematic analysis to categorize items, (3) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (4) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (5) audit tool finalization though project team consensus.

Results

Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with three broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation & Dissemination; Evaluation & Measurement methods; Sub-national level policies; Funding & Coordination; Participative approach; Actors & Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusions

To progress HP in the sports club context it is necessary to understand existing national level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Co-construct, implement and evaluate an intervention to prevent a sedentary lifestyle in children

Background

In children a sedentary lifestyle is associated with the development of chronic diseases, as well as unfavorable body composition and physical condition, lower levels of self-esteem, sociability, and school results. In Europe 39,8% of children (6-9 years) spend on average more than 2h/day in front of a screen, and 14,6% over 3h/day. In this context, designing and testing effective interventions to decrease sedentary behavior in children is a major public health research gap. The CIPRES intervention aims to reduce sedentary time in school-age children (7-10 years).

Methods

The CIPRES intervention is co-constructed with key local actors, by using a socio-ecological approach, and theory-based on the transcontextual model. The intervention is evaluated by a cluster-randomized controlled study currently ongoing. The target population is made up of 1000 children from 13 primary schools (in years 4-5) from southeast of France with different levels of social deprivation. Main outcomes are assessed by accelerometer and questionnaires before (T0) and after a six-week intervention (T1) and include sedentary behavior, physical activity (PA) and variables of the transcontextual model.

Results

Preliminary data were available in 152 children (53 intervention and 99 control). There was no significant difference across the time in sedentary time between intervention and control group (p = 0.11; η2=0,017); however, moderate-to-vigorous physical activity (MVPA) tended to be better in intervention vs control (p = 0.06; η2=0,023). In the intervention group, sedentary time and MVPA were significantly better across the time (p = 0.028 and p = 0.011, respectively) for children having a father with a university diploma as compared to children having a father with a lower education level.

Conclusions

Preliminary results on a small group of subjects (n = 152) are encouraging and suggest a positive impact of the intervention on children. More results will be available by summer 2022.

Key messages

• Based on the socio-ecological model, the CIPRES intervention aims to prevent sedentary in school-aged children.

• Preliminary data suggests a favorable impact of the intervention on physical activity.

Sport federation investment in health promotion: program implementation and viability

Background

Researchers have called for a better recognition of the potential of sports clubs for health promotion (HP), but less is known on the support provided by sports federation. The present study analyses the the implementation of the Gaelic Athletics Association (GAA) Healthy Club Project, to investigate its organization’s viability.

Methods

A single case study was realized, based on observation, document analysis and interviews, to document the viable system model.

Results

Results have identified a three-level structure, where 6 employees at national level support the work of 28 volunteer’s county health and well-being officers and 439 clubs implicated. Strengths of the organization are the identification of a single national referent for clubs or county, the learning process and openness to novelty, as well as the enhanced workforce through county implication as role model. Challenges are the financial and human resources provision, the ability to implicate county and club board and the training in HP of volunteers. Interlevel relationship are supported by the creation of a community of practice and the centralization of the project at national level, but hindered by a clear definition of county tasks. The strengths of the controlling system include a steering committee implicating partners completing each other and the proper use of evaluation to build evidence on the project, where challenges remains in wider collaboration within the GAA.

Conclusions

The present work has underlined key scaling up factors of the HCP implementation to support its viability, which could be learnt from other sports federation implementing HP interventions.

Key messages

• Sports federation have a key role to play to support sports clubs to promote health, by developing specific programs.

• Health Promotion development in sports clubs has similar scaling up implementation factor than other public health interventions.

Evaluation of implementation and effects of a health-promoting sports club intervention using a mixed-method design: PROSCeSS protocol

Public authorities and academics have advocated for applying been advocating for the application of the setting-based approach to sports clubs. However, studies have shown that existing health promotion (HP) interventions in sports clubs poorly understand and apply this approach. Moreover, methods used to evaluate these interventions do not inform their implementation process, limiting the generation effectiveness’ proofs. This study aims at evaluating the implementation process and effectiveness of an HP intervention in sports clubs (PROmotion de la Santé dans les ClubS de Spor; PROSCeSS), based on the health-promoting sports club (HPSC) model.

A type 3 hybrid design, using a multiphase mixed-method: QUAN→QUAL→ QUAN+QUAL (qual)→QUAL (quan+qual), will be used. Phase A will be a pre–post–quantitative study with one HP officer, five managers and five coaches from 30 sports clubs exploring the effects of the PROSCeSS intervention on HP perceptions and health literacy. Phase B will be focus groups with participants from HP initiatives that the 30 sports clubs will have previously put in place to detect changes in health. Phase C will explain the results of phases A and B by choice of strategies and adherence to standardised steps, measured through semistructured interviews and implementation data collection. Phase D will cross-reference the semistructured interviews, the sports club characteristics questionnaire and the implementation data collection to study the relationships between the context and the implementation process. This protocol will identify ‘what works’, ‘for whom’, in ‘what context’ in terms of HPSC and clarify which intervention components are more effective at improving HP. This evaluation design will help to develop appropriate approaches to evaluate HP interventions.

O4-2 Evaluate the health-enhancing physical activity policy of Rio de Janeiro: ‘Programa Academia Carioca'

Issue and problem

In Brazil, 47% of people are insufficiently physically active (Guthold et al, 2018). According to the Global Physical Activity Observatory, 13.2% of deaths in Brazil are caused by inactivity. Besides, Ding et al (2016) estimated the direct health cost attributable to physical inactivity in this country at 1.6 billion US dollars. Rio de Janeiro (RJ) is one of the largest cities in Brazil, with a high mortality rate (54.1%) from non-communicable diseases (NCDs) and substantial health inequalities (SIM/MRJ, 2019). As a large city, it reproduces a worldwide trend, which associates economic growth and urbanization with an unhealthy lifestyle and epidemic levels of obesity and remarkable physical inactivity (WHO, 2014).

Problem description

The multifactorial context above described enables NCDs and challenges health protection systems. For this reason, the Municipal Health Department of RJ implemented since 2009 a Health-Enhancing Physical Activity (HEPA) policy: ‘Programa Academia Carioca' (PAC). This policy supports regular physical activity free of charge, in Primary Care Health Units (UAP). The Program combines the practice of physical activity associated with various educational and community activities. It includes Physical Education professionals who work in a multidisciplinary way. Therefore, this study aims to evaluate the implementation of this policy.

Results (effects/changes)

After 11 years, the PAC has 142,969 participants, 80% of whom have NCDs. Among its participants, blood pressure control was demonstrated in 90% of hypertensive patients; weight loss, and a 60% reduction in cardiovascular risk classification, and suspension of medication in 20% of users. Being part of the PAC resulted in greater use and understanding of the general services of UAP in 86% and 98% of participants, respectively. Detailed results are not available at that time but will be presented at the conference.

Lessons

The PAC showed to be a successful tool to enhance health through physical activity at UAP. The use of trained and specialized professionals plays a fundamental key to develop educational and community actions in vulnerable groups.

Main messages

The implementation of an ambitious and integrated HEPA policy, considering environmental and health factors, can produce more effective institutional responses to change this epidemiological scenario.

P01-11 Economic impact of health-enhancing-physical activity from different settings in France

Background

There is strong evidence of the multiple benefits of physical activity on health in primary, secondary and tertiary prevention (WHO, 2020). However, economic evaluations are still needed to estimate direct and indirect costs that could be saved from various Health-Enhancing Physical Activity (HEPA) promotion strategies (Ding et al., 2020). Moreover, these savings might be influenced by specificities of the national health system. The aim of this study is to explore the economic impact of HEPA from different settings in France.

Methods

A systematic scoping review of grey and scientific literature was conducted. Relevant articles were identified through searching from PubMed, ScienceDirect, SportDiscus databases and from google. Searches were conducted in English and French between January 2000 and December 2020. A data extraction template was used to collect, organize and summarize data regarding the following variables: aim of the study, study population, study settings, methods, and main results.

Results

A total of 17 studies were included from the grey literature (n = 10) and the scientific peer-reviewed literature (n = 7). Data from each variables of interest were heterogeneous, making comparisons difficult. Studies were categorized in 5 types: studies aiming to estimate the cost of physical inactivity or the cost that could be saved from HEPA promotion in general population (n = 8); studies aiming to evaluate the medico-economic impact of a physical activity adapted program (n = 5); studies aiming to assess the economic benefit of active travel in a city (n = 3); study aiming to estimate the economic impact of physical activity from a company and its employee's perspectives (n = 1). Whatever the methods, the study population or the study setting, several tens of millions of euros to several billions of euros could be saved each year by investing in HEPA promotion.

Conclusions

HEPA promotion can lead to substantial saving. Methods should be standardized to more precisely estimate its extent in different settings in France. This could help policy-makers in their decision to invest in HEPA promotion, especially in phases of epidemics, where sedentarity and physical inactivity account for major health risks.

P01-16 EUMOVE Project: an Erasmus+ Project for the promotion of healthy lifestyles among children and adolescents

Physical inactivity is a worldwide public challenge and a leading risk factor for overweight and obesity. Despite the well-recognized benefits of physical activity (PA), only 29% of European youth meet recommended guidelines of at least 60 minutes of daily moderate-to-vigorous PA. The school setting provides an ideal environment to promote healthy lifestyles among young people as initiatives can target all students and the whole school community. The main goal of the EUMOVE project is to design and implement a comprehensive set of strategies and resources to enable the educational community to promote healthy lifestyles in order to reduce risk factors for non-communicable diseases.

EUMOVE project (https://eumoveproject.eu/) is a 3-year project delivered by a collaboration between academic and non-governmental institutions from Spain, Portugal, France, Italy, and the United Kingdom. The direct beneficiaries of the project will include school leaders, teachers, and parents, and indirect beneficiaries will be primary and secondary students. EUMOVE project will develop a set of strategies and resources such as Physically Active Lessons Toolkit, Real Time Active Breaks Platform, Active School Commuting Toolkit, Learning Units about healthy lifestyles promotion, School Leaders toolkit, Parents Toolkit about promoting healthy lifestyles, and Mobile phone APP. Project dissemination will be implemented across each partner region and includes: Online dissemination through a learning platform, scientific events aimed at teachers and researchers, workshops with teachers including training on how to use the teaching resources, and Workshops with parents providing recommendations for promoting healthy lifestyle in their children.

Thus, the EUMOVE project offers evidence-based and innovative resources to be applied by the educational community in the real-world setting to promote PA levels, appropriate diet and sleep habits, and reduce sedentary time amongst children and adolescents across a number of European countries.

P09-03 Costing the economic burden of sedentary behaviors in France

Background

There is strong evidence showing that sedentary behaviour (SB) increase the risk to develop several chronic diseases and to premature death (Chau et al., 2015). A dose response relation is observed with a more marked risk when people spend more than 7 hours/day in sitting position (Ekelund et al., 2019). The study INCA 3 on the lifestyle habits of French population indicated that 40% of people between 18 and 79 years had a high risk for health conditions with more than 7 hours of daily SB (ANSES, 2017). The economic consequences of this risk have never been evaluated. The aim of this study was to estimate the economic burden of SB-related diseases in France.

Methods

From meta-analysis or large cohorts based on individual SB time, we identified relative risk (RR) to develop cardiovascular disease (CVD), colon cancer, breast cancer and all-causes premature death after co-variables adjustments including physical activity. From RR and prevalence of SB time in France, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the national health insurance were used to calculate the annual average costs per case for each disease. Then, disease-specific and total health-care costs attributable to prolonged SB time were calculated. Indirect costs for private sector and households were calculated in a second stage.

Results

In France, 66 528 premature deaths/year appear related to a daily SB time ≥ 8,6 hours Each year prolonged SB cost 559 millions € for the national health insurance, including 359 millions € for CVD (≥ 10 hours of daily SB), 170 millions € for breast cancer (≥ 6 hours of daily SB), and 31 millions € for colon cancer (≥ 5 hours of TV/day).

Conclusions

These preliminary results showed that many deaths could be avoided by reducing prolonged SB prevalence in France. Moreover, direct health-care costs attributable to SB related diseases represent a high economic burden for the French health system. To address this issue, strong responses should be implemented to tackle SB, complementary to physical activity promotion.

P10-05 Evaluation of a MOOC on Heath Promotion in sports club

Background

The acquisition of health promotion (HP) skills and knowledge is essential for interventions development [1,2]. Considering the increasing recognition of the potential of HP in sports clubs (SC) [3] and the number of HP interventions [4,5], the development of training to optimize their implementation is important. To this end, the MOOC (Massive Open Online Course) PROSCeSS (PROmotion de la Santé dans les Clubs de SportS) was developed. The objective of this work was to evaluate the learning process of the MOOC, its acceptability and its effectiveness on the HP knowledge and on the abilities to implement the learning.

Methods

Questionnaires were sent to participants before and after the training between November and February 2022. The RE-AIM model, measuring reach (affected audience) of the training, effectiveness (knowledge gained), adoption (motivations to participate in the course), implementation (use of learning), and maintenance (long-term use of learning) was used to structure the study. Descriptive and multivariate statistics were performed using SPSS 23.0 software.

Preliminary Results

Of the 2000 learners, 21% completed the pre-MOOC questionnaire and 5% completed the post-MOOC questionnaire. Among non-exclusive categories, 32% of learners were SC coaches, 26% were managers, 43% were practitioners (on average for 10 years) and 46% were HP or sport professionals. A paired sample t-test showed an 11% increase in the post-MOOC knowledge questionnaire score compared to the pre-MOOC questionnaire, as well as a 10% increase in confidence in implementing HP actions. 48% of learners were “completely satisfied” with the MOOC and 47% “quite satisfied”. The strategies of participatory approach, communication and objective were considered as the most important and feasible while the lack of time, financial and human resources were considered the main barriers to learning's implementation.

Conclusions

SC actors seem to be interested in HP and want to be trained. This MOOC appears to be an effective solution for acquiring knowledge in HP. The results provide indications for the development of strategic tools and inform on strategies recognized as effective and feasible to implement HP projects and face the problems encountered by the SC.

O6-3 Analysis of the local health-enhancing physical activity policies in the French Riviera

Background

According to the socio-ecological model, policy is one of the levers to initiate structural and environmental changes to foster health-enhancing physical activity (HEPA) promotion (Golden et al., 2015). However, little is known about local evidence to support governments in their policies to promote HEPA (Bull, 2018). Research on HEPA policies at local level seems particularly remains scant (Noël Racine et al., 2020). This study aims to carry out the collection of comprehensive information on municipal HEPA policies of the French Riviera to provide an overview of the development of these policies on this territory.

Methods

Mid-size cities from 2 counties of the French South Region were targeted (n = 17). In each city, a local HEPA policy analysis tool, CAPLA-Santé, was administered to key informants heading the departments of sport, health and social. CAPLA-Santé is a local policy analysis tool adapted from the national HEPA policy analysis tool (HEPA PAT version 2) developed by the World Health Organization. Data were collected through semi-structured interviews and documents analysis. These empirical data were used to make an inductive analysis.

Results

A total of 10 mid-size cities were volunteered to participate. Key informants from sport (n = 10), health (n = 5) and social (n = 6) departments were interviewed. Several written HEPA policies were formalized in 6 cities, 4 of them based their policies on scientific evidences or a national policy. These policies (n = 14), were mainly from the sport (n = 8) and the health sectors (n = 4). Some cities had a department head to ensure cross-sectoral collaboration (n = 3). Key informants reported that the support of national policies, the commitment of elected officials and an important local stakeholders' network could facilitate the HEPA promotion; whereas lack of intersectoral collaboration and resources could be a limitation.

Conclusions

The results help to better understand the local HEPA policies, highlighting some barriers, facilitators and perspectives. Using a local HEPA policy analysis tool can provide evidence to support policymakers. These findings could be valuable to scale up the HEPA promotion at the local level.

P09-02 Risks assessment related to physical activity and sedentary lifestyle profiles among French children and adolescents

Introduction

Based on Anses's report (2016)[1][1], the French Public Health Policy emphasizes on health status improvement by acting on physical activity and sedentary behaviors. Since 2016, many countries have collected results of large epidemiological studies providing new insights into the effect of physical activity- and mainly sedentary-related behaviors on health. To date, behaviors inducing the highest risks are not identified. In this context, based on the data from the most recent French Food Consumption Survey “(Inca3 2017)”[1][2], Anses aims at characterizing the overweight and obesity risks related to physical fitness regarding the levels of physical activity (PA) and sedentary (SED) daily duration of children and adolescents.

Methods

For 11–17 year-old children, the PA and SED behavior were collected using an adapted Youth Risk Behavior Survey questionnaire. Physical activity and sedentary duration were compared to the thresholds considered as safe (Anses 2016): PA > 60 min/day and SED 20 min/day and SED >4h30/day) were set to disaggregate the population that does not reach these benchmarks, allowing to define nine profiles regarding the associated risks identified and updated in the literature. Profiles were compared according to BMI and age using Pearson chi-square tests. All statistical analysis were performed taking into account the survey complex sampling frame design and the individual weighting.

Results

The preliminary results show nine risk-based profiles of children and adolescents (n = 1285) related to the risk thresholds that can be identified. The most at risk profiles represented almost 50% of the 11-17 years old and were associated with the highest BMI. The highest sedentary (>4h30) profiles were observed in the oldest adolescents. However, among them, regarding the updated literature, those having a high physical activity level were considered as at lower risk.

Conclusion

Finally, definition of profiles based on risk thresholds, >60 min/day and >20 min/day for PA and allows to characterize the children and adolescents the most a risk in order to enhance the effectiveness of public health policy. The risk assessment could be further refined using accelerometer real time measurement of physical activity and sedentary behavior.

P10-01 Acceptability of videoconferencing physical activity intervention among elderly in rural areas: qualitative study

Background

Elderly's sustainable engagement in an active lifestyle is a complex phenomenon, implying a plurality of physical, psychological and environmental barriers and facilitators. One of the key factors limiting physical activity (PA) in rural area is the lack of accessibility to PA offers. The use of videoconferencing is a promising solution in terms of acceptability and efficiency to promote PA. However, the acceptability (initial stage of the technology adoption process) of the videoconferencing is still underexplored, as well as its role in promoting PA in rural areas. The purpose of this study was to explore, through the perceptions of the elderly and policymakers, the mechanisms of acceptability of the development of PA interventions using videoconferencing for elderly living in rural areas.

Methods

Elderly (n = 10) and policymakers (n = 12) from 11 different rural town of the South of France participated in the study. Semi-structured individual interviews were conducted, where a video presentation of PA interventions using videoconferencing was played as support. The interview guide assessed the acceptability of this type of intervention through the following themes: (1) perceptions of benefits, (2) barriers, and (3) intentions of use.

Results

Preliminary results showed shared perceptions between elderly and policymakers for barriers (e.g., lack of real social ties, lack of technological equipment) and benefits (e.g., breaking loneliness, overcome weather conditions). However, intentions of use are heterogeneous according to individual characteristics (e.g., “young” elderly between 60 to 65 years are more favourable to the use of technologies) and the specificity of towns (e.g., in the smallest towns with less than 500 people, elderly are less inclined to change their habits).

Conclusions

This study showed that the development of videoconferencing PA intervention could be accepted by elderly living in rural areas, taking into account some conditions (e.g., offer as punctual and non-regular use, set up individual support for the use of technology). Additional quantitative studies should be conducted for a more comprehensive understanding of the factors influencing the videoconferencing PA intervention acceptability in rural areas.

Development of the health promoting sports club-national audit tool

Background

Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs.

Methods

A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus.

Results

Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders.

Conclusion

To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Costing the economic burden of prolonged sedentary behaviours in France

BACKGROUND

There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France.

METHODS

Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach.

RESULTS

In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €.

CONCLUSION

Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.

PERSISTE: a mixed methods protocol to identify barriers and levers to a sustainable physical activity practice among patients with chronic disease after physical activity resumption programs

Physical activity (PA) has evidence-based benefits for physical, social and mental health, but investigation of how PA interventions for patients with chronic disease affects their PA practice up to 1 year after programmes are rare. Moreover, few studies document how the context and intervention mechanisms of PA programmes affect sustainable PA practice and its determinants. The present protocol describes a mixed methods study comparing the effectiveness and conditions for the effectiveness of two PA resumption programmes (a hospital-led and a community-based programme). Using a comparative longitudinal study, 60 patients (3-month duration) will be followed for 1 year though four data collections: before (T0) and at the end (T1) of the intervention, 6 months (T2) and 1 year (T3) after the start of the programme. The primary outcome will be PA practice in min/week and categorised as light, moderate or vigorous (using International Physical Activity Questionnaire (IPAQ)), and secondary outcomes will include sedentary time in min/week (IPAQ), quality of life evaluated though the physical and mental composite scores ('Medical Outcome Study Short Form 12'), and enjoyment using four statements rated from 1 to 5, a high score being synonymous of enjoyment (Intrinsic Motivation Inventory). Qualitative data on further determinants of PA practice and intervention mechanisms will be collected. The expected results will offer the opportunity to understand how the intervention context contributes to a more effective, sustainable PA practice. Trial registration number: NCT04954209.

Modeling the Development of Local Health-Enhancing Physical Activity Policies from Empirical Data and Policy Science Theories

Physical inactivity is considered a pandemic, requiring strong policy responses to address this major health issue. However, research on the development of Health-Enhancing Physical Activity policies (HEPA) remains scarce, particularly at the local level. There is a need to produce evidence to better understand the process to develop local HEPA policies. This study aims to model the development of HEPA policy promotion in French municipalities from empirical data and policy science theories. This research was undertaken in three steps: (1) assess the level of development of HEPA policies from 10 French municipalities using a local HEPA analysis tool, (2) provide a brief overview of core political science theories applied in health promotion, and (3) from these empirical and theoretical perspectives, model a conceptual framework to better understand the development of HEPA policy promotion in French municipalities. Based on empirical data and the Multiple Streams, policy cycles and Institutional Rational Choice theories, a conceptual framework of the development of municipal HEPA policy promotion was modeled. This conceptual framework is comprised of five stages describing the development of municipal HEPA policies. This paper contributes to a better understanding of the development of municipal HEPA policies.

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.

Effects of technology-based physical activity interventions for women after bariatric surgery: study protocol for a three-arm randomised controlled trial

INTRODUCTION

A recent meta-analysis provided proof of efficacy for mobile technology to increase physical activity or weight loss in the short term. Videoconferencing may also be effective, especially as it reduces the barriers related to face-to-face physical activity interventions. Both technologies seem particularly interesting for bariatric surgery management, but their long-term effects on physical activity maintenance are unknown. Moreover, the mechanisms underlying their effectiveness, such as technology acceptability and motivational processes, have not been examined.The objectives of this study are to determine the effects of two technology-based (mobile technology and videoconferencing) physical activity programmes after bariatric surgery compared with standard care and to assess the contribution of acceptability and motivational mechanisms in explaining these effects on physical activity, physiological measures and health indicators.

METHODS AND ANALYSIS

One hundred and twenty young women who have undergone bariatric surgery in the last 3-6 months will be included. The volunteers will be randomly assigned to one of three arms: CONTROL (standard care), ACTI-MOBIL (mobile technology) or ACTI-VISIO (videoconferencing). The primary outcome is the distance travelled during a 6 min walk test relativised according to Capadaglio's theoretical distance. Secondary outcomes are behavioural measures of physical activity, physiological measures, health indicators, technology acceptability and motivational concepts. Data will be collected at baseline (T0), 3 months (T3) and 6 months (T6). The technology groups will receive a physical activity programme for 12 weeks (between T0 and T3). A mixed model approach will be used to analyse the change in outcomes over time for each group.

ETHICS AND DISSEMINATION

This study protocol was reviewed and approved by the French East 1 Protection of Persons Ethics Committee (number: 2020.A00172-37) and the French National Commission for Information Technology and Civil Liberties (number: UCA-R20-034). The results will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT04478331.

Development and validation of the Cystic Fibrosis Decisional Balance for Physical Activity scale (CF-DB-PA)

BACKGROUND

People with cystic fibrosis (pwCF) derive several physiological and psychological benefits from regular physical activity (PA), but the practice is lower than recommended. Knowledge about the facilitators of and barriers to PA at the individual level is important to act positively on PA behaviors. This study validated the Cystic Fibrosis Decisional Balance for Physical Activity scale (CF-DB-PA) for adults with CF.

METHODS

French adults with CF were recruited in several specialist centres in France. The CF-DB-PA scale was validated following a quantitative study protocol comprising four stages: (1) tests of the clarity and relevance of a preliminary 44-item version and reduction analysis, (2) confirmatory factor analysis and tests of dimensionality through equation modelling analysis, (3) tests of reliability with Cronbach alphas for the internal consistency and a test-retest with a 2-to-3 week interval for temporal stability, and 4) tests of construct validity with Spearman correlations to measure the associations between each subscale and the theoretically related constructs (i.e., quality of life, PA and exercise tolerance).

RESULTS

A total of 201 French adults with CF participated in the validation study. The CF-DB-PA comprises 23 items divided into two factors: facilitators of and barriers to PA. Each factor is divided into three subscales: physical, psychological and environmental. The factors (facilitators and barriers) can be used independently or combined as a whole. A general score of decisional balance for PA can also be calculated. The bi-factor model presented satisfactory adjustment indexes: χ2 (194) = 362.33; p < .001; TLI = .87; CFI = .90; RMSEA = .067. The scale showed satisfactory internal consistency (Cronbach's α = .77). The test-retest reliability was not significant for either subscale, indicating stability over time. The facilitators subscale correlated significantly with the self-reported score of PA (r = .33, p < .01) and quality of life (r = .24, p < .05). The barriers subscale correlated significantly with the self-reported scores of PA (r =  - .42, p > .01), quality of life (r =  - .44, p < .01), exercise tolerance (r =  - .34, p < .01) and spirometry tests (r =  - .30, p < .05).

CONCLUSIONS

The CF-DB-PA is a reliable and valid questionnaire assessing the decisional balance for PA, the facilitators of and the barriers to PA for adults with CF in French-speaking samples.

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.

Analysis of the Local Health-Enhancing Physical Activity Policies on the French Riviera

Policy is a lever for initiating the structural and environmental changes that foster health-enhancing physical activity (HEPA) promotion. However, little is known about the evidence in support of local governments regarding their HEPA-promoting policies. The aim of this study was to collect comprehensive information on municipal HEPA policies on the French Riviera (Alpes-Maritimes and Var counties) to provide an overview of the development of these policies in this territory. Mid-sized cities from the two counties constituting the French Riviera were targeted (n = 17). In each city, a local tool for HEPA policy analysis, CAPLA-Santé, was used to gain information from key informants heading the departments of sports, health services, and social services. Data were collected through semi-structured interviews and document analysis. Ten mid-sized cities volunteered to participate. Key informants from the sports (n = 10), health services (n = 5), and social services (n = 6) departments were interviewed. Written HEPA policy documents were formalized in six cities. These documents (n = 14) were mainly from the sports (n = 8) and health services (n = 4) sectors. The key informants reported that support from national policy, the commitment of elected officials, and large local stakeholder networks facilitated HEPA promotion, whereas the lack of intersectoral collaboration and limited resources were limitations. The results provide insight into the development of municipal HEPA policies, highlighting some of the barriers, facilitators, and perspectives. These findings could be valuable to scale up HEPA promotion at the local level.

The health promoting sports club model: An intervention planning framework

Background

Researchers and policymakers have acknowledged sports clubs (SCs) as health promoting settings. Limited research links the health promoting sports club (HPSC) concept with evidence-driven strategies to offer SCs guidance to develop health promotion interventions. As implementation science insists on theoretically grounded interventions, this work's objective was to provide SCs an evidence-driven intervention framework for planning health promotions.

Methods

A 4-step process was undertaken: 1) investigate indicators for SCs to be considered health promoting, 2) adapt the theoretical HPSC concept to create a HPSC model, 3) reformulate published evidence-driven guidelines into implementable intervention components (ICs) and 4) merge the model with the ICs to provide an intervention planning framework for SCs. During 3 workshops, researchers defined the model elements and ICs. Workshop participants classified ICs into the HSPC model. Each IC could be classified multiple times within the model.

Results

Researchers drafted 5 HPSC indicators: 1) an approach embracing all SC actions, 2) involve all SC levels in actions and decisions, 3) involve external partners, 4) promoting health is continuous and iterative and 5) base actions on needs. To create the HPSC model, elements were defined: 3 SC levels (club, management, coaches) and 4 health determinants (organizational, social, environmental, economic) per level based on the indicators. Published guidelines from literature reviews aided in developing 14 strategies with 55 ICs. Workshop classification of ICs into the model included: club (n = 79), management (n = 67) and coaches (n = 48).

Conclusions

The theoretical HPSC model and intervention planning framework act as starting points to develop and implement interventions to increase HP efforts by stakeholders in several ways: 1) SCs can apply strategies based on goals, 2) SCs can target specific levels with corresponding ICs or 3) ICs can target specific health determinants.

Key messages

A Health Promoting Sports Club model defines 4 health determinants at 3 levels (coach, management operational) of sports clubs to plan, develop and implement targeted health promotion activities. This HPSC intervention planning framework has 14 strategies with 55 intervention components targeting multiple sports club levels giving stakeholders a path to become a health promoting sports club.

Analysis of the local health-enhancing physical activity policies in the French Riviera

Background

Policy is one of the levers to initiate structural and environmental changes to foster health-enhancing physical activity (HEPA) promotion. However, little is known about local evidence to support governments in their policies to promote HEPA. This study aims to analyze the local HEPA policies development in French mid-size cities.

Methods

Mid-size cities from 2 counties of the French South Region were targeted (n = 17). In each city, a local HEPA policy analysis tool, CAPLA-Santé, was administered to key informants heading the departments of sport, health and social. CAPLA-Santé is a local policy analysis tool adapted from the national HEPA policy analysis tool (HEPA PAT version 2) developed by the World Health Organization. Data were collected through semi-structured interviews and documents analysis.

Results

A total of 10 mid-size cities were volunteered to participate. Key informants from sport (n = 10), health (n = 5) and social (n = 6) departments were interviewed. Several written HEPA policies were formalized in 6 cities, 4 of them based their policies on scientific evidences or a national policy. These policies (n = 14), were mainly from the sport (n = 8) and the health sectors (n = 4). Some cities had a department head to ensure cross-sectoral collaboration (n = 3). Key informants reported that the support of national policies, the commitment of elected officials and an important local stakeholders' network could facilitate the HEPA promotion; whereas lack of intersectoral collaboration and resources could be a limitation.

Conclusions

The results help to better understand the local HEPA policies, highlighting some barriers, facilitators and perspectives. These findings could be valuable to scale up the HEPA promotion at the local level.

Key messages

Local policymakers had difficulties to adopt an intersectoral and global approaches in HEPA promotion. Using local HEPA policy analysis tool can provide evidence to support policymakers.

Building health promoting sports clubs: A participative concept mapping approach

Background

Sports clubs offer a unique position to increase performance and physical activity but may also provide additional health promoting opportunities. Research is limited on support clubs need to increase health promotion efforts. This study took a participative approach to gather French stakeholder ideas on perceived assistance sports clubs need to increase health promotion efforts and prioritized them based on ratings of importance and feasibility.

Methods

This concept mapping study had 4-steps: 1) drafting a focus prompt to a key issue, 2) brainstorming ideas in response to the focus prompt, 3) sorting ideas into themed piles and 4) rating ideas (1-6) based on two indicators. French stakeholders (45) in sports and health organizations were invited to respond using the groupwisdom™ platform. Researchers produced visual cluster maps of themed piles and Go-Zone graphs displaying ideas perceived as important and feasible.

Results

Participants generated 62 ideas responding to the focus prompt: 'What assistance would benefit sports clubs to become health-promoting settings?'. Once researchers edited ideas, 78 were available to sort. Final sorting formed 9 clusters: Tools for health promotion, Communication tools, Stakeholder training courses, Diagnostic & Financing, Awareness & Mobilization, Advocacy, Policies & Methods, Sharing & Networking, Communication & Dissemination. Importance and feasibility ratings produced Go-Zones with 34 ideas above the mean for both indicators. Top focus areas include: increasing awareness of health promotion benefits, mobilizing actors, advocating for support and educating club actors.

Conclusions

Understanding support stakeholders need to increase health promotion efforts in sports clubs is a crucial step to plan and implement policies. Including stakeholders' perceptions helps establish effective interventions by increasing the possibility of integration into current or emerging policies and acceptance from those working in clubs.

Key messages

Generating and organizing stakeholder ideas gives insight into perceptions of what support is needed to develop and implement health promotion interventions in the sports club context. Based on importance and feasibility, sports clubs can increase health promotion efforts by focusing on: increasing awareness of health promotion benefits, mobilizing actors, advocacy and education.

Perceptions of barriers and levers of health-enhancing physical activity policies in mid-size French municipalities

Background

Policy is one of the levers for initiating structural change to foster the promotion of health-enhancing physical activity (HEPA). To this end, policy-makers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been conducted on this topic at the local level. The purpose of this study was to identify the perceived barriers and levers of HEPA policies according to department heads and elected officials across various sectors in mid-size French municipalities.

Methods

This study used a mixed method primarily based on an adaptation of the concept mapping approach. A list of statements completing the sentence: ‘In a mid-size municipal context, to develop HEPA policies, it is necessary to …’ was submitted to key informants of 17 mid-sized French cities. Key informants in each municipality first rated the importance of each statement without considering their local context; they then rated the feasibility of each statement given their local context. In both cases, they used a Likert scale ranging from 1 to 6.

Results

A total of 23 municipal department heads and 10 elected officials from the sport (n = 14), health (n = 10) and social (n = 9) sectors in 11 mid-size French cities participated in this study. A list of 84 statements, sorted into 16 categories, was rated by participants according to their importance (M = 4.52, SD = 0.86) and their feasibility (M = 3.77, SD = 0.74). Potential barriers to (n = 10) and levers of (n = 38) HEPA policy development were identified. These results varied according to the position and sector of the participants.

Conclusions

The results suggest that local contextual factors can affect the development of HEPA policies in mid-size French municipalities. The different perceptions of the potential levers and barriers according to sector might affect intersectoral collaboration. This study contributes by enhancing understanding of how local HEPA policies are developed in the French context.

How to deal with COVID-19 epidemic-related lockdown physical inactivity and sedentary increase in youth? Adaptation of Anses' benchmarks

Faced with the spread of the SARS-CoV-2 virus, regulatory measures aiming to prevent interpersonal contaminations have been undertaken and among these, lockdown. Due to strong restrictions out-of-home movements, we hypothesize that overall physical activity will decrease and sedentary behavior increase. This could result in highest exposure to the well-known risk related to insufficient physical activity. To mitigate physical inactivity and sedentary behaviors health-related risks related to children and adolescents lockdown and school closure, Anses (French Agency for Food, Environmental and Occupational Health & Safety) has adapted, within the first days of the public authorities' prescription, its former benchmarks. This paper supports and comments Anses' Opinion by raising the questions of whether, why, and how to deal with short- or medium-term lockdown-related physical inactivity and sedentary behavior increases. Short-term and unknown long term-impacts on mental health and well-being, physical fitness and eating behaviors clearly appearing for children and adolescents as being the main issues of concern are highlighted. Targeting the compensations of the physical inactivity increase, the types, frequencies and durations of physical activity, are adapted to restricted environment. Sedentary behavior limitation and frequent interruptions becomes a priority. Overall, considering children and adolescents, the emerging risk justifies proposing specific adaptations and type of activities in order to ensure maintaining health underpinned, at least partly, by physiological equilibrium and physical fitness and avoid the installation of new unhealthy habits or routines that young people could keep after lockdown.

Development of a Local Health-Enhancing Physical Activity Policy Analysis Tool in France: CAPLA-Santé

The promotion of health-enhancing physical activity (HEPA) has become a key objective in public health policy. Therefore, based on the national HEPA Policy Audit Tool Version 2 (HEPA PAT v2) of the World Health Organization, a tool was designed to support local governments in assessing HEPA policies. This study aims to describe the adaptation and testing of the HEPA policy analysis tool (CAPLA-Santé) at the local level in France. The work was conducted in three stages: (1) an intersectoral group of experts was constituted, and the group adapted each item of the HEPA PAT v2 tool to the local level; (2) a testing phase with seven local governments helped to collect data and feedback on the tool; and (3) a final workshop was organized to adjust and finalize the tool. The final version of CAPLA-Santé contains 21 items divided into six major sections: overview of HEPA stakeholders in the local government area, policy documents, policy contents, funding and political engagement, studies and measures relating to physical activity in the local government area, and progress achieved and future challenges. CAPLA-Santé allows the collection and in-depth analysis of local level policies to assess the progress in promoting HEPA and intersectoral collaboration as well as identifying successful policy levers and remaining challenges.

Measuring Health Promotion in Sports Club Settings: A Modified Delphi Study

Settings-based approaches have become an increasing health promotion focus since the World Health Organization's 1986 Ottawa Charter. While schools, cities, and prisons have implemented this approach, its development within sports environments is recent. Sports are a popular leisure-time activity, requiring validated tools to measure health promotion activity. This study's aim was to develop a measurement tool based on international consensus that measures perceptions of health promotion within sports clubs. It is grounded in the settings-based approach and builds on theory from previous works expanding their context and knowledge. An online, three-round international Delphi study was conducted, inviting experts in sports and health fields to participate in designing the tool. Round 1 created a collaborative list of items; Round 2 validated items based on relevance, importance, and feasibility; and the final round classified items into one determinant category-social, cultural, environmental, or economic. Panelists (69 experts) from 13 countries participated, creating a final list of 62 items at 3 organizational levels; the sports club level included 23 items, the officials level retained 20 items, and the coaching level contained 19 items. This study provides several innovations: (1) applying the settings-based approach to health promotion within sports clubs, (2) defining each club level (sports club, official, coaching) and determinants (social, cultural, environmental, economic) within 3-levels, (3) creating a tool that measures perceptions of health-promotion activities per level and determinant, and (4) obtaining expert consensus on included items. These advancements allow further research on promoting health within sports clubs.

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The "indice de position sociale des élèves" was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (β = -0.06; p < 0.0001), overweight and obesity prevalence (β = -2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (β = -0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (β = -0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.

Perceptions of barriers and levers to health-enhancing physical activity policies in French cities

Background

Policy is one of the levers to initiate structural change to foster the promotion of Health-Enhancing Physical Activity (HEPA). To this end, policymakers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been published on this topic at the local level. The purpose of this study was to identify the barriers and levers to develop HEPA policies from the point of view of municipals managers and elected officials in mid-size French cities.

Methods

This study was conducted following the concept mapping approach: a list of statements was submitted to 17 French mid-size cities. These statements completed the beginning of this sentence: “In a mid-size municipality context, to develop HEPA policies, it is necessary to...”. First, key informants in each city rated the importance of each statement without considering their local context according to a Likert scale, ranging from 1 (not at all important) to 6 (extremely important). Then, they had to rate the feasibility of each statement considering their local context according to a Likert scale ranging from 1 (not at all feasible) to 6 (extremely feasible).

Results

A total of 23 municipal managers and 10 elected officials from sport (n = 14), health (n = 10), and social (n = 9) sectors from 11 French mid-size cities participated in this study. Statements related to political commitment, shared governance and partnership appeared as potential levers to develop HEPA policies. Statements related to the economic model of the local HEPA promotion, mandate of the mayor, and land use planning appeared as potential barriers to develop HEPA policies. The results varied according to the position and the sector of the respondent.

Conclusions

The results suggest that some local contextual factors could affect the development of HEPA policies in mid-size French cities. This study contributes to a better understanding of the development of local HEPA policies in the French context.

Key messages

Local contextual factors should be considered when developing health-enhancing physical activity policies. The perceptions of these local contextual factors varied according to the position and the sector of the respondent.

Measuring health promotion in a sports club setting: a modified Delphi study

Background

The settings-based approach has become an increasing focus in health promotion since the World Health Organization’s 1986 Ottawa Charter. Schools and cities have implemented this approach, but development within sports clubs is limited. Thus, an internationally validated measurement of health promotion within this setting is lacking.

Methods

A modified Delphi study was completed to develop an international evaluation tool grounded in the settings-based approach. Expert panelists from academia, sports and health sectors were invited to participate in 3 online rounds. Items were generated or selected based on 3 prior Delphi-based studies and 2 nationally validated scales. Round one created a collaborative list of items, round two validated items based on relevance, importance and feasibility and the final round classified items into one of four determinants: cultural, social, environmental or economic.

Results

Panelists (69) from 13 countries participated in creating a final list of 62 items at 3 organizational levels. The sports club level included; 5 cultural, 6 social, 6 environmental and 5 economic items. The management level included; 5 cultural, 5 social, 5 environmental and 3 economic items. The coaching level included; 5 cultural, 5 social, 4 environmental and 4 economic items.

Conclusions

This study provides three important innovations; 1- it is rooted in theory through the settings-based approach, 2- the measurement tool includes three levels within sports clubs, capturing a whole club dynamic and 3- all items included in the tool have been validated by an international panel of experts.

Key messages

This 62-item measurement tool allows the comparison of perceptions from participants, coaches and management regarding how health is promoted within their sports club. This information offers insight on the capacity of sports clubs to implement and monitor policies and practices on the promotion of health beyond sports performance within their organization.

Using theory of change to develop an intervention theory for designing and evaluating behavior change SDApps for healthy eating and physical exercise: the OCAPREV theory

Background

Connected health devices and applications (referred to hereafter as “SDApps” - Smart devices and applications) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. This article seeks to unpack this black box, and describes the process of elaboration of an intervention theory for healthy eating and physical activity SDApps. It includes a set of requirements relative to their impact on social health inequalities.

Methods

To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC) method. To this end, we developed a cumulative and iterative process combining scientific data from the literature with knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process, as follows: 1 - identifying the evidence base; 2 - developing the theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome.

Results

We produced an evidence-based theory according to the ToC model, based on scientific evidence and knowledge from experts and users. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals: Capacity, Opportunity, Motivation – Behavior (COM-B). Furthermore, the theory specifically integrates requirements relative to the impact on SHIs.

Conclusions

This theory is an aid to SDAapp design and evaluation and it can be used to consider the question of the possible impact of SDApps on the increase in inequalities. Firstly, it enables developers to adopt a more overarching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered.

Physical activity promotion in primary care: a Utopian quest?

The health benefits of physical activity (PA) are acknowledged and promoted by the scientific community, especially within primary care. However, there is little evidence that such promotion is provided in any consistent or comprehensive format. Brief interventions (i.e. discussion, negotiation or encouragement) and exercise referral schemes (i.e. patients being formally referred to a PA professional) are the two dominant approaches within primary care. These cost-effective interventions can generate positive changes in health outcomes and PA levels in inactive patients who are at increased risk for non-communicable diseases. Their success relies on the acceptability and efficiency of primary care professionals to deliver PA counselling. To this end, appropriate training and financial support are crucial. Similarly, human resourcing and synergy between the different stakeholders must be addressed. To obtain maximum adherence, specific populations should be targeted and interventions adapted to their needs. Key enablers include motivational interviewing, social support and multi-disciplinary approaches. Leadership and lines of accountability must be clearly delineated to ensure the success of the initiatives promoting PA in primary care. The synergic and multisectoral action of several stakeholders, especially healthcare professionals, will help overcome physical inactivity in a sustainable way.

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.