The positive impact of a care–physical activity initiative for people with low socioeconomic status

Background

Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. We answered the research question: what are the short- and long-term outcomes of participation in X-Fittt 2.0 in terms of health, quality of life and societal participation?

Methods

Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), 1 year (t2) and 2 years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using linear mixed-model analysis, while we used descriptive statistics for the categorical variables. Qualitative data were analysed using thematic analysis.

Results

Body weight was significantly lower at all three post-initiative time points compared with t0, with a maximum of 3.8 kg difference at t2 (p < 0.05). BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks (p < 0.05). A positive trend regarding paid work was observed, participants reported increased PA levels (including sports) and a few stopped smoking or drinking alcohol. Participants felt healthier and more energetic, reported improved self-esteem and stress levels, and had become more socially active. However, barriers to being physically active included a lack of money or time, or physical or mental health problems.

Conclusions

X-Fittt 2.0 improved the physical health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results.

Key messages

Citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income

Overweight and obesity are a growing problem, especially among people with a low income. Policymakers aspire to alleviate this problem by implementing publicly funded projects. This study has three aims: 1) to explore citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income, 2) to identify whether such preferences differ between citizens with a low income and those with a higher income, and 3) to identify the reasons underlying these preferences. We conducted a Participatory Value Evaluation (PVE) among 1053 Dutch citizens to achieve these aims. In an online choice experiment, respondents were asked to advise on the implementation of eight different projects that encourage a healthy body weight among citizens with a low income, with a total resource constraint of 100,000 euros. The projects were 1) lifestyle coaching including sports, 2) lifestyle coaching without sports, 3) local sports coach, 4) fruit and vegetable boxes, 5) bariatric surgery, 6) improving the living environment, 7) courses on healthy lifestyles, and 8) sports vouchers. We used the "Multiple Discrete-Continuous Extreme Value" model to estimate the preferences of respondents towards these eight projects. Fruit and vegetable boxes and sports vouchers were the most popular projects, while bariatric surgery was least popular. Respondents with a low income tended to spend less of the budget than respondents with a higher income. Respondent arguments for the choices they made were qualitatively analysed using inductive content analysis. They often mentioned the value judgements 'importance', 'healthiness' and 'usefulness', as well as project costs and efficacy, as reasons for their decisions. Policymakers could use the results to ensure their decisions on the allocation of public funding to projects that encourage a healthy weight among people with a low income are aligned with citizen preferences.

Effective elements of care-physical activity initiatives for adults with a low socioeconomic status: A concept mapping study with health promotion experts

In care-physical activity (care-PA) initiatives, primary care and sports are combined to stimulate PA among adults at risk of lifestyle related diseases. Preliminary results from Dutch care-PA initiatives for adults with a low socioeconomic status (SES) indicate a decrease in participants' body weight and an improved quality of life, however, the elements that make these initiatives successful are yet to be identified. In total, 19 Dutch health promotion experts participated in our concept mapping (CM) of the effective elements of care-PA initiatives for adults with a low SES. The experts identified 111 effective elements of these initiatives, which were grouped into 11 clusters, focusing on: 1) approaching participants within the care-PA initiative, 2) barriers experienced throughout the initiative, 3) long-term implementation, 4) customizing the care-PA initiative to the target population, 5) social support, 6) structure and guidance, 7) the professionals within the care-PA initiative, 8) the accessibility of the care-PA initiative, 9) targeted behaviour and progression, 10) recruitment and administration, and 11) intersectoral collaboration. CM was useful for creating a valuable overview of these effective elements. Our results could be used to improve the development and implementation of future care-PA initiatives for adults with a low SES.

Effective elements of Dutch care-physical activity initiatives for low socioeconomic status adults

Background

In care-physical activity (care-PA) initiatives, primary care and sports collaborate to stimulate PA among adults at risk of lifestyle related diseases. Preliminary results of Dutch care-PA initiatives for low socioeconomic status (SES) adults indicate that these initiatives successfully lower participants’ body weight and improve quality of life. However, insight into elements that make these initiatives work is lacking. Therefore, this research aims to unravel the effective elements of care-PA initiatives for low SES adults.

Methods

Concept Mapping (CM) was used as tool to identify and cluster the effective elements. Nineteen Dutch health promotion experts individually listed as many elements as they felt were of importance to the effectiveness of care-PA initiatives. Next, each expert was asked to cluster the elements and to score them on importance. Then, CS Global MAX software was used for multidimensional scaling and a hierarchical cluster analysis to develop a cluster map. Finally, the cluster map was presented, discussed, and refined in a group meeting with 11 of the experts.

Results

The experts came up with 113 unique effective elements of care-PA initiatives for low SES adults, clustered into 11 clusters: 1) approach of professionals, 2) barriers experienced during the programme, 3) local embedding, 4) customisation of the programme to target population, 5) social support, 6) methods within the programme, 7) competencies of professionals, 8) accessibility of the programme, 9) actions within the programme, 10) recruitment of participants, and 11) intersectoral collaboration.

Conclusions

A valuable overview of the effective elements of care-PA initiatives for low SES adults was created. The results can be used to improve existing care-PA initiatives and to develop new ones targeted at low SES adults at risk of lifestyle related diseases. This may eventually help to reduce health inequalities between low and high SES adults.

Key messages

Concept mapping has been a useful group-based tool to obtain information on the effective elements of care-PA initiatives, in which individual input from health promotion experts has been collected. The overview of effective elements of care-PA initiatives for low SES adults as presented in this study is valuable for the development of care-PA initiatives specifically targeted at low SES adults.

Care-physical activity initiatives in the neighbourhood: study protocol for mixed-methods research on participation, effective elements, impact, and funding methods

BACKGROUND

In the Netherlands, people with a low socioeconomic status (SES) live approximately 6 years less and are less engaged in physical activity (PA) than high SES citizens. This contributes to the persistent health inequalities between low and high SES citizens. Care-PA initiatives are deemed effective for stimulating PA and improving health and participation among peoples with a low SES. In those initiatives, multiple sectors (e.g. sports, health insurers, municipalities) collaborate to connect primary care and PA at neighbourhood level. This study focuses on two Dutch municipalities that aim to invest in Health in All Policies (HiAP) and care-PA initiatives to improve the health of people with low SES. The aim is to gain insight into (1) the short-term (3 months) and long-term (1 year) outcomes of participating in care-PA initiatives for low SES citizens in terms of health, quality of life, and societal participation, (2) the effective elements that contribute to these outcomes, (3) the direct and perceived societal costs and benefits of care-PA initiatives, and (4) alternative ways to fund integrated care, prevention, and care-PA initiatives at neighbourhood level.

METHODS

The study will be built on a mixed-methods design guided by action research to continuously facilitate participatory processes and practical solutions. To assess outcomes, body measurements and questionnaires will be used as part of a pre-test/post-test design. Focus groups and interviews will be conducted to gain an in-depth understanding of outcomes and action elements. Action elements will be explored by using multiple tools: concept mapping, the logic model, and capacity mapping. Direct and perceived societal costs will be measured by administrative data from healthcare insurers (before-after design) and the effectiveness arena. An alternative funding model will be identified based on literature study, expert meetings, and municipal workshops.

DISCUSSION

Initiatives addressing multiple factors at different levels in an integral way are a challenge for evaluation. Multi-methods and tools are required, and data need to be interpreted comprehensively in order to contribute to a contextual insight into what works and why in relation to HiAP and care-PA initiatives.