Scaling Up a Community-Based Exercise Program for Women in Difficult Life Situations in Germany-The BIG Project as a Case-Study

Scaling up community-based participatory research (CBPR) remains challenging. This case-study reports on how, and under which conditions, a CBPR project aiming at promoting exercise among socially disadvantaged women (BIG) scaled up at four project sites. As part of BIG, researchers support city administrations in implementing a participatory project to reach socially disadvantaged women for exercise. The case study was conducted in winter 2020 in southern Germany and is based on a co-creative process involving city administrators and researchers. Following Kohl and Cooley's scaling up dimensions, scaling up BIG was investigated at the four sites using a mixed-method approach. Course registrations and offers were analysed, and qualitative interviews (n = 4) with administrative staff members were conducted and analysed using content analysis. The geographical coverage of exercise classes, the addressed groups, and the utilisation of participatory methods by city administrations are described. All four sites managed to scale-up project activities. Three of the four sites reported that further growth of the project was no longer possible due to limited resources. All sites attempted to reach a larger number of, and more diverse, women. One site managed to scale-up the use of participatory methods within the city administration. The following important facilitators for scaling up CBPR projects were reported: advertisements tailored to the needs of the addressed women, utilising participatory approaches, and equipping project coordinators with sufficient resources.

Transferring a Community-Based Participatory Research Project to Promote Physical Activity Among Socially Disadvantaged Women-Experiences From 15 Years of BIG

Introduction: Community-based participatory research (CBPR) is an effective approach to health promotion, especially in relation to socially disadvantaged groups. However, the long-term implementation of CPBR-based projects on a broad scale is often challenging, and research regarding the sustainable transfer of participatory research is lacking. This limits the scaling-up and public health impact of CBPR. Therefore, this study examines the mechanisms utilized to transfer and sustain the BIG project, a multifaceted CBPR project aimed at promoting physical activity among women in difficult life situations.

Materials and Methods: Borrowing from the RE-AIM framework, we analyzed project documentation and conducted a reflection workshop to investigate methods of transferring BIG to new sites as well as strategies from researchers to support project implementation and the maintenance of program activities at those sites. Moreover, we analyzed the reasons for discontinuing program activities at some former BIG sites and the costs involved in transferring BIG.

Results: Since its establishment in 2005, BIG was transferred to and implemented at 17 sites. As of the winter of 2019, the program activities were maintained at eight sites. The average duration of sites that continue to offer program activities was more than 9 years. Discontinued sites maintained project activities for an average of 4 years. According to the study findings, the extent of scientific support, the provision of seed funding, and the local project coordinator, the person managing the project at the site, all have a significant impact on the sustainability of the transfer. A patchwork of funding agencies was needed to finance scientific support and seed funding in BIG. The transfer of BIG projects accrued annual costs of approximately EUR20,000 per site; however, long-term project implementation resulted in a decline in the annual transfer costs of BIG.

Discussion and Conclusion: The sustainable transfer of CBPR is challenging but possible, and increased support of research and seed funding can facilitate long-term transfer. Nevertheless, other factors in the implementation setting are beyond scientific control. With scarce financial resources, researchers need to carefully balance the efforts of the sustainability and transfer of CBPR projects. To address this issue, there is a need for further research into the interrelationship of the sustainability and transfer of CBPR projects as well as increased long-term funding.

Capabilities for Physical Activity by Turkish- and Russian-Speaking Immigrants Aged 65 Years and Older in Germany: A Qualitative Study

This study builds upon Sen's seminal capability approach to analyze the interplay of individual and structural factors for immigrants' physical activity (PA) in old age. The authors conducted software-assisted thematic analysis of group interviews with Turkish- and Russian-speaking immigrants aged 65 years and older in Germany (n = 19). The authors present how interviewees perceive diverse resources, environmental, social, and individual factors that shape their capabilities for PA. Age-related health literacy, family support, and access rules to sport opportunities shape both groups' capabilities for PA. Turkish interviewees' continuous bilocation and Russian interviewees' past experience with PA as workplace exercise are two major differences between those groups. Results indicate that capabilities are ambiguous-managed and shaped by individuals, which makes more static terms like barriers and options less helpful for an analysis. Systematically applying the capability approach in intervention research would allow to analyze interaction and to ultimately better reach underserved groups like immigrants 65 years and older.

A multicenter controlled study for dementia prevention through physical, cognitive and social activities - GESTALT-kompakt

Prevention of dementia is a public health priority. Physical activity (PA) can reduce the risk of dementia, but the majority of people remain sedentary. We conducted a multicenter controlled study with older adults (60+ years). We hypothesized that an evidence-based PA intervention - GEhen, Spielen und Tanzen Als Lebenslange Tätigkeiten - kompakt [walking, playing and dancing as lifelong activities-compact] (GESTALT-kompakt) - would lead to significantly larger improvements in PA levels (step counts/Fitbit Zip™), cognitive functions (DemTect) and social activities (Social Activity Log), compared to an active control group. Data were collected at baseline and after 3 and 12 months. The intervention group received a 12-week (1/week) multimodal and multicomponent PA program, which combined PA with cognitive and social activities. The control group received either regular gymnastics or cognitive training (1/week). A mixed linear model was chosen for analysis. A total of 87 older individuals were recruited in the GESTALT-kompakt study (68 females, average age =76.0 years, SD ±9.2, range 52-95 years). Marginally significant differences were observed in the intervention group (n=57) in comparison to the control group (n=30), regarding improvements in PA (difference of mean changes =866.4 steps, p=0.055) after 3 months. However, their PA decreased to the baseline score value after 12 months (-866.0 steps, p=0.061). GESTALT-kompakt did not cause significant differences in cognitive functioning (-0.8620, p=0.074) and social activities (-0.2428, p=0.288) in comparison to the control intervention from T0 to T1. Sixteen (24.2%) study participants who finished T2 reported a negative life event during the follow-up period, which severely influenced their PA behavior. GESTALT-kompakt might be effective in increasing PA in the short term, but did not have a long-term impact on the PA levels, cognitive functions or social activities of the participants. We recommend PA programs with longer duration to change behavior in the long term.

[Sustainable Implementation of Evidence-Based Programmes in Health Promotion: A Theoretical Framework and Concept of Interactive Knowledge to Action]

OBJECTIVES

This article discusses 2 current issues in the field of public health research: (i) transfer of scientific knowledge into practice and (ii) sustainable implementation of good practice projects. It also supports integration of scientific and practice-based evidence production. Furthermore, it supports utilisation of interactive models that transcend deductive approaches to the process of knowledge transfer.

METHODS

Existing theoretical approaches, pilot studies and thoughtful conceptual considerations are incorporated into a framework showing the interplay of science, politics and prevention practice, which fosters a more sustainable implementation of health promotion programmes. The framework depicts 4 key processes of interaction between science and prevention practice: interactive knowledge to action, capacity building, programme adaptation and adaptation of the implementation context.

RESULTS

Ensuring sustainability of health promotion programmes requires a concentrated process of integrating scientific and practice-based evidence production in the context of implementation. Central to the integration process is the approach of interactive knowledge to action, which especially benefits from capacity building processes that facilitate participation and systematic interaction between relevant stakeholders. Intense cooperation also induces a dynamic interaction between multiple actors and components such as health promotion programmes, target groups, relevant organisations and social, cultural and political contexts. The reciprocal adaptation of programmes and key components of the implementation context can foster effectiveness and sustainability of programmes.

CONCLUSION

Sustainable implementation of evidence-based health promotion programmes requires alternatives to recent deductive models of knowledge transfer. Interactive approaches prove to be promising alternatives. Simultaneously, they change the responsibilities of science, policy and public health practice. Existing boundaries within disciplines and sectors are overcome by arranging transdisciplinary teams as well as by developing common agendas and procedures. Such approaches also require adaptations of the structure of research projects such as extending the length of funding.

[Interactive Knowledge to Action in Health Promotion: The GESTALT Project. Initial Results of a Pilot Study on Sustainable Implementation of an Evidence-Based Programme]

OBJECTIVES

The present article outlines a pilot study to demonstrate the concept of the interactive knowledge to action approach in order to foster sustainable implementation of an evidence-based physical activity programme for dementia prevention into practice. The approach and procedures will be introduced, and initial results of the pilot study "GESTALT", with special regard to the interplay of science, politics and prevention practice, will be outlined.

METHODS

In the GESTALT project (2011-2014) the concept of interactive knowledge to action was realised through a cooperative planning approach that systematically engaged and involved stakeholders from science, politics and practice. Evaluation of the project's sustainability focused on 3 dimensions: target group, organisations and context. Target group analysis included assessment of changes in physical activity behaviour (n=75). Organisational and context evaluations included an analysis of relevant documentation of cooperative planning meetings, conduction of the programme, bilateral talks and further meetings.

RESULTS

In relation to the target group, the majority of participants (60%) were committed to an active lifestyle 6 months after completion of the GESTALT programme. Regarding organisations and context, 14 partner organisations maintained active engagement in cooperative planning processes. After adapting the GESTALT programme to the context and needs of the organisations and participants, 5 organisations were able to implement it. These same organisations also continued to provide exercise classes for ex-participants of the initial GESTALT programme. Through developing partnerships, increasing publicity and attracting policy makers, resources for the sustainable implementation of the GESTALT project were obtained.

CONCLUSION

The pilot study GESTALT shows that the concept of interactive knowledge to action has substantially contributed to the sustainability of a physical activity programme in the field of dementia prevention. For this purpose changes in local structures, as well as adaptations of the GESTALT programme to the existing structures of prevention practice had to be made. The approach of cooperative planning proved to be appropriate for the generation of knowledge in terms of practice-based evidence, and it favoured the reciprocal adaptation of the GESTALT programme and implementation contexts.