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Vahid F, Dessenne C, Tur JA, Bouzas C, Devaux Y, Malisoux L, Monserrat-Mesquida M, Sureda A, Desai MS, Turner JD, Lamy E, Perez-Jimenez M, Ravn-Haren G, Andersen R, Forberger S, Nagrani R, Ouzzahra Y, Fontefrancesco MF, Onorati MG, Bonetti GG, de-Magistris T, Bohn T. Multicomponent (bio)markers for obesity risk prediction: a scoping review protocol. BMJ Open 2024; 14:e083558. [PMID: 38458803 PMCID: PMC10928751 DOI: 10.1136/bmjopen-2023-083558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Despite international efforts, the number of individuals struggling with obesity is still increasing. An important aspect of obesity prevention relates to identifying individuals at risk at early stage, allowing for timely risk stratification and initiation of countermeasures. However, obesity is complex and multifactorial by nature, and one isolated (bio)marker is unlikely to enable an optimal risk stratification and prognosis for the individual; rather, a combined set is required. Such a multicomponent interpretation would integrate biomarkers from various domains, such as classical markers (eg, anthropometrics, blood lipids), multiomics (eg, genetics, proteomics, metabolomics), lifestyle and behavioural attributes (eg, diet, physical activity, sleep patterns), psychological traits (mental health status such as depression) and additional host factors (eg, gut microbiota diversity), also by means of advanced interpretation tools such as machine learning. In this paper, we will present a protocol that will be employed for a scoping review that attempts to summarise and map the state-of-the-art in the area of multicomponent (bio)markers related to obesity, focusing on the usability and effectiveness of such biomarkers. METHODS AND ANALYSIS PubMed, Scopus, CINAHL and Embase databases will be searched using predefined key terms to identify peer-reviewed articles published in English until January 2024. Once downloaded into EndNote for deduplication, CADIMA will be employed to review and select abstracts and full-text articles in a two-step procedure, by two independent reviewers. Data extraction will then be carried out by several independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and Peer Review of Electronic Search Strategies guidelines will be followed. Combinations employing at least two biomarkers from different domains will be mapped and discussed. ETHICS AND DISSEMINATION Ethical approval is not required; data will rely on published articles. Findings will be published open access in an international peer-reviewed journal. This review will allow guiding future directions for research and public health strategies on obesity prevention, paving the way towards multicomponent interventions.
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Affiliation(s)
- Farhad Vahid
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Coralie Dessenne
- Science Office, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Josep A Tur
- Research Group in Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, IdISBa & CIBEROBN (ISCIII), Palma de Mallorca, Spain
| | - Cristina Bouzas
- Research Group in Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, IdISBa & CIBEROBN (ISCIII), Palma de Mallorca, Spain
| | - Yvan Devaux
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Laurent Malisoux
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Margalida Monserrat-Mesquida
- Research Group in Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, IdISBa & CIBEROBN (ISCIII), Palma de Mallorca, Spain
| | - Antoni Sureda
- Research Group in Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS, IdISBa & CIBEROBN (ISCIII), Palma de Mallorca, Spain
| | - Mahesh S Desai
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
| | - Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch sur Alzette, Luxembourg
| | - Elsa Lamy
- MED-Mediterranean Institute for Agriculture, Environment and Development & CHANGE-Global Change and Sustainability InstituteUniversity of Évora, Evora, Portugal, Evora, Portugal
| | - Maria Perez-Jimenez
- MED-Mediterranean Institute for Agriculture, Environment and Development & CHANGE-Global Change and Sustainability InstituteUniversity of Évora, Evora, Portugal, Evora, Portugal
| | | | - Rikke Andersen
- Technical University of Denmark, Kongens Lyngby, Denmark
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Rajini Nagrani
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Yacine Ouzzahra
- Science Office, Luxembourg Institute of Health, Strassen, Luxembourg
| | | | | | | | | | - Torsten Bohn
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Ochterbeck D, Frense J, Forberger S. A survey of international addiction researchers' views on implications of brain-based explanations of addiction and the responsibility of affected persons. Nordisk Alkohol Nark 2024; 41:39-56. [PMID: 38356788 PMCID: PMC10863558 DOI: 10.1177/14550725231188802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 07/04/2023] [Indexed: 02/16/2024] Open
Abstract
Aim: To complement existing stakeholder surveys by exploring addiction researchers' views on the implications of brain-based explanations of addiction and the responsibilities of addicted persons. Methods: A total of 190 researchers from 29 countries (13.2%) participated in a LimeSurvey. Their perspectives on implications of brain-based explanations of addiction were explored qualitatively using open-ended questions. In addition, respondents could indicate their views on the responsibility of addicted individuals for their condition and actions using a Likert scale and a free-text field ("mixed methods light"). Qualitative analyses inductively identified the most frequent themes and deductively assessed the overall impact (positive, negative or both/ambivalent). Quantitative analyses included frequencies and proportions. Results: The major themes mentioned were medicalisation and the neglect of other factors, better treatment options and access, (reduced) stigma and (impaired) agency of affected persons. The overall evaluation yielded 46% positive, 33% negative and 16% ambivalent views. Approximately 60% of the participants considered addicted persons to be responsible for their condition and 80% for their actions. Conclusions: According to researchers, a brain-based approach to addictions has positive and negative implications. In particular, the neglect of factors other than biomedical seems to be of concern. Thus, a re-consideration of research priorities as well as affected individuals' agency and role in treatment and care seems warranted.
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Affiliation(s)
- Doris Ochterbeck
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jennifer Frense
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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Gannon J, Bach K, Cattaruzza MS, Bar-Zeev Y, Forberger S, Kilibarda B, Azari R, Okwor U, Lomazzi M, Borisch B. Big tobacco's dirty tricks: Seven key tactics of the tobacco industry. Tob Prev Cessat 2023; 9:39. [PMID: 38124801 PMCID: PMC10731746 DOI: 10.18332/tpc/176336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Affiliation(s)
- John Gannon
- World Federation of Public Health Associations
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Nagdeo KP, Lee H, Forberger S. International and national frameworks, guidelines, recommendations, and strategies for maternal tobacco prevention and cessation: A scoping review protocol. Tob Induc Dis 2023; 21:144. [PMID: 37941819 PMCID: PMC10629224 DOI: 10.18332/tid/173088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/24/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
Tobacco use during and around pregnancy can significantly increase the risk of stillbirth, congenital disabilities, premature birth, and low-weight birth. To establish maternal tobacco prevention and cessation frameworks for primary care and dental providers and to facilitate cross-national learning, this scoping review aims: 1) to analyze the body of literature on maternal tobacco prevention and cessation frameworks, guidelines, recommendations, and strategies at the international and national level; 2) to identify common core elements; and 3) to identify gaps in the literature, and propose future initiatives and policy development directions. A systematic database search based on the JBI methodology and corresponding PRISMA-ScR guidelines will be conducted from January 2015 to August 2023. Searches in different databases will be combined with an expert survey among the members of the World Federation of Public Health Associations (WFPHA) - Oral Health, Tobacco Control, and the Women, Adolescent, and Children's Working Groups to evaluate the search outcomes and add maternal tobacco prevention and cessation frameworks, guidelines, recommendations, or strategies. Using a systematic review tool to support the screening, two independent reviewers will screen the titles and abstracts of all articles, in order to include the relevant ones for full-text screening, and an independent third author will resolve conflicts, if there is any discrepancy between the two independent reviewers' search. After a full-text review, data extraction will be conducted for analysis. Descriptive analyses include the publication year, country, legal quality, and target group addressed. A narrative synthesis will describe the scope and content of the frameworks, guidelines, recommendations, and strategies. The scoping review will serve as a stepping-stone to creating a WFPHA policy resolution on tobacco prevention and cessation framework for women of childbearing age led by the WFPHA Oral Health, Tobacco Control and the Women, Adolescent, and Children's Working Group members. This WFPHA policy resolution 'Maternal Tobacco Cessation and Prevention Recommendations for Primary Care Providers and Dental Providers' will be forwarded to the WFPHA General Council and the General Assembly for approval and will be disseminated to the WFPHA public health association members. Ultimately, this recommendation will be used by each national public health association to consider integrating it into their maternal health strategy.
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Affiliation(s)
- Kiran P. Nagdeo
- Icahn School of Medicine at Mount Sinai, New York City, United States
| | - Hyewon Lee
- Dental Research Institute and School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Wendt J, Scheller DA, Banik A, Luszczynska A, Forberger S, Zeeb H, Scheidmeir M, Kubiak T, Lien N, Meshkovska B, Lobczowska K, Romaniuk P, Neumann-Podczaska A, Wieczorowska-Tobis K, Steinacker JM, Mueller-Stierlin AS. Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour. BMC Public Health 2023; 23:1259. [PMID: 37380979 DOI: 10.1186/s12889-023-15775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/27/2023] [Indexed: 06/30/2023] Open
Abstract
Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.
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Affiliation(s)
- Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Piotr Romaniuk
- Department of Health Policy, Medical University of Silesia, Katowice, Poland
| | | | | | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Annabel S Mueller-Stierlin
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany.
- Department of Psychiatry & Psychotherapy II, Ulm University, Günzburg, Germany.
- Institute for Epidemiology & Medical Biometry, Ulm University, Ulm, Germany.
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Chugh A, Arora M, Jain N, Vidyasagaran A, Readshaw A, Sheikh A, Eckhardt J, Siddiqi K, Chopra M, Mishu MP, Kanaan M, Rahman MA, Mehrotra R, Huque R, Forberger S, Dahanayake S, Khan Z, Boeckmann M, Dogar O. The global impact of tobacco control policies on smokeless tobacco use: a systematic review. Lancet Glob Health 2023; 11:e953-e968. [PMID: 37202029 DOI: 10.1016/s2214-109x(23)00205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/22/2023] [Accepted: 04/18/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Smokeless tobacco, used by more than 300 million people globally, results in substantial morbidity and mortality. For smokeless tobacco control, many countries have adopted policies beyond the WHO Framework Convention on Tobacco Control, which has been instrumental in reducing smoking prevalence. The impact of these policies (within and outside the Framework Convention on Tobacco Control) on smokeless tobacco use remains unclear. We aimed to systematically review policies that are relevant to smokeless tobacco and its context and investigate their impact on smokeless tobacco use. METHODS In this systematic review, we searched 11 electronic databases and grey literature between Jan 1, 2005, and Sept 20, 2021, in English and key south Asian languages, to summarise smokeless tobacco policies and their impact. Inclusion criteria were all types of studies on smokeless tobacco users that mentioned any smokeless tobacco relevant policies since 2005, except systematic reviews. Policies issued by organisations or private institutions were excluded as well as studies on e-cigarettes and Electronic Nicotine Delivery System except where harm reduction or switching were evaluated as a tobacco cessation strategy. Two reviewers independently screened articles, and data were extracted after standardisation. Quality of studies was appraised using the Effective Public Health Practice Project's Quality Assessment Tool. Outcomes for impact assessment included smokeless tobacco prevalence, uptake, cessation, and health effects. Due to substantial heterogeneity in the descriptions of policies and outcomes, data were descriptively and narratively synthesised. This systematic review was registered in PROSPERO (CRD42020191946). FINDINGS 14 317 records were identified, of which 252 eligible studies were included as describing smokeless tobacco policies. 57 countries had policies targeting smokeless tobacco, of which 17 had policies outside the Framework Convention on Tobacco Control for smokeless tobacco (eg, spitting bans). 18 studies evaluated the impact, which were of variable quality (six strong, seven moderate, and five weak) and reported mainly on prevalence of smokeless tobacco use. The body of work evaluating policy initiatives based on the Framework Convention on Tobacco Control found that these initiatives were associated with reductions in smokeless tobacco prevalence of between 4·4% and 30·3% for taxation and 22·2% and 70·9% for multifaceted policies. Two studies evaluating the non-Framework policy of sales bans reported significant reductions in smokeless tobacco sale (6·4%) and use (combined sex 17·6%); one study, however, reported an increased trend in smokeless tobacco use in the youth after a total sales ban, likely due to cross-border smuggling. The one study reporting on cessation found a 13·3% increase in quit attempts in individuals exposed (47·5%) to Framework Convention on Tobacco Control policy: education, communication, training, and public awareness, compared with non-exposed (34·2%). INTERPRETATION Many countries have implemented smokeless tobacco control policies, including those that extend beyond the Framework Convention on Tobacco Control. The available evidence suggests that taxation and multifaceted policy initiatives are associated with meaningful reductions in smokeless tobacco use. FUNDING UK National Institute for Health Research.
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Affiliation(s)
| | - Monika Arora
- HRIDAY, New Delhi, India; Health Promotion Division, Public Health Foundation of India, Gurugram, India.
| | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | | | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Muhammad Aziz Rahman
- Institute of Health and Wellbeing, Federation University Australia, Berwick, VIC, Australia
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK; Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Melanie Boeckmann
- Faculty of Human and Health Sciences, University of Bremen, Breman, Germany
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK; Usher Institute, University of Edinburgh, Edinburgh, UK
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Wendt J, Scheller DA, Flechtner-Mors M, Meshkovska B, Luszczynska A, Lien N, Forberger S, Banik A, Lobczowska K, Steinacker JM. Barriers and facilitators to the adoption of physical activity policies in elementary schools from the perspective of principals: An application of the consolidated framework for implementation research-A cross-sectional study. Front Public Health 2023; 11:935292. [PMID: 36908436 PMCID: PMC9992422 DOI: 10.3389/fpubh.2023.935292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/24/2023] [Indexed: 02/24/2023] Open
Abstract
Background Studies have shown that policies to promote physical activity in schools can have a positive impact on children's physical activity behavior. However, a large research gap exists as to what determinants may influence the adoption of such policies. Applying the Consolidated Framework for Implementation Research (CFIR), we investigated barriers and facilitators to the adoption of physical activity policies in elementary schools in Baden-Wuerttemberg, Germany, from the perspective of school principals. Methods A cross-sectional study was conducted between May and June 2021. School principals from elementary and special needs schools (n = 2,838) were invited to participate in the study. The online questionnaire used was developed based on the CFIR and included questions on school characteristics and constructs of the CFIR domains inner setting, characteristics of individuals, and process. Logistic regression analyses were performed to examine associations between policy adoption and school characteristics as well as CFIR determinants. Results In total, 121 schools (4%) participated in the survey, of which 49 (40.5%) reported having adopted a policy to promote physical activity. Positive associations with policy adoption were found for general willingness among teaching staff [odds ratio (OR): 5.37, 95% confidence interval (CI): 1.92-15.05], available resources (OR: 2.15, 95% CI: 1.18-3.91), access to knowledge and information (OR: 2.11, 95% CI: 1.09-4.09), and stakeholder engagement (OR: 3.47, 95% CI: 1.24-9.75). Conclusions This study provides a first insight into potential barriers and facilitators at the organizational level of schools that may be relevant to the adoption of physical activity policies, from the perspective of school principals. However, due to a low response rate, the results must be interpreted with caution. A strength of this study includes theoretical foundation through the use of the CFIR. The CFIR could be well-adapted to the school setting and provided valuable support for developing the questionnaire and interpreting the study results.
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Affiliation(s)
- Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland.,Melbourne School of Psychological Sciences, Melbourne Centre for Behavior Change, University of Melbourne, Melbourne, VIC, Australia
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, University Hospital Ulm, Ulm, Germany
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Ahmad F, Khan Z, Siddiqi K, Khan MN, Kibria Z, Forberger S, Bauld L, Kanaan M, Zeeb H. Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan. Tob Control 2022; 31:e111-e117. [PMID: 34226260 DOI: 10.1136/tobaccocontrol-2020-056377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales. METHODS We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors. RESULTS Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business. CONCLUSIONS There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Kamran Siddiqi
- Institute of Health Sciences, University of York, UK, York, UK
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zeeshan Kibria
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Linda Bauld
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
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Scheidmeir M, Kubiak T, Luszczynska A, Wendt J, Scheller DA, Meshkovska B, Müller-Stierlin AS, Forberger S, Łobczowska K, Neumann-Podczaska A, Wieczorowska-Tobis K, Zeeb H, Steinacker JM, Woods CB, Lakerveld J. Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes. Eur J Public Health 2022; 32:iv32-iv49. [PMID: 36444105 PMCID: PMC9897019 DOI: 10.1093/eurpub/ckac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents. METHODS A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science). RESULTS Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability. CONCLUSION Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
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Affiliation(s)
- Marie Scheidmeir
- Correspondence: Marie Scheidmeir, Department of Health Psychology, Johannes Gutenberg University, Binger Str. 14-16, 55122 Mainz, Germany, Tel: +49 6131 39 39 132, e-mail:
| | - Thomas Kubiak
- Department of Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Janine Wendt
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences (UiO-PHN), University of Oslo, Oslo, Norway
| | | | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Karolina Łobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland
| | | | | | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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10
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den Braver NR, Garcia Bengoechea E, Messing S, Kelly L, Schoonmade LJ, Volf K, Zukowska J, Gelius P, Forberger S, Woods CB, Lakerveld J. The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens. Eur J Public Health 2022; 32:iv71-iv83. [PMID: 36444108 PMCID: PMC9706123 DOI: 10.1093/eurpub/ckac085] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This review of reviews aimed to: (1) summarize the evidence from published reviews on the effectiveness of mass-media campaigns to promote physical activity (PA) or PA-related determinants (intermediate psychological and proximal outcomes) and (2) to identify policy-relevant recommendations related to successful PA campaigns. METHODS An extensive literature search was performed on 1 March 2021. Reviews that evaluated the impact of campaigns on distal (e.g. PA) and/or proximal outcomes of PA (awareness, knowledge, etc.) and that targeted the general population or subsets were included. Quality of reviews was assessed using the AMSTAR-2 tool. Policy-relevant recommendations were systematically derived and synthesized and formulated as good practice statements. A protocol was registered beforehand (ID: CRD42021249184). RESULTS A total of 1915 studies were identified, of which 22 reviews were included. The most consistent evidence was found for the effectiveness of mass-media campaigns on proximal outcomes, while the evidence for distal outcomes was mixed. Good practice statements were derived: (1) to achieve behaviour change, mass-media is an important component of larger, multilevel and multicomponent strategies; (2) mass-media strategies should be coordinated and aligned at local- and national-level and be sustained, monitored and resourced at these levels and (3) media should be tailored to reduce socioeconomic inequalities. CONCLUSIONS Mass-media can play an important role in the promotion of PA. In general, evidence was more inconsistent for effectiveness on distal outcomes than for proximal outcomes. Policy-relevant recommendations include that mass-media strategies should be resourced, coordinated, aligned, sustained, monitored and evaluated on the local and national level.
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Affiliation(s)
- Nicolette R den Braver
- Correspondence: Nicolette R. den Braver, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institutes, Amsterdam University Medical Centres, De Boelelaan 1089a, 1081HV Amsterdam, The Netherlands, Tel: +31 20 44 430 80, e-mail:
| | - Enrique Garcia Bengoechea
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland,Research and Innovation Unit, Sport Ireland, Ireland
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kevin Volf
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - J Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institutes, Amsterdam University Medical Centres, Amsterdam, The Netherlands,Upstream Team, Amsterdam, The Netherlands
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11
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Stadelmaier J, Rehfuess EA, Forberger S, Eisele-Metzger A, Nagavci B, Schünemann HJ, Meerpohl JJ, Schwingshackl L. Using GRADE Evidence to Decision frameworks to support the process of health policy-making: an example application regarding taxation of sugar-sweetened beverages. Eur J Public Health 2022; 32:iv92-iv100. [PMID: 36444109 PMCID: PMC9706117 DOI: 10.1093/eurpub/ckac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks are well-known tools that enable guideline panels to structure the process of developing recommendations and making decisions in healthcare and public health. To date, they have not regularly been used for health policy-making. This article aims to illustrate the application of the GRADE EtD frameworks in the process of nutrition-related policy-making for a European country. METHODS Based on methodological guidance by the GRADE Working Group and the findings of our recently published scoping review, we illustrate the process of moving from evidence to recommendations, by applying the EtD frameworks to a fictitious example. Sugar-sweetened beverage (SSB) taxation based on energy density was chosen as an example application. RESULTS A fictitious guideline panel was convened by a national nutrition association to develop a population-level recommendation on SSB taxation aiming to reduce the burden of overweight and obesity. Exemplary evidence was summarized for each EtD criterion and conclusions were drawn based on all judgements made in relation to each criterion. As a result of the high priority to reduce the burden of obesity and because of the moderate desirable effects on health outcomes, but considering scarce or varying research evidence for other EtD criteria, the panel made a conditional recommendation for SSB taxation. Decision-makers may opt for conducting a pilot study prior to implementing the policy on a national level. CONCLUSIONS GRADE EtD frameworks can be used by guideline panels to make the process of developing recommendations in the field of health policy more systematic, transparent and comprehensible.
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Affiliation(s)
- Julia Stadelmaier
- Correspondence: Julia Stadelmaier, Institute for Evidence in Medicine, Breisacher Strasse 86, 79110 Freiburg, Germany, Tel: +49 (0)761 203 679 57, e-mail:
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Angelika Eisele-Metzger
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, Canada
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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12
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Woods CB, Kelly L, Volf K, Gelius P, Messing S, Forberger S, Lakerveld J, den Braver NR, Zukowska J, García Bengoechea E. The Physical Activity Environment Policy Index for monitoring government policies and actions to improve physical activity. Eur J Public Health 2022; 32:iv50-iv58. [PMID: 36444111 PMCID: PMC9706113 DOI: 10.1093/eurpub/ckac062] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND A multifaceted response, including government action, is essential to improve population levels of physical activity (PA). This article describes the development process of the 'Physical Activity Environment Policy Index' (PA-EPI) monitoring framework, a tool to assess government policies and actions for creating a healthy PA environment. METHODS An iterative process was undertaken. This involved a review of policy documents from authoritative organizations, a PA policy audit of four European countries, and a systematic review of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops were conducted, where quantitative and qualitative data, alongside theoretical and pragmatic considerations, were used to inform PA-EPI development. RESULTS The PA-EPI is conceptualized as a two-component 'policy' and 'infrastructure support' framework. The two-components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development and health-in-all-policies. Forty-five 'good practice statements' or indicators of ideal good practice within each domain conclude the PA-EPI. A potential eight-step process for conducting the PA-EPI is described. CONCLUSIONS Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI good practice statements will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.
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Affiliation(s)
- Catherine B Woods
- Correspondence: Catherine B. Woods, Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland, Tel: +353 (0) 61 202379, e-mail:
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kevin Volf
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands,Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Nicolette R den Braver
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam, Amsterdam Public Health Research institute, Amsterdam, The Netherlands,Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Enrique García Bengoechea
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland,Research and Innovation Unit, Sport Ireland, Dublin, Ireland
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13
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Kamphuis CBM, Forberger S, Lien N, Rehfuess E, Luszczynska A. Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework. Eur J Public Health 2022; 32:iv3-iv9. [PMID: 36444110 PMCID: PMC9706121 DOI: 10.1093/eurpub/ckac068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The Policy Evaluation Network (PEN) is a multidisciplinary Pan-European research consortium focussing on policies affecting dietary intake, physical activity and sedentary behaviour. At the start, the PEN consortium expressed the need for an overarching, system-based framework covering the complexities between the different domains of the policy process (design, implementation and outcomes) in order to execute all research activities in a coherent way. This article describes the PEN framework itself and its development process. METHODS A staged approach to the development of a system-based framework was executed between February 2019 and February 2022. We started with a point-of-departure framework, made use of existing models, collected PEN outputs at different project stages (through online meetings, e-mail exchanges and workshops with PEN researchers) and drew updated versions of the framework, which resulted in the system-based PEN framework. RESULTS The system-based PEN framework depicts the policy process as a complex system, visualizing the dynamic interrelations between and within policy domains (i.e. policy design, policy implementation and policy outcomes), the ways they interact with the context, and how to assure a focus on equity in each domain. CONCLUSIONS The system-based PEN framework may guide researchers and professionals involved in the evaluation of health- or sustainability-related policies to consider their evaluation in a comprehensive picture, including domain interactions, contextual influences and equity considerations, as these can have important implications for the scope of their research. The stage-based process as applied for the development of the PEN framework can serve as a template for other research projects wishing to develop their own framework.
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Affiliation(s)
- Carlijn B M Kamphuis
- Correspondence: Carlijn B.M. Kamphuis, Department of Interdisciplinary Social Science, Utrecht University, Padualaan 14, 3584 CH, Utrecht, The Netherlands, Tel: +31 (0) 30 253 3489, e-mail:
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Nanna Lien
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Eva Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Aleksandra Luszczynska
- Wroclaw Faculty of Psychology, SWPS University of Social Sciences & Humanities, Wroclaw, Poland
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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14
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Forberger S, Reisch LA, Meshkovska B, Lobczowska K, Scheller DA, Wendt J, Christianson L, Frense J, Steinacker JM, Woods CB, Luszczynska A, Zeeb H. What we know about the actual implementation process of public physical activity policies: results from a scoping review. Eur J Public Health 2022; 32:iv59-iv65. [PMID: 36444100 PMCID: PMC9706118 DOI: 10.1093/eurpub/ckac089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix). METHODS A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included. RESULTS The current evidence includes high-income countries (USA, n = 7; UK, New Zealand and Oman, n = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n = 4), state (n = 1), county (n = 1), school district (n = 1) and city (n = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors. CONCLUSION Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour.
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Affiliation(s)
- Sarah Forberger
- Correspondence: Sarah Forberger, PhD, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstrasse 30, 28359 Bremen, Germany. Tel: +49 421 218 56907, Fax: +49 421 218 56941, e-mail:
| | - Lucia A Reisch
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany,Behavioural Economics and Policy, University of Cambridge, Cambridge, UK
| | - Biljana Meshkovska
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway,Domus Medica, Oslo, Norway
| | - Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Daniel A Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jennifer Frense
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | - Catherine B Woods
- School of Health and Human Performance, Dublin City University, Dublin, Ireland,Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany,Health Sciences Bremen, University of Bremen, Bremen, Germany
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15
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Kelly L, Twohig C, Woods CB, Luszczynska A, Murrin C, Lien N, Meshkovska B, Kamphuis CBM, Poelman MP, Terragani L, Forberger S, Hebestreit A, Ahrens W, Harrington JM. Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network. Eur J Public Health 2022; 32:iv10-iv20. [PMID: 36444104 PMCID: PMC9706120 DOI: 10.1093/eurpub/ckac147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the 'Policy Evaluation Network' (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. METHODS A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. RESULTS Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. 'Outcome' and 'Impact'). A conceptual 'Inter-relations in policy-related concepts' diagram was developed to enable navigation through an online database with key terms. CONCLUSIONS The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages.
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Affiliation(s)
- Liam Kelly
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cliona Twohig
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, CARE-BEH Center for Applied Research on Health Behaviour and Health, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Celine Murrin
- School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin, Ireland
| | - Nanna Lien
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Biljana Meshkovska
- Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Laura Terragani
- Department of Nutrition, Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Janas M Harrington
- Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
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16
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Woods C, Kelly L, Volf K, Gelius P, Messing S, Forberger S, Lakerveld J, den Braver N, Zukowska J. The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment.
Methods
An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development.
Results
The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described.
Conclusions
Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.
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Affiliation(s)
- C Woods
- Physical Activity for Health Research Cluster, University of Limerick , Limerick, Ireland
| | - L Kelly
- Physical Activity for Health Research Cluster, University of Limerick , Limerick, Ireland
| | - K Volf
- Physical Activity for Health Research Cluster, University of Limerick , Limerick, Ireland
| | - P Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen- Nürnberg , Erlangen, Germany
| | - S Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen- Nürnberg , Erlangen, Germany
| | - S Forberger
- Leibniz Institute for Prevention Research and Epidemiology , Bremen, Germany
| | - J Lakerveld
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam , Amsterdam, Netherlands
- Upstream Team, VU University Amsterdam , Amsterdam, Netherlands
| | - N den Braver
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Amsterdam , Amsterdam, Netherlands
- Upstream Team, VU University Amsterdam , Amsterdam, Netherlands
| | - J Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Gdansk, Poland
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17
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Forberger S, Lobczowska K, Banik A, Romaniuk P, Kubiak T, Meshkovska B, Neumann-Podczaska A, Kaczmarek M, Scheidmeir M. Finding the fitting framework for the implementation of policies promoting healthy nutrition and physically active lifestyle: Results from a systematic review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Policies are an important upstream component of health promotion to influence the general population. Various frameworks exist to help implement policies. However, there is currently no overarching synthesis that describes the differences between policy implementation frameworks. In this study, we examined frameworks for implementing policies to promote healthy eating, physical activity and reduce physical inactivity and aimed to explore the scope of the frameworks, the content of the constructs they contain (e.g. processes, determinants, evaluation), the level at which these constructs operate and the inclusion of equity factors.
Methods
A systematic review (PROSPERO registration number: CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analysed.
Results
All three constructs were covered by 18 frameworks: description of the process, determinants and evaluation of implementation. The majority of frameworks (25/38) considered constructs from three levels: the individual, organisational/community and system levels, with system level constructs being included less frequently than individual level or organisational/community level constructs. Most frameworks (32/38) contained sections that were exclusively descriptive. In addition, 19 frameworks contained prescriptive and 23 explanatory sections. The complex systems approach was included in 8 of the frameworks. More than half of the frameworks (21/38) did not consider equity constructs.
Conclusions
Most frameworks have a complex scope, include multi-level constructs, combine sections that are purely descriptive with sections that consider prescriptive and/or explanatory associations, and include few or no equity constructs. The findings of this study can facilitate the process of selecting the framework that best fits the needs and goals of policy makers, researchers and policy implementation actors seeking guidance.
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Affiliation(s)
- S Forberger
- Leibniz Institute for Prevention Research and Epidemiology, BIPS , Bremen, Germany
| | - K Lobczowska
- Psychology Department, SWPS University of Social Sciences and Humanities , Wroclaw, Poland
| | - A Banik
- Psychology Department, SWPS University of Social Sciences and Humanities , Wroclaw, Poland
| | - P Romaniuk
- Department of Health Policy, Medical University of Silesia in Katowice, Bytom, Poland
| | - T Kubiak
- Institute of Psychology, Johannes Gutenberg University Mainz , Mainz, Germany
| | - B Meshkovska
- Department of Nutrition, University of Oslo , Oslo, Norway
| | - A Neumann-Podczaska
- Department of Palliative Medicine, Poznan University of Medical Sciences , Poznan, Poland
| | - M Kaczmarek
- Department of Health Policy, Medical University of Silesia in Katowice, Bytom, Poland
| | - M Scheidmeir
- Institute of Psychology, Johannes Gutenberg University Mainz , Mainz, Germany
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18
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Schüz B, Müllmann S, Pan CC, Jahnel T, Forberger S, Jürgens D, Pedros Barnils N, Gerhardus A. A framework for developing and evaluating digital and public health tools. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
To paraphrase a classic, evaluating digital technologies in health is a bit like eating spinach - no one is against it in principle because it is good for you. However, no one would do it unless being asked to. In recent years, the sheer number of digital health technologies that potentially fulfil public health purposes has increased tremendously. The basis for evaluating such tools for public health purposes however has not met this pace, and in particular frameworks for the systematic development and evaluation of digital technologies in public health are rare. Existing frameworks for digital technologies focus on clinical aspects of digital health applications (e.g., NICE Evidence standards framework for digital health technologies), thus lacking both a population and prevention focus. Generic frameworks such as the Health Technology Assessment (HTA) methodology do not contain items specific to digital technologies and public health purposes. Here, we describe the process of developing a framework specific for the development and evaluation of digital public health technologies based on the core HTA model. We conduct a scoping review of frameworks for the development and the evaluation of technologies in public health and digital health, following PRISMA-SCR guidelines. The identified frameworks are then mapped onto the core HTA model to develop additional items specific for the development and the evaluation of digital technologies in public health. These additional items can be used to integrate the development and evaluation of digital technologies for public health purposes within the wider HTA context, making this process both transferable and scalable.
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Affiliation(s)
- B Schüz
- Institute for Public Health and Nursing Science, University of Bremen , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
| | - S Müllmann
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
- BIPS , Bremen, Germany
| | - C-C Pan
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
- BIPS , Bremen, Germany
| | - T Jahnel
- Institute for Public Health and Nursing Science, University of Bremen , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
| | - S Forberger
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
- BIPS , Bremen, Germany
| | - D Jürgens
- Institute for Public Health and Nursing Science, University of Bremen , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
| | - N Pedros Barnils
- Institute for Public Health and Nursing Science, University of Bremen , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
| | - A Gerhardus
- Institute for Public Health and Nursing Science, University of Bremen , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health B , Bremen, Germany
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Meyer J, Ratz T, Pauls A, Hellmers S, Boll S, Fudickar S, Hein A, Bauer JM, Koppelin F, Lippke S, Peters M, Pischke CR, Voelcker-Rehage C, Zeeb H, Forberger S. Designing and applying technology for prevention-Lessons learned in AEQUIPA and its implications for future research and practice. Front Public Health 2022; 10:832922. [PMID: 36339229 PMCID: PMC9627148 DOI: 10.3389/fpubh.2022.832922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/16/2022] [Indexed: 01/21/2023] Open
Abstract
Almost all Western societies are facing the challenge that their population structure is changing very dynamically. Already in 2019, ten countries had a population share of at least 20 percent in the age group of 64 years and older. Today's society aims to improve population health and help older people live active and independent lives by developing, establishing, and promoting safe and effective interventions. Modern technological approaches offer tremendous opportunities but pose challenges when preventing functional decline. As part of the AEQUIPA Prevention Research Network, the use of technology to promote physical activity in older people over 65 years of age was investigated in different settings and from various interdisciplinary perspectives, including technology development and evaluation for older adults. We present our findings in three main areas: (a) design processes for developing technology interventions, (b) older adults as a user group, and (c) implications for the use of technology in interventions. We find that cross-cutting issues such as time and project management, supervision of participants, ethics, and interdisciplinary collaboration are of vital importance to the success of the work. The lessons learned are discussed based on the experiences gained in the overall AEQUIPA network while building, particularly on the experiences from the AEQUIPA sub-projects TECHNOLOGY and PROMOTE. Our experiences can help researchers of all disciplines, industries, and practices design, study and implement novel technology-based interventions for older adults to avoid pitfalls and create compelling and meaningful solutions.
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Affiliation(s)
- Jochen Meyer
- OFFIS – Institute for Information Technology, Oldenburg, Germany,*Correspondence: Jochen Meyer
| | - Tiara Ratz
- Jacobs University Bremen, Bremen, Germany
| | - Alexander Pauls
- Section Technology and Health for Humans, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
| | - Sandra Hellmers
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University, Oldenburg, Germany
| | - Susanne Boll
- OFFIS – Institute for Information Technology, Oldenburg, Germany
| | - Sebastian Fudickar
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University, Oldenburg, Germany
| | - Andreas Hein
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University, Oldenburg, Germany
| | - Jürgen M. Bauer
- Center for Geriatric Medicine and Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Frauke Koppelin
- Section Technology and Health for Humans, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
| | | | - Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Claudia R. Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Claudia Voelcker-Rehage
- Institute of Sport and Exercise Sciences, University of Muenster, Muenster, Germany,Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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Zeeb H, Brandes M, Bauer U, Forberger S, Gelius P, Muellmann S, Okan O, Pfeifer K, Renner B, Wright M. [Perspective Paper "Future Prevention Research" - Current and Future Coordinated Research on Prevention and Health Promotion]. Gesundheitswesen 2022; 85:388-394. [PMID: 36055281 PMCID: PMC10155309 DOI: 10.1055/a-1816-3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
From 2014 to 2022, the BMBF has funded five research networks in prevention research and health promotion that are also jointly coordinated (Research Network Primary Prevention and Health Promotion, www.fp2g.net). The researchers have produced a large number of relevant research outputs with insights gained into essential aspects of prevention research and health promotion. The networks research focused on basic principles, application-relevant findings, and implementation conditions of long-term prevention and health promotion for non-communicable diseases (NCDs). The constraints imposed by the pandemic from 2020 onwards were partly addressed by integrating Corona-related research and transfer activities. The importance of resilience for dealing with multiple health and social challenges got increased attention and was analyzed and discussed during the pandemic. For prevention research, research questions such as how to better implement prevention measures through digital tools are gaining additional importance. Together, the research networks have presented achievements and desiderata for future research. This perspective paper with its nine theses formulated in conclusion is intended as a stimulus for discussion among funders as well as the communty of researchers on the subject of successful prevention and health promotion. It is explicitly part of the continuity of the memoranda on prevention research developed in 2012.
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Affiliation(s)
- Hajo Zeeb
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany.,Health Sciences Bremen, Universität Bremen, Bremen, Germany
| | - Mirko Brandes
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
| | - Ullrich Bauer
- Fakultät für Erziehungswissenschaft, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Universität Bielefeld, Bielefeld, Germany
| | - Sarah Forberger
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
| | - Peter Gelius
- Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Saskia Muellmann
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
| | - Orkan Okan
- Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, München, Germany
| | - Klaus Pfeifer
- Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Britta Renner
- Fachbereich Psychologie, AG Psychologische Diagnostik und Gesundheitspsychologie, Universität Konstanz, Konstanz, Germany
| | - Michael Wright
- Institut für Soziale Gesundheit, Katholische Hochschule fur Sozialwesen Berlin, Berlin, Germany
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21
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Woods CB, Kelly L, Volf K, Gelius P, Messing S, Forberger S, Lakerveld J, den Braver NR, Zukowska J, Bengoechea EG. S09-4 The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity. Eur J Public Health 2022. [PMCID: PMC9435359 DOI: 10.1093/eurpub/ckac093.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Insufficient physical activity (PA) is a global issue for health. A multifaceted response, including government action, is essential to improve population levels of PA. The purpose of this study was to develop the ‘Physical Activity Environment Policy Index’ (PA-EPI) monitoring framework to assess government policies and actions for creating a healthy PA environment. Methods An iterative process was undertaken. This involved a review of policy documents from authoritative organisations, a policy audit of four European countries, and systematic reviews of scientific literature. This was followed by an online consultation with academic experts (N = 101; 20 countries, 72% response rate), and policymakers (N = 40, 4 EU countries). During this process, consensus workshops where quantitative and qualitative data alongside theoretical and pragmatic considerations were used to inform PA-EPI development. Results The PA-EPI is conceptualised as a two-component ‘policy’ and ‘infrastructure support’ framework. The two components comprise eight policy and seven infrastructure support domains. The policy domains are education, transport, urban design, healthcare, public education (including mass media), sport-for-all, workplaces and community. The infrastructure support domains are leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development, and health-in-all-policies. Forty-five ‘good practice statements’ (GPS) or indicators of ideal good practice within each domain concludes the PA-EPI. A potential eight-step process for conducting the PA-EPI is described. Conclusions Once pre-tested and piloted in several countries of various sizes and income levels, the PA-EPI GPS will evolve into benchmarks established by governments at the forefront of creating and implementing policies to address inactivity.
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Affiliation(s)
- Catherine B Woods
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Liam Kelly
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Kevin Volf
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , 91058 Erlangen, Germany
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , 91058 Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS , 28359 Bremen, Germany
| | - Jeroen Lakerveld
- Amsterdam UMC, VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research institute , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
- Upstream Team , www.upstreamteam.nl . Amsterdam UMC, VU University Amsterdam, De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
| | - Nicolette R den Braver
- Amsterdam UMC, VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research institute , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
- Upstream Team , www.upstreamteam.nl . Amsterdam UMC, VU University Amsterdam, De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Gdansk 80-213, Poland
| | - Enrique García Bengoechea
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
- Research and Innovation Unit , Sport Ireland, Dublin, Ireland
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Woods C, Zukowska J, Forberger S, Garcia E, Gelius P, Gobis A, Kelly L, Krajewski P, Lakerveld J, Messing S, denBraver N, Volf K. S09 Insights into the development of the physical activity environment policy index, a tool for benchmarking implementation of public policies to create healthy physical activity policy environments. Eur J Public Health 2022. [PMCID: PMC9421901 DOI: 10.1093/eurpub/ckac093.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The UN Sustainable Development Goals' (https://sustainabledevelopment.un.org/) and the Global Action Plan on Physical Activity (https://www.who.int/ncds/prevention/physical-activity/gappa) highlight the need to move beyond individual behaviour change to broader policy and system approaches, focusing not only on health but also on sustainability. Recently, policy responses to the epidemics of physical inactivity and sedentary behaviour have grown. The Global Observatory for Physical Activity (GoPA) reports that by 2013, 139 countries were members of its physical activity advocacy alliance and 26.6% of these countries had already published a stand-alone physical activity plan. The ‘Policy Evaluation Network' is a multi-disciplinary European research network aimed at understanding the impact of public policy for promoting healthy lifestyles in an effort to prevent non-communicable disease. To understand the progress governments are making in creating healthy policy environments, the benchmarking of best practice has proven effective for advancing the food policy agenda; however its usefulness for physical activity requires evaluation. Individual country results promote mutual learning between countries. This symposium will take a deep look at public policy in physical activity. It will summarise evidence from systematic literature reviews and present a tool for benchmarking progress. It will also discuss the potential next steps for addressing the inactivity, obesity and climate challenges through policy solutions in a systematic way. The Chair will give an overview of context within which this symposium takes place e.g. GAPPA, Policy developments etc. They will also explain the symposium's purpose and objectives, introduce the speakers and direct questions.
Symposium Objectives
1. To review evidence for the contribution of transport, sport and mass media policy to the promotion of physical activity. 2. To show how evidence generate in each of these reviews contributed to the development of the physical activity environment policy index (PA-EPI). 3. To discuss the next steps for addressing inactivity by using policy intervention as a tool to catalyse change. Abstract 1: Which transport policies increase physical activity of the whole of society? A Systematic Review. Abstract 2: The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens. Abstract 3: Evidence of the impact of Sport Policies on physical activity and sport participation: A Systematic Mixed Studies Review. Abstract 4: The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity. The Discussant summarizes the presentations and provides insights on the specific topic area, generating an interactive discussion with the audience for at least 15 minutes, moderated by the Chair. (15 minutes) Conclusions: Some discussion of the possible contribution to, or implications for, the advancement of HEPA related goals.
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Affiliation(s)
- Catherine Woods
- Physical Activity for Health Research Cluster, Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Joanna Zukowska
- Faculty of Civil and Environmenatl Engineering, Gdansk University of Technology , Poland, Gdansk, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Leibniz Institute for Prevention Research and Epidemiology, BIPS , Germany, Bremen, Germany
| | - Enrique Garcia
- Physical Activity for Health Research Cluster, Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
- Sport Ireland, Sport Ireland, The Courtyard, Blanchardstown , Dublin, Dublin, Ireland
| | - Peter Gelius
- Friedrich-Alexander-Universitat, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen, Germany, Erlangen, Germany
| | - Anna Gobis
- Faculty of Civil and Environmenatl Engineering, Gdansk University of Technology , Poland, Gdansk, Poland
| | - Liam Kelly
- Physical Activity for Health Research Cluster, Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Piotr Krajewski
- Faculty of Civil and Environmenatl Engineering, Gdansk University of Technology , Poland, Gdansk, Poland
| | - Jeroen Lakerveld
- VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health research institute , De Boelelaan 1089a, Amsterdam, the Netherlands., Amsterdam, The Netherlands
| | - Sven Messing
- Friedrich-Alexander-Universitat, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen, Germany, Erlangen, Germany
| | - Nicole denBraver
- VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health research institute , De Boelelaan 1089a, Amsterdam, the Netherlands., Amsterdam, The Netherlands
| | - Kevin Volf
- Physical Activity for Health Research Cluster, Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
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23
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den Braver NR, Bengoechea EG, Messing S, Kelly L, Schoonmade LJ, Volf K, Zukowska J, Gelius P, Forberger S, Woods C, Lakerveld J. S09-2 The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens. Eur J Public Health 2022. [PMCID: PMC9435356 DOI: 10.1093/eurpub/ckac093.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
This review of reviews aims to summarize the evidence from published reviews on the effectiveness of mass-media campaigns to promote physical activity (PA), or PA-related determinants, and identify policy-relevant recommendations related to successful PA campaigns.
Methods
An extensive literature search was performed on March 1st, 2021. Reviews that evaluated the impact of campaigns on distal (e.g., PA) and/or proximal outcomes of PA (awareness, knowledge etc.) and that targeted the general population or subsets were included. Quality of reviews was assessed using the AMSTAR-2 tool. Policy-relevant recommendations were systematically derived and synthesized, and formulated as good practice statements. A protocol was registered beforehand (ID: CRD42021249184).
Results
A total of 1,915 studies were identified, of which 22 reviews were included. Results indicate that the most consistent evidence was found for the effectiveness of mass-media campaigns on proximal outcomes, while the evidence for distal outcomes was mixed. Good practice statements were derived: 1) to achieve behaviour change, mass-media is an important component of larger, multilevel, and multicomponent strategies, 2) mass-media strategies should be coordinated and aligned at local- and national-level, and be sustained, monitored and resourced at these levels, 3) media should be tailored to reduce socioeconomic inequalities.
Conclusions
Mass-media can play an important role in the promotion of PA. In general, evidence was more inconsistent for effectiveness on distal outcomes than for proximal outcomes. The policy-relevant recommendations identified will serve to inform the PA environment policy index (PA-EPI), a tool for monitoring, evaluating and benchmarking government progress in implementing public policies.
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Affiliation(s)
- Nicolette R den Braver
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institutes, Amsterdam University Medical Centres , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
- Upstream Team , www.upstreamteam.nl , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
| | - Enrique Garcia Bengoechea
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
- Research & Innovation Unit , Sport Ireland, Ireland
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , Gebbertstr. 123b, 91058 Erlangen, Germany
| | - Liam Kelly
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Linda J Schoonmade
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , Gebbertstr. 123b, 91058 Erlangen, Germany
| | - Kevin Volf
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Narutowicza 11, Gdansk 80-233, Poland
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , Gebbertstr. 123b, 91058 Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen , Germany
| | - Catherine Woods
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick , Limerick, Ireland
| | - J Lakerveld
- Department of Epidemiology & Data Science, Amsterdam Public Health Research Institutes, Amsterdam University Medical Centres , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
- Upstream Team , www.upstreamteam.nl , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
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Zukowska J, Gobis A, Krajewski P, Morawiak A, Okraszewska R, Woods CB, Volf K, Kelly L, Gelius P, Messing S, Forberger S, Lakerveld J, Bengoechea EG. S09-1 Which transport policies increase physical activity of the whole of society? A Systematic Review. Eur J Public Health 2022. [PMCID: PMC9421807 DOI: 10.1093/eurpub/ckac093.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There is strong evidence of the links between car-dependence and the global physical inactivity epidemic. If eliminated, physical inactivity would remove between 6% and 10% of major non-communicable diseases that are the leading cause of death globally, killing 38 million people each year. Research consistently shows that unlike passive transport (e.g. driving a car), active transport (i.e., walking, cycling) is associated with higher total daily physical activity (PA). While there are public policies that support PA in transport and, as a result, overall PA levels, the specific quantitative effect of such policies on PA behaviour has not been sufficiently investigated. The aim of this systematic review is to determine the level and type of evidence for policies in the area of transport that contribute to higher PA levels of society at large. Methods Six databases (MEDLINE (Ebsco), SportDiscus, Cinahl, Cochrane library, Web of Science, and Scopus) were searched for key concepts of policy, transport, evaluation and PA. Methodological quality was assessed using standardised tools. The strength of the evidence of policy impact was described based on pre-determined categories of positive, negative, inconclusive or untested. Results 17 of 2,549 studies were included in the data synthesis. The authors identified three main transport policy areas with 60 individual policy actions that had a direct or indirect effect on PA. The policy areas were: convenient transport infrastructure development, active travel promotion and shift of transport mode. These areas correspond to Haddon's methodological approach of the transport system division in to three elements (human, vehicle, road). More than half of the policy actions identified (53%) had a positive effect on PA. Study quality ratings were moderate to good. Conclusions PA levels can be increased by implementing policies that provide convenient, safe, and connected walking and cycling infrastructures, promote active travel and give strong support to public transport. There is also clear evidence that active travel policies work best when implemented in a comprehensive way (very often as a combination of several policies). This may include infrastructure and facility improvements as well as educational programmes to achieve substantial shifts towards active modes of travel.
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Affiliation(s)
- Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Poland
| | - Anna Gobis
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Poland
| | - Piotr Krajewski
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Poland
| | - Agnieszka Morawiak
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Poland
| | - Romanika Okraszewska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Poland
| | - Catherine B Woods
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick
| | - Kevin Volf
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick
| | - Liam Kelly
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen , Germany
| | - Jeroen Lakerveld
- Amsterdam UMC, VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health research institute , De Boelelaan 1089a, Amsterdam, the Netherlands
- Upstream Team , www.upstreamteam.nl , Amsterdam UMC, VU University Amsterdam, De Boelelaan 1089a, Amsterdam, the Netherlands
| | - Enrique García Bengoechea
- Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick
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Volf K, Kelly L, Bengoechea EG, Casey B, Gelius P, Messing S, Forberger S, Lakerveld J, Den Braver NR, Zukowska J, Woods C. S09-3 Evidence of the impact of Sport Policies on physical activity and sport participation: A Systematic Mixed Studies Review. Eur J Public Health 2022. [PMCID: PMC9435366 DOI: 10.1093/eurpub/ckac093.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Sport is recognised as a potential public health intervention through its influence on physical activity (PA) levels and consequent health benefits. International policy actors such as the Council of Europe, the World Health Organisation and the International Society for Physical Activity and Health have recommended that sport for all is promoted both for public health and as a basic right. Purpose: This review aims to provide evidence to support the development of policies aimed at maximising the opportunity to participate in PA and sporting activity. Methods We systematically searched six electronic databases for quantitative, qualitative, and review studies investigating how public sport policy affects PA and sport participation outcomes”. The scientific literature was screened according to predetermined eligibility criteria. Following study selection and data extraction, the quality was assessed using modified versions of existing quality assessment tools. Results were synthesised narratively. Results Database searches identified 3705 unique articles. A total of 93 full-text articles were assessed, with 31 meeting our inclusion criteria. Fourteen unique policy actions were identified and were categorised into the policy areas Build Sport Facilities, Reduce Financial Barriers, Build Capacity and Establish Partnerships with Sport Sector, and Promote Public Interest in Sports. Conclusions Policy actions to promote physical activity and sport participation have demonstrated qualified success but there is limited evidence of success in reaching hard to reach groups. Therefore, policymakers utilising sport to increase physical activity should treat it as a complementary intervention alongside other policy actions based on a systems perspective.
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Affiliation(s)
- Kevin Volf
- Department of Physical Education and Sport Sciences, University of Limerick
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, University of Limerick
| | - Enrique García Bengoechea
- Department of Physical Education and Sport Sciences, University of Limerick
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick
- Research & Innovation Unit , Sport Ireland, Dublin, Ireland
| | - Bláthín Casey
- Department of Physical Education and Sport Sciences, University of Limerick
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick
| | - Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , 91058 Erlangen, Germany
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg , 91058 Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, 28359 Bremen , Germany
| | - Jeroen Lakerveld
- Amsterdam UMC, VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
- Upstream Team , www.upstreamteam.nl , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
| | - Nicolette R Den Braver
- Amsterdam UMC, VU University Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
- Upstream Team , www.upstreamteam.nl , De Boelelaan 1089a, Amsterdam 1081 HV, The Netherlands
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology , Narutowicza 11, Gdansk 80-233, Poland
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, University of Limerick
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick
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Forberger S, Khan Z, Ahmad F, Ahmed F, Frense J, Kampfmann T, Ullah S, Dogar O, Siddiqi K, Zeeb H. Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated? Nicotine Tob Res 2022; 24:1344-1354. [PMID: 35428887 DOI: 10.1093/ntr/ntac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. METHODS Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). RESULTS Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. CONCLUSIONS There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. IMPLICATION Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.
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Affiliation(s)
- Sarah Forberger
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Z Khan
- Office of Research, Innovation, and Commercialization (ORIC), Khyber Medical University, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - F Ahmad
- Faculty Institute of Public Health & Social Sciences, Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa 25100, Pakistan
| | - F Ahmed
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - J Frense
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - T Kampfmann
- Institute for Ethics and Transdisciplinary Sustainability Research, Leuphana University Universitätsallee 1, 21335 Lüneburg, Germany
| | - S Ullah
- Office of Research Innovation and Commercialization, Khyber Medical University Peshawar; Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - O Dogar
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Usher Institute, The University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YLUK
| | - K Siddiqi
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK
| | - H Zeeb
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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27
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Ochterbeck D, Forberger S. Is a brain-based understanding of addiction predominant? An assessment of addiction researchers' conceptions of addiction and their evaluation of brain-based explanations. Drug Alcohol Rev 2022; 41:1630-1641. [PMID: 35915578 DOI: 10.1111/dar.13520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Brain-based explanations of addiction have become a prominent explanatory model in recent decades. Although opposing views have been published, there is no large-scale study of researchers' opinions, unlike for treatment staff, the public and affected individuals. Therefore, this study aimed to examine international addiction researchers' perspectives on: (i) brain-based explanations of addiction; (ii) the perceived dominance of the concept in science, society, treatment and among those affected; and (iii) researchers' general conception of addiction in terms of ontologies and causes. METHODS A sample of 1440 international addiction researchers was compiled. Views were assessed online via LimeSurvey using a 'mixed methods light' approach (Likert-type scales, free-text fields). Qualitative content analyses of free-text comments complemented descriptive statistics. RESULTS One hundred and ninety researchers participated (13.19% response). The classification of substance use disorders as brain diseases/disorders was shared by about 60% of the respondents. Approximately 80% considered it the dominant view in science, but fewer in treatment, society and affected persons. Approximately 75% found it an oversimplification, but regarded it as helpful for understanding substance use disorders. Altogether, various biological, psychological and social factors were considered causal. Comments indicated that an over-simplistic nature of brain-based explanations of addiction was viewed as particularly problematic. DISCUSSION AND CONCLUSIONS A rejection of a simplistic view of addiction in favour of a multi-causal concept in which the brain plays a role seems to be the majority view of participating researchers. Therefore, the orientation of future research, treatment and support for addicted persons need to be reconsidered accordingly.
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Affiliation(s)
- Doris Ochterbeck
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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28
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Lobczowska K, Banik A, Forberger S, Kaczmarek K, Kubiak T, Neumann-Podczaska A, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Bekker MPM, Zeeb H, Luszczynska A. Social, economic, political, and geographical context that counts: meta-review of implementation determinants for policies promoting healthy diet and physical activity. BMC Public Health 2022; 22:1055. [PMID: 35619065 PMCID: PMC9137101 DOI: 10.1186/s12889-022-13340-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background This meta-review investigated the context-related implementation determinants from seven domains (geographical, epidemiological, sociocultural, economic, ethics-related, political, and legal) that were systematically indicated as occurring during the implementation of obesity prevention policies targeting a healthy diet and a physically active lifestyle. Methods Data from nine databases and documentation of nine major stakeholders were searched for the purpose of this preregistered meta-review (#CRD42019133341). Context-related determinants were considered strongly supported if they were indicated in ≥60% of the reviews/stakeholder documents. The ROBIS tool and the Methodological Quality Checklist-SP were used to assess the quality-related risk of bias. Results Published reviews (k = 25) and stakeholder documents that reviewed the evidence of policy implementation (k = 17) were included. Across documents, the following six determinants from three context domains received strong support: economic resources at the macro (66.7% of analyzed documents) and meso/micro levels (71.4%); sociocultural context determinants at the meso/micro level, references to knowledge/beliefs/abilities of target groups (69.0%) and implementers (73.8%); political context determinants (interrelated policies supported in 71.4% of analyzed reviews/documents; policies within organizations, 69.0%). Conclusions These findings indicate that sociocultural, economic, and political contexts need to be accounted for when formulating plans for the implementation of a healthy diet and physical activity/sedentary behavior policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13340-4.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Krzysztof Kaczmarek
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Agnieszka Neumann-Podczaska
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14; D89075, Ulm, Germany
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, bode 60, 6700 EW, Wageningen, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland. .,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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29
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Forberger S, Reisch L, Meshkovska B, Lobczowska K, Scheller DA, Wendt J, Christianson L, Frense J, Steinacker JM, Luszczynska A, Zeeb H. Sugar-sweetened beverage tax implementation processes: results of a scoping review. Health Res Policy Syst 2022; 20:33. [PMID: 35331245 PMCID: PMC8944035 DOI: 10.1186/s12961-022-00832-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Taxing sugar-sweetened beverages (SSB) is seen as a win–win situation for governments. It is argued that SSB taxes are relatively easy to implement from a practical perspective compared to for example other nutrition policies. However, the implementation of SSB taxation laws does not happen by itself. Therefore, this work examines implementation processes for SSB taxation in terms of (1) pre-implementation context, (2) taxation instruments used and (3) interactions in the implementation process. Ten databases and grey literature were systematically searched for studies reporting on SSB taxation implementation processes up to February 2020. All studies (N = 1248) were screened independently by two reviewers according to predefined criteria. The selection of variables to be extracted was based on the policy cycle heuristic and informed by intervention implementation research. Information on the process of implementing SSB taxation is limited. Only six cases based on three publications were identified, indicating a gap in this research area. SSB taxation implementation was accomplished by hiring a subcontractor for the implementation or using pre-existing tax collection structures. Political and public support within the implementation process seems to be supportive for the city of Berkeley and for Portugal but was not reported for the Pacific Islands. However, the existing data are very limited, and further research on SSB taxation implementation processes is needed to determine whether the aim of the policy and the envisaged outcome are linked in practice.
Registration The protocol was registered with the Open Science Framework (OSF) (osf.io/7w84q/)
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Affiliation(s)
- Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Lucia Reisch
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.,El-Erian Professor of Behavioural Economics and Policy, University of Cambridge, Cambridge, CB3 9ET, United Kingdom
| | - Biljana Meshkovska
- Institute of Basic Medical Sciences, University of Oslo, Domus Medica, Gaustad, Sognsvannsveien 9, 2. etg., 0372, Oslo, Norway
| | - Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, 53238, Wroclaw, Poland
| | - Daniel Alexander Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jennifer Frense
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Jürgen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II, Ulm University Medical Center, Leimgrubenweg 14, 89075, Ulm, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, 53238, Wroclaw, Poland.,National Institute for Human Resilience, University of Colorado at Colorado Springs, 1420 Austin Bluffs Pkwy, CO Springs, CO, 80918, United States of America
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstraße 30, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bibliothekstr.1, 28359, Bremen, Germany
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30
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Lobczowska K, Banik A, Romaniuk P, Forberger S, Kubiak T, Meshkovska B, Neumann-Podczaska A, Kaczmarek K, Scheidmeir M, Wendt J, Scheller DA, Wieczorowska-Tobis K, Steinacker JM, Zeeb H, Luszczynska A. Frameworks for implementation of policies promoting healthy nutrition and physically active lifestyle: systematic review. Int J Behav Nutr Phys Act 2022; 19:16. [PMID: 35151330 PMCID: PMC8841124 DOI: 10.1186/s12966-021-01242-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/23/2021] [Indexed: 12/21/2022] Open
Abstract
Abstract
Background
Policy frameworks focusing on policy implementation may vary in terms of their scope, included constructs, relationships between the constructs, and context factors. Although multiple policy implementation frameworks exist, the overarching synthesis characterizing differences between the frameworks is missing. This study investigated frameworks guiding implementation of policies aiming at healthy nutrition, physical activity promotion, and a reduction of sedentary behavior. In particular, we aimed at examining the scope of the frameworks and the content of included constructs (e.g., referring to implementation processes, determinants, or implementation evaluation), the level at which these constructs operate (e.g., the individual level, the organizational/community level), relationships between the constructs, and the inclusion of equity factors.
Methods
A systematic review (the PROSPERO registration no. CRD42019133251) was conducted using 9 databases and 8 stakeholder websites. The content of 38 policy implementation frameworks was coded and analyzed.
Results
Across the frameworks, 47.4% (18 in 38) addressed three aims: description of the process, determinants, and the evaluation of implementation. The majority of frameworks (65.8%; 25 in 38) accounted for constructs from three levels: individual, organizational/community, and the system level. System-level constructs were included less often (76.3%; 29 in 38) than individual-level or organizational/community-level constructs (86.8% [33 in 38 frameworks] and 94.7% [36 in 38 frameworks] respectively). The majority of frameworks (84.2%, 32 in 38) included at least some sections that were solely of descriptive character (a list of unassociated constructs); 50.0% (19 in 38) included sections of prescriptive character (general steps of implementation); 60.5% (23 in 38) accounted for explanatory sections (assuming bi- or uni-directorial associations). The complex system approach was accounted for only in 21.1% (8 in 38) of frameworks. More than half (55.3%; 21 in 38) of frameworks did not account for any equity constructs (e.g., socioeconomic status, culture).
Conclusions
The majority of policy implementation frameworks have two or three aims (combining processes, determinants and/or the evaluation of implementation), include multi-level constructs (although the system-level determinants are less frequently included than those from the individual- or organizational/community-level), combine sections of purely descriptive character with sections accounting for prescriptive and/or explanatory associations, and are likely to include a little or no equity constructs.
Registration
PROSPERO, #CRD42019133251.
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Forberger S, Wichmann F, Comito CN. Nudges used to promote physical activity and to reduce sedentary behaviour in the workplace: Results of a scoping review. Prev Med 2022; 155:106922. [PMID: 34933021 DOI: 10.1016/j.ypmed.2021.106922] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 12/01/2021] [Accepted: 12/13/2021] [Indexed: 12/17/2022]
Abstract
Physical inactivity is one of the most important risk factors for non-communicable diseases. Workplace health promotion is therefore of growing interest to support an active day using nudges. The scoping review aims to (a) analyse how frequently nudges are applied in workplace health promotion to increase physical activity and/or reduce sedentary behaviour, and (b) characterise the nudges used. A systematic database search was conducted for the period 2009 to June 2020. According to predefined inclusion and exclusion criteria, studies promoting physical activity and/or reducing sedentary behaviour using nudges were included. Nudges were classified according to MINDSPACE and TIPPME. A study protocol was previously published. Of the 256 studies identified, 26 used nudges. Most studies were conducted in Europe (n = 12) and the USA (n = 8). N = 18 studies targeted physical activity and n = 8 studies targeted sedentary behaviour. In most studies promoting physical activity, prompts were given to climb stairs (n = 11). Interventions targeting sedentary behaviour were more diverse, using digital interventions or mixed approaches (n = 8). Although nudges can help increase physical activity and reduce sedentary behaviour, there are still gaps in terms of their effective and efficient use. There is a lack of long-term studies that analyse habituation and behavioural changes beyond the intervention period. In addition, the potential of digital and mixed approaches is not yet fully exploited. Further studies from low- and middle-income countries with different climates and working conditions are needed to investigate the feasibility of approaches and advance the fight against physical inactivity.
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Affiliation(s)
- Sarah Forberger
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Frauke Wichmann
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | - Chiara Nicoletta Comito
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
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32
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Volf K, Kelly L, García Bengoechea E, Casey B, Gobis A, Lakerveld J, Zukowska J, Gelius P, Messing S, Forberger S, Woods C. Policy Evaluation Network (PEN): Protocol for systematic literature reviews examining the evidence for impact of policies on physical activity across seven different policy domains. HRB Open Res 2022; 3:62. [PMID: 34805740 PMCID: PMC8567685 DOI: 10.12688/hrbopenres.13089.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown. The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap. Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria. Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA. Registration: PROSPERO CRD42020156630 (10/07/2020).
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Affiliation(s)
- Kevin Volf
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Kelly
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bláthín Casey
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Gobis
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | | | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Catherine Woods
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Policy Evaluation Network (PEN) Consortium
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
- Amsterdam University Medical Center, Amsterdam, The Netherlands
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Lobczowska K, Banik A, Brukalo K, Forberger S, Kubiak T, Romaniuk P, Scheidmeir M, Scheller DA, Steinacker JM, Wendt J, Wieczorowska-Tobis K, Bekker MPM, Zeeb H, Luszczynska A. Meta-review of implementation determinants for policies promoting healthy diet and physically active lifestyle: application of the Consolidated Framework for Implementation Research. Implement Sci 2022; 17:2. [PMID: 34991624 PMCID: PMC8734337 DOI: 10.1186/s13012-021-01176-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although multiple systematic reviews indicate that various determinants (barriers and facilitators) occur in the implementation processes of policies promoting healthy diet, physical activity (PA), and sedentary behavior (SB) reduction, the overarching synthesis of such reviews is missing. Applying the Consolidated Framework for Implementation Research (CFIR), this meta-review aims to (1) identify determinants that were systematically indicated as occurring during the implementation processes and (2) identify differences in the presence of determinants across reviews versus stakeholder documents on healthy diet/PA/SB policies, reviews/stakeholder documents addressing healthy diet policies versus PA/SB policies targeting any population/setting, and healthy diet/PA/SB policies focusing on school settings. METHODS A meta-review of published systematic scoping or realist reviews (k = 25) and stakeholder documents (k = 17) was conducted. Data from nine bibliographic databases and documentation of nine major stakeholders were systematically searched. Included reviews (72%) and stakeholder documents (100%) provided qualitative synthesis of original research on implementation determinants of policies promoting healthy diet or PA or SB reduction, and 28% of reviews provided some quantitative synthesis. Determinants were considered strongly supported if they were indicated by ≥ 60.0% of included reviews/stakeholder documents. RESULTS Across the 26 CFIR-based implementation determinants, seven were supported by 66.7-76.2% of reviews/stakeholder documents. These determinants were cost, networking with other organizations/communities, external policies, structural characteristics of the setting, implementation climate, readiness for implementation, and knowledge/beliefs of involved individuals. Most frequently, published reviews provided support for inner setting and individual determinants, whereas stakeholder documents supported outer and inner setting implementation determinants. Comparisons between policies promoting healthy diet with PA/SB policies revealed shared support for only three implementation determinants: cost, implementation climate, and knowledge/beliefs. In the case of healthy diet/PA/SB policies targeting school settings, 14 out of 26 implementation determinants were strongly supported. CONCLUSIONS The strongly supported (i.e., systematically indicated) determinants may guide policymakers and researchers who need to prioritize potential implementation determinants when planning and monitoring the implementation of respective policies. Future research should quantitatively assess the importance or role of determinants and test investigate associations between determinants and progress of implementation processes. TRIAL REGISTRATION PROSPERO, # CRD42019133341.
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Affiliation(s)
- Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Anna Banik
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland
| | - Katarzyna Brukalo
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Thomas Kubiak
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Piotr Romaniuk
- Department of Health Policy, School of Health Sciences in Bytom, Medical University of Silesia in Katowice, 18 Piekarska Street, PL41902, Bytom, Poland
| | - Marie Scheidmeir
- Johannes Gutenberg University Mainz, Institute of Psychology, Binger Street 14-16, D55122, Mainz, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Juergen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Leimgrubenweg 14, D89075, Ulm, Germany
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, Russa Street 55, PL61245, Poznan, Poland
| | - Marleen P M Bekker
- Wageningen University and Research, Health and Society Group, Center for Space, Place and Society, P.O. Box 8130, Bode 60, 6700 EW, Wageningen, the Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achter Street 30, D28359, Bremen, Germany
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Ostrowskiego Street 30b, PL53238, Wroclaw, Poland.
- Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville Campus, Melbourne, VIC, 3010, Australia.
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Messing S, Forberger S, Woods C, Abu-Omar K, Gelius P. [Policies to promote physical activity in Germany : An analysis based on a policy audit tool from the World Health Organization]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:107-115. [PMID: 34448901 PMCID: PMC8732938 DOI: 10.1007/s00103-021-03403-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/02/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Physical inactivity is a key determinant of noncommunicable diseases. Therefore, the World Health Organization (WHO) as well as researchers worldwide have developed different tools to monitor and audit policies to promote physical activity. However, these tools have so far not been used to systematically collect and analyse data on physical activity promoting policies in Germany. AIM This study aims to provide a systematic overview of policies to promote physical activity in Germany. METHODS The study was conducted as part of the Policy Evaluation Network ( www.jpi-pen.eu ). Data from the European Union Physical Activity Monitoring Framework, desk research, and an expert survey were utilised and collected with the WHO's health-enhancing physical activity (HEPA) policy audit tool (PAT). RESULTS The results highlight the wide range of relevant stakeholders and provide an overview of current policies as well as surveillance, evaluation, and funding. Significant accomplishments and persistent challenges are identified. DISCUSSION An international comparison shows that, in contrast to Germany, other countries have formulated measurable goals for physical activity promotion on a national level. However, Germany is among a minority of countries with specific physical activity recommendations for adults with noncommunicable diseases. Further structural development of physical activity promotion in Germany is necessary.
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Affiliation(s)
- Sven Messing
- Department für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstraße 123 b, 91058, Erlangen, Deutschland.
| | - Sarah Forberger
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland
| | | | - Karim Abu-Omar
- Department für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstraße 123 b, 91058, Erlangen, Deutschland
| | - Peter Gelius
- Department für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Gebbertstraße 123 b, 91058, Erlangen, Deutschland
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Forberger S, Zeeb H. AEQUIPA – Physical Activity And Health EQUITY: Primary Prevention For Healthy Aging. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Forberger
- Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie – BIPS
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Ahmad F, Boeckmann M, Khan Z, Zeeb H, Khan MN, Ullah S, Dreger S, Haq ZU, Forberger S. Implementing smokeless tobacco control policy in Pakistan: a qualitative study among Naswar supply chain actors. Tob Control 2021; 30:548-552. [PMID: 32817262 PMCID: PMC8394737 DOI: 10.1136/tobaccocontrol-2020-055748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To obtain insights into the perceptions of barriers and facilitators to implementation of the WHO Framework Convention on Tobacco Control (FCTC) among smokeless tobacco (SLT) supply chain actors in the Khyber Pakhtunkhwa province of Pakistan. METHODS We conducted a qualitative study to investigate the perceptions about SLT control policy formulation and implementation among exclusive Naswar sellers and point of sale vendors. We conducted five focus group discussions in three districts of Khyber Pakhtunkhwa using combined deductive-inductive thematic analyses. RESULTS We identified three central themes that potentially impact policy formulation, its implementation and application. The first theme examines the role of children in the Naswar business: as potential customers, and as potential heirs to a Naswar-selling business. A second theme targets the 'business of Naswar', which includes a specific identity of Naswar sellers, its potential to generate profits and the special case of Naswar regulation as a socially accepted and culturally rooted product. The third theme addresses the unusual ingredients of Naswar and its production process, making Naswar a health risk for consumers and producers. We also report conflicting views regarding SLT control among the supply chain actors. CONCLUSIONS This study provides insights into the perceptions of important SLT supply-side stakeholders regarding various SLT control policy options based on the FCTC. While there is some opposition to policy approaches like taxation and switching of business, implementing a ban on selling SLT to minors may be a viable option for policymakers in the short term.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
- School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Melanie Boeckmann
- School of Public Health, University of Bielefeld, Bielefeld, Germany
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Safat Ullah
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Steffen Dreger
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Zia Ul Haq
- Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
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Ahmad F, Khan Z, Boeckmann M, Khan MN, Siddiqi K, Ullah S, Zeeb H, Forberger S. Supply Chain Actors' Willingness to Switch the Business of Smokeless Tobacco: A Mixed-Methods Study on Naswar Business in Pakistan. Nicotine Tob Res 2021; 23:1498-1506. [PMID: 33740043 DOI: 10.1093/ntr/ntab045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/17/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Provision of alternate livelihoods to smokeless tobacco (SLT) supply chain (SC) actors can help in curtailing SLT business and its consumption. We explored the reasons for SC actors' engagement in Naswar (SLT used in South Asia) business and their willingness to switch to other alternatives. AIMS AND METHODS We conducted an equal-status concurrent mixed-methods study in four districts of Khyber Pakhtunkhwa province of Pakistan. We surveyed 286 general points of sale (GPOS) and exclusive Naswar (EN) vendors through multistage cluster sampling. Additionally, we interviewed 15 tobacco farmers interpretively, being distinct from other SC actors. We assessed the association between vendors' willingness to switch and their awareness about tobacco-harms, profit margin, Naswar as a family business, length of business, education level, and shop type using logistic regression. Qualitative data assessed the farmer's viable alternatives to switch and were analyzed using deductive-inductive thematic analysis. RESULTS Product demand-77% and profit margins-75% were the main drivers for selling SLT by EN vendors. Half of the GPOS and 25% EN vendors expressed willingness to stop Naswar's sale. Vendors aware of tobacco-harms were more willing to switch, but less likely to switch if Naswar was perceived to bring "good profit." Farmers were mainly cultivating tobacco because of profitability, family-run farm, and perceived land-suitability for tobacco. Lack of government support was main constraint for farmers looking to switch. CONCLUSIONS A considerable portion of Naswar SC actors in Pakistan are willing to switch to viable alternatives, with profitability of alternatives, support from authorities, and social obligations as key considerations in doing so. IMPLICATIONS This study highlights that good profit margins in the Naswar business, lack of awareness of tobacco-related health harms, and absence of the government's support are key detriments to switching to alternative businesses among Naswar SC actors in Pakistan. These findings are the first to come out in the context of both Pakistan and Naswar product, making a case for policy interventions focusing on tax increases, awareness campaigns about tobacco-harms, and a proactive role by the government to provide support for the security of livelihoods to those tobacco SC actors who want to switch to other alternatives.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health & Social Sciences (IPH&SS), Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research Innovation and Commercialization (ORIC), Khyber Medical University, Peshawar, Pakistan
| | - Melanie Boeckmann
- School of Public Health, Department of Environment and Health, University of Bielefeld, Bielefeld, Germany
| | - Muhammad Naseem Khan
- Health Services Academy, Islamabad, Pakistan.,Department of Psychological Medicine, University of Liverpool, Liverpool, UK
| | - Kamran Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York,UK
| | - Safat Ullah
- Office of Research Innovation and Commercialization (ORIC), Khyber Medical University, Peshawar, Pakistan
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Woods CB, Volf K, Kelly L, Casey B, Gelius P, Messing S, Forberger S, Lakerveld J, Zukowska J, Bengoechea EG. The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review. J Sport Health Sci 2021; 10:263-276. [PMID: 33482424 PMCID: PMC8167338 DOI: 10.1016/j.jshs.2021.01.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/24/2020] [Accepted: 11/13/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND Despite the well-established health benefits of physical activity (PA) for young people (aged 4-19 years), most do not meet PA guidelines. Policies that support PA in schools may be promising, but their impact on PA behavior is poorly understood. The aim of this systematic review was to ascertain the level and type of evidence reported in the international scientific literature for policies within the school setting that contribute directly or indirectly to increasing PA. METHODS This systematic review is compliant with Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Six databases were searched using key concepts of policy, school, evaluation, and PA. Following title and abstract screening of 2323 studies, 25 progressed to data synthesis. Methodological quality was assessed using standardized tools, and the strength of the evidence of policy impact was described based on pre-determined codes: positive, negative, inconclusive, or untested statistically. RESULTS Evidence emerged for 9 policy areas that had a direct or indirect effect on PA within the school setting. These were whole school PA policy, physical education, sport/extracurricular PA, classroom-based PA, active breaks/recess, physical environment, shared use agreements, active school transport, and surveillance. The bulk of the evidence was significantly positive (54%), 27% was inconclusive, 9% was significantly negative, and 11% was untested (due to rounding, some numbers add to 99% or 101%). Frequency of evidence was highest in the primary setting (41%), 34% in the secondary setting, and 24% in primary/secondary combined school settings. By policy area, frequency of evidence was highest for sport/extracurricular PA (35%), 17% for physical education, and 12% for whole school PA policy, with evidence for shared use agreements between schools and local communities rarely reported (2%). Comparing relative strength of evidence, the evidence for shared use agreements, though sparse, was 100% positive, while 60% of the evidence for whole school PA policy, 59% of the evidence for sport/extracurricular PA, 57% of the evidence for physical education, 50% of the evidence for PA in classroom, and 50% of the evidence for active breaks/recess were positive. CONCLUSION The current evidence base supports the effectiveness of PA policy actions within the school setting but cautions against a "one-size-fits-all" approach and emphasizes the need to examine policy implementation to maximize translation into practice. Greater clarity regarding terminology, measurement, and methods for evaluation of policy interventions is needed.
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Affiliation(s)
- Catherine B Woods
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland.
| | - Kevin Volf
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Bláthín Casey
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen 91058, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen 91058, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen 28359, Germany
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research institute, Amsterdam UMC, VU University Amsterdam, Amsterdam 1081 HV, the Netherlands; Upstream Team, Amsterdam UMC, VU University Amsterdam, Amsterdam 1081 HV, the Netherlands
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdańsk University of Technology, Gdańsk 80-213, Poland
| | - Enrique García Bengoechea
- Department of Physical Education and Sport Sciences, Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
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Brandes M, Muellmann S, Allweiss T, Bauer U, Bethmann A, Forberger S, Frense J, Gelius P, Pfeifer K, Okan O, Renner B, Schupp H, Wright M, Zeeb H. [Evidence-based primary prevention and health promotion: methods and procedures in 5 research consortia]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:581-589. [PMID: 33835197 PMCID: PMC8033542 DOI: 10.1007/s00103-021-03322-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/29/2021] [Indexed: 11/24/2022]
Abstract
Von 2014 bis 2022 erforschen die 5 deutschen Forschungsverbünde AEQUIPA, CAPITAL4HEALTH, HLCA, PartKommPlus und SMARTACT Themen der Primärprävention und Gesundheitsförderung mit dem Ziel, die Evidenzgrundlagen in diesen Bereichen weiterzuentwickeln. In diesem Beitrag wird die Arbeit der 5 Forschungsverbünde für Primärprävention und Gesundheitsförderung unter dem Aspekt der Evidenzbasierung aus der internen Perspektive vorgestellt, analysiert und diskutiert. Als orientierender Rahmen dient ein Modell der evidenzbasierten Public Health. Die 5 Forschungsverbünde nutzen für die Evidenzgenerierung vielfältige Zugangswege bzgl. der Beteiligung nichtakademischer, zivilgesellschaftlicher Akteur*innen und Nutzer*innen. Es finden sich vielfältige Studiendesigns, die von randomisiert kontrollierten Studien und systematischen Reviews zu diversen qualitativen Designs reichen. Die Nutzung von Modellen und Theorien unterstützt die Evidenzbasierung. Über die Evidenzentwicklung hinaus legen alle Verbünde einen Schwerpunkt auf die zumindest exemplarische Implementierung des neuen Wissens. Durch die Methodenvielfalt kann eine breit gefächerte Evidenzbasierung unter Berücksichtigung verbundspezifischer Aspekte realisiert werden. Grenzen für eine weitere systematische Stärkung der Evidenzbasierung liegen in strukturellen Rahmenbedingungen. Insbesondere die Einbindung von nichtakademischen, zivilgesellschaftlichen Akteur*innen und Nutzer*innen für die Arbeit mit schwer erreichbaren Zielgruppen kann oft nicht ausfinanziert bzw. zeitlich berücksichtigt werden. Die COVID-19-Pandemie verdeutlicht die Wichtigkeit eines flexiblen Methodenspektrums, in dem ein sinnvolles Zusammenspiel von digitalen und analogen Methoden anzustreben ist.
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Affiliation(s)
- Mirko Brandes
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
| | - Saskia Muellmann
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
| | - Theresa Allweiss
- Katholische Hochschule für Sozialwesen Berlin, Berlin, Deutschland
| | - Ulrich Bauer
- Fakultät für Erziehungswissenschaft, Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Universität Bielefeld, Bielefeld, Deutschland
| | - Andreas Bethmann
- Katholische Hochschule für Sozialwesen Berlin, Berlin, Deutschland
| | - Sarah Forberger
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
| | - Jennifer Frense
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland
| | - Peter Gelius
- Department für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Klaus Pfeifer
- Department für Sportwissenschaft und Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Orkan Okan
- Fakultät für Erziehungswissenschaft, Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Universität Bielefeld, Bielefeld, Deutschland
| | - Britta Renner
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Deutschland
| | - Harald Schupp
- Fachbereich Psychologie, Universität Konstanz, Konstanz, Deutschland
| | - Michael Wright
- Katholische Hochschule für Sozialwesen Berlin, Berlin, Deutschland
| | - Hajo Zeeb
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Achterstr. 30, 28359, Bremen, Deutschland. .,Wissenschaftsschwerpunkt Gesundheitswissenschaften, Universität Bremen, Bremen, Deutschland.
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Volf K, Kelly L, García Bengoechea E, Casey B, Gobis A, Lakerveld J, Zukowska J, Gelius P, Messing S, Forberger S, Woods C. Policy Evaluation Network (PEN): Protocol for systematic literature reviews examining the evidence for impact of policies on physical activity across seven different policy domains. HRB Open Res 2021; 3:62. [PMID: 34805740 PMCID: PMC8567685 DOI: 10.12688/hrbopenres.13089.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown. The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap. Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria. Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA. Registration: PROSPERO CRD42020156630 (10/07/2020).
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Affiliation(s)
- Kevin Volf
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Kelly
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bláthín Casey
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Gobis
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | | | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Catherine Woods
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Policy Evaluation Network (PEN) Consortium
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
- Amsterdam University Medical Center, Amsterdam, The Netherlands
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Gelius P, Messing S, Forberger S, Lakerveld J, Mansergh F, Wendel-Vos W, Zukowska J, Woods C. The added value of using the HEPA PAT for physical activity policy monitoring: a four-country comparison. Health Res Policy Syst 2021; 19:22. [PMID: 33588865 PMCID: PMC7885477 DOI: 10.1186/s12961-021-00681-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/19/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Public policy is increasingly recognized as an important component of physical activity promotion. This paper reports on the current status of physical activity policy development and implementation in four European countries based on the Health-Enhancing Physical Activity Policy Audit Tool (HEPA PAT) developed by WHO. It compares the findings to previous studies and discusses the general utility of this tool and its unique features in relation to other instruments. METHODS The study was conducted as part of the Policy Evaluation Network ( www.jpi-pen.eu ) in Germany, Ireland, the Netherlands and Poland. Data collection built upon information obtained via the EU Physical Activity Monitoring Framework survey, additional desk research and expert opinion. Data analysis employed Howlett's policy cycle framework to map and compare national physical activity policies in the four countries. RESULTS In all countries under study, policy agenda-setting is influenced by prevalence data from national health monitoring systems, and the sport and/or health sector takes the lead in policy formulation. Key policy documents were located mainly in the health sector but also in sport, urban design and transport. Physical activity programmes implemented to meet policy objectives usually cover a broad range of target groups, but currently only a small selection of major policies are evaluated for effectiveness. National experts made several suggestions to other countries wishing to establish physical activity policies, e.g. regarding cross-sectoral support and coordination, comprehensive national action plans, and monitoring/surveillance. CONCLUSIONS This study provides a detailed overview of physical activity policies in the four countries. Results show that national governments are already very active in the field but that there is room for improvement in a number of areas, e.g. regarding the contribution of sectors beyond sport and health. Using the HEPA PAT simultaneously in four countries also showed that procedures and timelines have to be adapted to national contexts. Overall, the instrument can make an important contribution to understanding and informing physical activity policy, especially when used as an add-on to regular monitoring tools like the EU HEPA Monitoring Framework.
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Affiliation(s)
- Peter Gelius
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Sven Messing
- Department of Sport Science and Sport, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - Wanda Wendel-Vos
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Catherine Woods
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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Arora M, Chugh A, Jain N, Mishu M, Boeckmann M, Dahanayake S, Eckhardt J, Forberger S, Huque R, Kanaan M, Khan Z, Mehrotra R, Rahman MA, Readshaw A, Sheikh A, Siddiqi K, Vidyasagaran A, Dogar O. Global impact of tobacco control policies on smokeless tobacco use: a systematic review protocol. BMJ Open 2020; 10:e042860. [PMID: 33361080 PMCID: PMC7768955 DOI: 10.1136/bmjopen-2020-042860] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Smokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated. METHODS AND ANALYSIS A systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project's 'Quality Assessment Tool for Quantitative Studies' will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used. ETHICS AND DISSEMINATION Permission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control's Institutional Ethics Committee, India (CCDC_IEC_06_2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences. PROSPERO REGISTRATION NUMBER CRD42020191946.
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Affiliation(s)
- Monika Arora
- HRIDAY, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | | | - Neha Jain
- Health Promotion Division, Public Health Foundation of India, Gurugram, Haryana, India
| | - Masuma Mishu
- Department of Health Sciences, University of York, York, UK
| | | | - Suranji Dahanayake
- Department of Health Sciences, University of York, York, UK
- Ministry of Health, Nutrition and Indigenous Medicine, Colombo, Sri Lanka
| | | | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | | | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Zohaib Khan
- Khyber Medical University, Peshawar, Pakistan
| | - Ravi Mehrotra
- Indian Council of Medical Research, India Cancer Research Consortium, New Delhi, India
| | - Muhammad Aziz Rahman
- School of Health, Federation University Australia, Berwick, Victoria, Australia
- La Trobe University, Melbourne, Victoria, Australia
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | | | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Volf K, Kelly L, García Bengoechea E, Casey B, Gobis A, Lakerveld J, Zukowska J, Gelius P, Messing S, Forberger S, Woods C. Policy Evaluation Network (PEN): Protocol for systematic literature review examining the evidence for impact of policies across seven different policy domains. HRB Open Res 2020; 3:62. [PMID: 34805740 PMCID: PMC8567685 DOI: 10.12688/hrbopenres.13089.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2020] [Indexed: 04/06/2024] Open
Abstract
Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity contributes an estimated 9% to this figure. Global responses have included the Sustainable Development Goals (SDGs) and the Global Action Plan on Physical Activity (GAPPA). Both point to policy action on physical activity (PA) to address change, yet the impact of policy on PA outcomes is unknown. The protocol described outlines the methodology for systematic literature reviews that will be undertaken by the Policy Evaluation Network (PEN) to address this knowledge gap. Methods: The seven best investments for promotion of population PA identified in the Toronto Charter highlighted seven policy domains (schools, transport, urban design, primary health care systems, public education, community-wide programmes and sport) which will form the basis of these PEN reviews. Seven individual scientific literature searches across six electronic databases will be conducted. Each will use the key concepts of policy, PA, evaluation and a distinct concept for each of the seven policy domains. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined criteria. Conclusions: Each review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, each review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by GAPPA. Registration: PROSPERO CRD42020156630 (10/07/2020).
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Affiliation(s)
- Kevin Volf
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Kelly
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bláthín Casey
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Gobis
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | | | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Catherine Woods
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Policy Evaluation Network (PEN) Consortium
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
- Amsterdam University Medical Center, Amsterdam, The Netherlands
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Abstract
INTRODUCTION Physical inactivity and sedentary behaviour are associated with numerous health problems and increasing risks of premature morbidity and mortality. Workplace health promotion with a focus on increasing physical activity (PA) and reducing sedentary behaviour is of growing interest. The concept of choice architecture with the use of nudges is a promising approach to influence decision making regarding health behaviours. It can help to understand why people often fail to act in their best interest, to follow well-informed preferences or to achieve their set goals. Nudges, the way the choice is presented, can help to overcome these challenges by using the same habits, biases or boundaries to alter our decision-making in favour of the more preferred behaviour. Aims of the scoping review will be to analyse (a) to what extent the concept of choice architecture is used in workplace health promotion to promote PA and/or to reduce sedentary behaviour and (b) which instruments (nudges) are used to archive that. METHODS AND ANALYSES Medline, PsychInfo, Web of Science and CINHAL will be searched from 2009 until June 2020. Applying a two-level screening process, title and abstracts will be screened according to a set of predetermined inclusion and exclusion criteria. Included articles will be screened a second time to determine the extent to which choice architecture has been used. Analyses for publication year, location, setting and target group will be provided. Interventions will be analysed presenting the instruments used, number of studies per instrument, combinations of instruments and alteration of the environment. Outcome measures and results will be reported as they occur. ETHICS AND DISSEMINATION Due to the nature of the scoping review, ethical concerns are minimal. No patient data will be included. Results are published in peer-review journals.
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Affiliation(s)
- Sarah Forberger
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Frauke Wichmann
- Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Peters M, Muellmann S, Christianson L, Stalling I, Bammann K, Drell C, Forberger S. Measuring the association of objective and perceived neighborhood environment with physical activity in older adults: challenges and implications from a systematic review. Int J Health Geogr 2020; 19:47. [PMID: 33168094 PMCID: PMC7654613 DOI: 10.1186/s12942-020-00243-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/30/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A supportive environment is a key factor in addressing the issue of health among older adults. There is already sufficient evidence that objective and self-reported measures of the neighborhood environment should be taken into account as crucial components of active aging, as they have been shown to influence physical activity; particularly in people aged 60+. Thus, both could inform policies and practices that promote successful aging in place. An increasing number of studies meanwhile consider these exposures in analyzing their impact on physical activity in the elderly. However, there is a wide variety of definitions, measurements and methodological approaches, which complicates the process of obtaining comparable estimates of the effects and pooled results. The aim of this review was to identify and summarize these differences in order to emphasize methodological implications for future reviews and meta analyzes in this field and, thus, to create a sound basis for synthesized evidence. METHODS A systematic literature search across eight databases was conducted to identify peer-reviewed articles examining the association of objective and perceived measures of the neighborhood environment and objectively measured or self-reported physical activity in adults aged ≥ 60 years. Two authors independently screened the articles according to predefined eligibility criteria, extracted data, and assessed study quality. A qualitative synthesis of the findings is provided. RESULTS Of the 2967 records retrieved, 35 studies met the inclusion criteria. Five categories of methodological approaches, numerous measurement instruments to assess the neighborhood environment and physical activity, as well as several clusters of definitions of neighborhood, were identified. CONCLUSIONS The strength of evidence of the associations of specific categories of environmental attributes with physical activity varies across measurement types of the outcome and exposures as well as the physical activity domain observed and the operationalization of neighborhood. The latter being of great importance for the targeted age group. In the light of this, future reviews should consider these variations and stratify their summaries according to the different approaches, measures and definitions. Further, underlying mechanisms should be explored.
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Affiliation(s)
- Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
| | - Imke Stalling
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Karin Bammann
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Carina Drell
- Institute for Public Health and Nursing Research (IPP), Working Group Epidemiology of Demographic Change, University of Bremen, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Achterstraße 30, 28215 Bremen, Germany
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Volf K, Kelly L, García Bengoechea E, Casey B, Gobis A, Lakerveld J, Zukowska J, Gelius P, Messing S, Forberger S, Woods C. Policy Evaluation Network (PEN): Protocol for systematic literature review examining the evidence for impact of school policies on physical activity. HRB Open Res 2020; 3:62. [PMID: 34805740 PMCID: PMC8567685 DOI: 10.12688/hrbopenres.13089.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 04/06/2024] Open
Abstract
Introduction: Over 40 million deaths annually are due to noncommunicable diseases, 15 million of these are premature deaths and physical inactivity attributes an estimated 9% to this figure. Global responses have included the sustainable development goals and the global action plan on physical activity. Both point to policy action in physical activity (PA) to address change, yet the impact of policy is unknown. The protocol described outlines a systematic literature review that will be undertaken by the Policy Evaluation Network to address this knowledge gap. Protocol: This review of school PA policies is the first of seven planned reviews. The seven best investments for promotion of population PA identified in the Toronto Charter (whole-of-school programmes, transport policy, urban design policy, primary health care policy, public education policy, community programmes and sport programmes) will form the basis of these reviews. Seven individual scientific literature searches across six electronic databases, using key concepts of policy, PA, evaluation and a distinct concept for each area will be conducted. This will be supplemented with a search of the reference list of included articles. Methodological quality will be assessed and overall effectiveness for each included study will be described according to pre-determined categories. Conclusions: The review will provide policy makers with a list of policy statements and corresponding actions which the evidence has determined impact on PA directly or indirectly. By collating the evidence, and demonstrating the depth of the science base which informs these policy recommendations, this review will provide guidance to policymakers to use evidence-based or evidence-informed policies to achieve the 15% relative reduction in physical inactivity as defined by the 'Global Action Plan on Physical Activity'. Registration: PROSPERO CRD42020156630 (10/07/2020).
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Affiliation(s)
- Kevin Volf
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam Kelly
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Enrique García Bengoechea
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Bláthín Casey
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Gobis
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | | | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - Peter Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sven Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Catherine Woods
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Policy Evaluation Network (PEN) Consortium
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
- Amsterdam University Medical Center, Amsterdam, The Netherlands
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Volf K, Kelly L, García Bengoechea E, Gobis A, Lakerveld J, Zukowska J, Gelius P, Messing S, Forberger S, Woods C. Systematic review examining the evidence for impact of school policies on physical activity. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Epidemiological evidence has demonstrated that physical activity can have substantive health benefits for children and young people. The 'Policy Evaluation Network' is a multi-disciplinary research network across 7 European countries and New Zealand aimed at building capacity and evaluating the level of impact of policy interventions for promoting healthy lifestyles. The Toronto Charter identified 'whole-of-school' programmes as one of seven key investments for promotion of PA. This paper presents results of a SLR, designed to assess the level of evidence for policies within the school setting that contribute directly or indirectly to increasing PA.
Methods
Researchers searched six online databases for scientific literature regarding PA policy interventions in the school setting using key concepts of policy, school, PA and evaluation. Risk of bias will be assessed with tools appropriate to the design of the studies considered. Evidence of actual or potential positive PA outcomes arising directly or indirectly from policy actions will be catalogued.
Results
Preliminary searches identified 2327 unique scientific articles. 1938 (83.3%) were excluded on first reading and 189 (8.8%) were included for full text analysis. Initial findings suggest that organisational policies, for example avoiding overcrowding in playgrounds during school breaks, may be a promising policy action. Detailed analysis revealing other potential policy actions supported by evidence will be presented (SLR in progress).
Conclusions
Preliminary findings suggest that few studies link policy actions in the school setting to PA outcomes. However, studies that have investigated the effects of changes to the school environment on PA levels may provide evidence for policy actions. Preliminary recommendations include strengthening the evidence base for school-based PA policy by supporting studies into the effects of particular policy or legislative changes on PA outcomes.
Key messages
School physical activity policies are an underappreciated public health intervention. More studies should link policy changes to physical activity outcomes.
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Affiliation(s)
- K Volf
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - L Kelly
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - E García Bengoechea
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - A Gobis
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - J Lakerveld
- Amsterdam University Medical Center, Amsterdam, Netherlands
| | - J Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - P Gelius
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S Messing
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - C Woods
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Forberger S, Gelius P, Messing S, Volf K, Kelly L, Taylor S, Zukowska J, Lakerveld J, Woods C. Sub-national structures matter when evaluating physical activity promotion: Lessons from Germany. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Public policies are increasingly acknowledged as important part of promoting physical activity (PA). However, especially in states with sub-national administrative structures such as Germany, national and sub-national approaches differ considerably. In Germany, sport for all (SfA) promotion is mostly organized at sub-national level, which is usually not covered in national evaluations. Knowledge of these structures helps to understand national outcomes, enables comparisons and learning within and between countries, and assists in identifying support structures for effective PA promotion.
Methods
Data were collected in the PEN Policy Evaluation Network project. In addition to the WHO HEPA PAT, a questionnaire was sent to the sports representatives of the 16 federal states. Responses of 11 state representatives were included and overarching issues were identified using inductive thematic analysis.
Results
PA promotion in Germany is organized in three areas: SfA, professional sports and school sports. SfA promotion at sub-national level is assigned to different administrative bodies (ministries, senate administration, state chancellery) and policy areas: culture, health and care, home affairs with various aspects, education, social affairs and family. The priorities of the federal states are more diverse and specific compared to the national level. There is an overlap in the topics: urban planning, cycling, health prevention and targeting children. Cooperation mechanisms and partners vary between federal states, but some partners are active at sub-national and national level.
Conclusions
The results provide an insight into the complexity of PA and especially SfA promotion at sub-national level in Germany. Our results suggest that a broader range of approaches is used in the 16 German states than national overviews would suggest. These particularities must be taken into account when assessing and comparing the results from different countries.
Key messages
The promotion of SfA at German sub-national level is much more diverse than represented at national level evaluations. Knowledge of sub-national structures enables the understanding of national outcomes, the promotion of cross-national learning and the identification of supportive structures for effective PA promotion.
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Affiliation(s)
- S Forberger
- BIPS, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - P Gelius
- FAU, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - S Messing
- FAU, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - K Volf
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - L Kelly
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - S Taylor
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
| | - J Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
| | - J Lakerveld
- VUmc, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - C Woods
- Physical Activity for Health, Health Research Institute, Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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Zähringer J, Schwingshackl L, Movsisyan A, Stratil JM, Capacci S, Steinacker JM, Forberger S, Ahrens W, Küllenberg de Gaudry D, Schünemann HJ, Meerpohl JJ. Use of the GRADE approach in health policymaking and evaluation: a scoping review of nutrition and physical activity policies. Implement Sci 2020; 15:37. [PMID: 32448231 PMCID: PMC7245872 DOI: 10.1186/s13012-020-00984-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/18/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nutrition and physical activity policies have the potential to influence lifestyle patterns and reduce the burden of non-communicable diseases. In the world of health-related guidelines, GRADE (Grading of Recommendations, Assessment, Development and Evaluation) is the most widely used approach for assessing the certainty of evidence and determining the strength of recommendations. Thus, it is relevant to explore its usefulness also in the process of nutrition and physical activity policymaking and evaluation. The purpose of this scoping review was (i) to generate an exemplary overview of documents using the GRADE approach in the process of nutrition and physical activity policymaking and evaluation, (ii) to find out how the GRADE approach has been applied, and (iii) to explore which facilitators of and barriers to the use of GRADE have been described on the basis of the identified documents. The overarching aim of this work is to work towards improving the process of evidence-informed policymaking in the areas of dietary behavior, physical activity, and sedentary behavior. METHODS A scoping review was conducted according to current reporting standards. MEDLINE via Ovid, the Cochrane Library, and Web of Science were systematically searched up until 4 July 2019. Documents describing a body of evidence which was assessed for the development or evaluation of a policy, including documents labeled as "guidelines," or systematic reviews used to inform policymaking were included. RESULTS Thirty-six documents were included. Overall, 313 GRADE certainty of evidence ratings were identified in systematic reviews and guidelines; the strength of recommendations/policies was assessed in four documents, and six documents mentioned facilitators or barriers for the use of GRADE. The major reported barrier was the initial low starting level of a body of evidence from non-randomized studies when assessing the certainty of evidence. CONCLUSION This scoping review found that the GRADE approach has been used for policy evaluations, in the evaluation of the effectiveness of policy-relevant interventions (policymaking), as well as in the development of guidelines intended to guide policymaking. Several areas for future research were identified to explore the use of GRADE in health policymaking and evaluation.
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Affiliation(s)
- Jasmin Zähringer
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ani Movsisyan
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Jan M Stratil
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - Sara Capacci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Jürgen M Steinacker
- Division of Sports- and Rehabilitation Medicine, Medical Center, Ulm University Hospital, Ulm, Germany
| | - Sarah Forberger
- Department Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Department Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Daniela Küllenberg de Gaudry
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger J Schünemann
- McMaster GRADE Centre and Department of Health Research Methods, Evidence, and Impact, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany.
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Forberger S, Reisch L, Kampfmann T, Zeeb H. Nudging to move: a scoping review of the use of choice architecture interventions to promote physical activity in the general population. Int J Behav Nutr Phys Act 2019; 16:77. [PMID: 31481090 PMCID: PMC6724306 DOI: 10.1186/s12966-019-0844-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Nudges are used to alter lifestyles and thus curb the rise of non-communicable diseases. Physical activity is a core prevention strategy to reduce the burden of non-communicable diseases. This paper aims to (1) give an overview of the scope of interventions using choice architecture techniques to promote physical activity at the population levels and (2) identify research gaps by analysing the different approaches in terms of class and type of intervention used. Methods A systematic electronic database search was combined with snowball citation sampling of a starter set of publications to search for studies published through October 2018 reporting interventions to promote physical activity at the population level using choice architecture techniques. The methodology of the Joanna Briggs Institute for Scoping Reviews was applied. Results In all, 35 publications were included. Most of the interventions used point-of-choice prompts tested at railway stations, shopping malls and airports (N = 27). Eight studies were online studies. While all studies were aimed at the general population, details, if reported at all, were vague and basic. All studies focused on individual-level lifestyle behaviour. None of the studies attempted to alter population-based lifestyle behaviour. Online and “real-world” approaches were rarely combined. Neither, interventions targeting meso- and macro-level structures nor combinations of individual-level and specific meso- or macro-level interventions were found. Conclusion Nudging is in principle an effective approach to promote physical activity within the general population. However, there are large gaps in research. Available opportunities have not yet been exhausted. Further research is needed that is explicitly based on behavioural insights and covering the full range of nudging approaches, particularly focussing on theoretical developments, practical feasibility tests and scale-up activities. Electronic supplementary material The online version of this article (10.1186/s12966-019-0844-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Forberger
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - L Reisch
- Leibniz-Chair, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Copenhagen Business School, MSC, Dalgas Have 15, 2000, Frederiksberg, Denmark
| | - T Kampfmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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