Methods of policy monitoring in physical activity promotion: a systematic review across different levels of government

Background

Even though the importance of policy monitoring in public health has increased in the last decades, there is still a lack of understanding what different approaches of policy monitoring exist and which methodology they employ. In order to address this research gap, this review attempts to provide a comprehensive overview about the methods of policy monitoring in the field of physical activity promotion.

Methods

A systematic search was conducted in five scientific databases, using the terms “physical activity”, “policy” and “monitoring” and their variations. In total, 12.963 studies were identified and, after the elimination of duplicates, screened independently by two reviewers. During full text analysis, information on the methods applied for policy monitoring was extracted and studies were categorized based on their key characteristics (monitoring tool, policy level, and setting).

Results

The search yielded in a total of 112 studies that were structured into seven categories: Report Cards on Physical Activity for Children and Youth, HEPA Monitoring Framework, HEPA Policy Audit Tool, national policies, subnational policies, school setting, and childcare setting. Across all categories, policy monitoring focused mainly on national level policies in a single country. Differences were identified with regards to the level of government involvement which allowed to differentiate between research-driven approaches (little or no government involvement), government-driven approaches (led by governments), and co-production approaches (strong collaboration between researchers and governments).

Conclusions

Research-driven, government-driven and co-production approaches have different strengths and weaknesses with regards to the monitoring of policies. Awareness needs to be raised regarding the implications of these approaches, and more research is needed to analyse the impact of policy monitoring on policy-making in public health.

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

BACKGROUND

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSION

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

Assessment of organizational readiness for health promotion policy implementation: test of a theoretical model

Models explaining the engagement of organizations in different policy sectors in health promotion policy implementation often utilize retrospective data. The current study attempted to model determinants of organizational readiness (goals, resources, obligation, opportunities) in supporting health policy implementation prospectively. Twenty qualitative interviews with representatives of organizations from different policy sectors, levels of government and organizational legal entities were conducted at the beginning of a project for the promotion of physical activity among women in difficult life situations. Organizational support in developing, implementing and disseminating the project was documented over 36 months. Results indicated that in most organizations, determinants were not favorable for health promotion policy action for physical activity among women in difficult life situations. Six organizations did not report any favorable determinant, and two organizations reported four. The other 12 organizations reported positive results for some of the determinants. Project work received support from 6 out of the 20 organizations. A case study of three organizations indicated that engagement or disengagement of organizations in health promotion policy actions might be partly explained by the theoretical model. The prospective assessment of organizational readiness in implementing health promotion policy is highly relevant for health promotion. Considering the proposed theoretical framework may aid in advancing our understanding of factors that are related to organizational engagement in health promotion actions.

[Physical activity and prevention of Alzheimer's dementia: current evidence and feasibility of an interventional trial]

There is accumulating evidence from animal and epidemiologic studies that physical exercise is neuroprotective in healthy animals and humans and can prevent cognitive decline in chronic neurodegenerative processes like Alzheimer's dementia. However, data from well-designed interventional, randomized non-pharmacologic trials is lacking in contrast to other areas of medicine like prevention of hypertension, diabetes or the antipsychotic-associated metabolic syndrome. The demonstration of a potential positive effect of physical exercise on preventing dementia using a controlled study design would represent a significant progress in the prevention of dementia and public health, especially as long as other treatments for dementia prevention are lacking.

[Empowerment of women in difficult life situations: the BIG project]

BIG is a project for the promotion of physical activity among women in difficult life situations. Following the main health promotion principles of the WHO, the women shall be enabled or empowered to take control of determinants of their health. A comprehensive participatory approach was applied and women were included in planning, implementing and evaluating the project. For measuring the effects of BIG on the empowerment of participating women, qualitative semi-structured interviews with 15 women participating in BIG were conducted. For data analysis, qualitative content analysis was used. Results showed the empowerment of the women on the individual level as they gained different competencies and perceived self-efficacy. These effects were supported through the empowerment process on the organizational and community levels where women gained control over their life situations and over policies influencing them. Therefore, the participatory approach of BIG is a key success factor for empowerment promotion of women in difficult life situations.

Research note: social catalysts in health promotion implementation

Recent work carried out by WHO has recognised that an assets based approach to health promotion is crucial to support the promotion of population health and to reduce health inequalities. The assets approach was applied in a project aimed at promoting physical activity among women in difficult life situations. Within the participatory and collaborative work of the project, a specific set of assets for health that might initiate social participation and collaboration in health promotion action emerged. These assets are referred to as social catalysts for health promotion implementation. The article describes empowered individuals, informal social networks, mediating social institutions and organisational structures as potential social catalysts for health promotion implementation, and outlines some directions for further research on this topic.

[Sedentary lifestyles. Classification of different target groups for the promotion of health-enhancing physical activities]

The article investigates different sub-groups of sedentary adults based on their socio-demographic characteristics and perceived barriers to physical activity. Data stem from the Germans Survey of Sedentary Adults (n=10.000) and the data analysis used logistic regressions and cluster analysis. The results indicate that sedentary adults are a diverse group when socio-demographic characteristics and perceived barriers to physical activity are considered. Barriers such as lack of social contacts or time for physical activity are perceived by specific subgroups of this population. In contrast, only few sedentary adults report multiple barriers to physical activity. The results also provide indications for potentially successful strategies to promote physical activity among sedentary adults.

[Sports and physical activity in the elderly: social structural context and relation to health]

OBJECTIVES

The following contribution analyses the socio-structural context of sport as well as the relationship between sport/physical activity and health among older people (> or = 60 years).

METHODS

The data are part of a telephone-survey by random sample with 436 realised cases in the independent cities of the Western Ruhr-District and thus represent a situation in highly urbanised areas.

RESULTS

In the cardinal question concerning the meaning of sport and physical activity for health a positive relationship was found, in particular between sport intensity and health measured by Advanced Activities of Daily Living (AADL) as well as for sport as hobby, which showed a highly significant relationship with subjective health. With regard to socio-demographic variables results show that sport and physical activity vary with gender and age. Apart from that attitudes like low external control for one's health as well as the value of appearance show strong relationships with sport participation. Stratification variables with the exception of income only show weak effects.

CONCLUSIONS

The results, which are partly not congruent, indicate that further research is needed in the field of sport and health among the aged.