- M.C. Herens (1)
- S.A.M. Kool de (1)
- B.C. Mierlo van (1)
- L. Noorduyn (1)
- H. Reuler van (1)
- T. Vermeulen (1)
- W. Zaalmink (1)
Promoting physical activity in socially vulnerable groups : a mixed method evaluation in multiple community-based physical activity programs
Herens, M.C. - \ 2016
University. Promotor(en): Maria Koelen, co-promotor(en): Annemarie Wagemakers; Johan van Ophem; Lenneke Vaandrager. - Wageningen : Wageningen University - ISBN 9789462578081 - 276 p.
physical activity - community health - community health services - community programs - netherlands - program development - quality of life - socioeconomic status - lichamelijke activiteit - gezondheid op regionaal niveau - voorzieningen tbv de gezondheid op regionaal niveau - gemeenschapsprogramma's - nederland - programmaontwikkeling - kwaliteit van het leven - sociaal-economische positie
Background: In the Netherlands, inequalities in physical activity behaviour go hand in hand with socioeconomic inequalities in health. To promote physical activity effectively and equitably, participatory community-based physical activity interventions seem promising and are supported by the Dutch government’s policy. Although many strategies have been developed to increase physical activity levels in general and in socially vulnerable groups in particular, most evaluations show only small to moderate effects. To date, the evidence base rests mainly on correlational, cross-sectional studies at participant level, lacking insight into causal relationships and interaction patterns between factors influencing physical activity. In addition, in line with Dutch health promotion policy, there is a general demand for community-based health-enhancing physical activity (CBHEPA) programs to be evaluated for impacts and (cost)effectiveness.
Aim: The aim of this PhD research was to assess the effectiveness of these community-based physical activity programs at different impact levels (individual, group, and program), including the mechanisms generating outcomes. This study aims to contribute to the evidence base of programs targeting socially vulnerable groups, by applying systematically a multilevel and realist perspective in order to generate recommendations about how to evaluate physical activity promotion interventions targeting socioeconomic inequalities in health and physical activity.
Methods: The research used a mixed methods design, grounded in an ecological perspective on human health, enabling the identification of underlying mechanisms at multiple levels which explain what works and why. A total of 268 participants in 19 groups in seven ongoing CBHEPA programs were monitored between 2012 and 2015. At individual level, a sequential cohort design was used to acquire longitudinal data on developments in physical activity behaviour and health-related indicators, and to assess participants’ willingness to pay for sport and physical activity. At group and program level, qualitative techniques of measurement and analyses were used, thus linking outcomes at multiple impact levels from different datasets over a period of time, adding contextual and time-related value to our findings building a realist synthesis protocol.
Results: Based on a multilevel analysis, our findings showed that the CBHEPA programs reach socially vulnerable, but not necessarily inactive, groups in terms of socioeconomic and health-related quality of life outcomes. No increase in physical activity levels over time were found, but the findings suggest that ongoing programs contributed to physical activity maintenance in the target population. Significant positive associations were found between leisure-time physical activity, and health-related quality of life, self-efficacy, and enjoyment.
Furthermore, participants’ willingness to pay (WTP) for sports and physical activity was explored in terms of money and time in relation to WTP predictors. The average monetary WTP amounted to €9.60/month, exceeding the average monthly program fees actually paid by €2.64, and was positively associated with income and sport and physical activity experiences. The average WTP in travel time was close to18 minutes and was positively associated with income and age. Indications are that short-term program satisfaction is probably more decisive for willingness to pay than long-term perspectives of improving health-related quality of life.
At group level, fostering group processes was found as an overarching principle, conditional for spin-offs in terms of enjoyment and active participation, which, in turn, lead to a sense of ownership among participants, who take up responsibility for the exercise group as well as for their individual activity behaviour. CBHEPA programs thrive on participants having fun together and on exercise trainers’ leadership skills.
The issue of physical activity maintenance was explored in the case of women of non-Western origin. The factors influencing physical activity maintenance at individual level were: perceived (health) benefits, self-regulation, and learning outcomes regarding physical activity and social participation. At group level, mutual support, security, sharing stories, and trust were important factors. At program level program, quality, staff responsiveness, continuity, and accessibility were important factors. Individual perceived benefits and factors at group and program level, aimed at an appropriate mix of exercise and social activities, contributed significantly to physical activity maintenance by women of non-Western origin.
At program level, outcomes of interest, identified by local stakeholders, related to community outreach, program sustainability, intersectoral collaboration, and enhancing participants’ active lifestyles. Supportive contexts were municipal policies in support of community-based programs, established collaborative structures and community networks, and alignment with other health and welfare projects. Stakeholders’ past experiences with sport and physical activity projects and commitment to the target group were strong additional supportive contextual factors. Supportive mechanisms were entrepreneurship, leadership, responsiveness, deployment of professional exercise trainers, and ensuring the implementation of tailored and accessible program activities. Local governance structures, however, appeared often to lack adaptive capacity to accommodate multilevel processes to realise the sustainment of CBHEPA programs. Policy volatility often results in discontinuity of project funding and collaborative processes, and a reduction in the availability of professional expertise, thus hampering program development and sustainability.
Conclusions: CBHEPA programs, if supported in their performance and sustainability, succeed in generating physical activity maintenance in socially vulnerable groups. Two parallel tracks of value co-creation were identified, reflecting value-in-social-context shaped by social forces and reproduced in social structures through interaction and dialogue: the institutional track, involving the collaborative processes at institutional level, and the exercise group track, involving the collaborative processes in the exercise groups. The exercise trainer is usually the only linchpin responsible for connecting these parallel tracks. Strong evidence was found on how contextual dynamics shape local CBHEPA initiatives and on the need for responsiveness and adaptive mechanisms in the institutional track as well as in the exercise group track, in order to realise sustained CBHEPA programs.
We suggest future research on physical activity behaviour and maintenance to focus not only on how individuals act, but also on how individuals, groups, and environments interact. This calls for evaluation strategies which align accountability with learning through evaluation.
Teelt de grond uit mogelijk, maar niet zonder onderzoek. (over het onderzoek van: JJ de Haan, T. Vermeulen, H. van Reuler en S. de Kool)
Baakman, L. ; Haan, J.J. de; Vermeulen, T. ; Kool, S.A.M. de; Reuler, H. van; Blind, M. - \ 2013
BloembollenVisie 2013 (2013)286. - ISSN 1571-5558 - p. 58 - 59.
tuinbouw - gewasteelt - alternatieve methoden - substraten - gesloten systemen - cultuurmethoden - emissie - reductie - pesticiden - programmaontwikkeling - landbouwkundig onderzoek - horticulture - crop management - alternative methods - substrates - closed systems - cultural methods - emission - reduction - pesticides - program development - agricultural research
De meeste bolgewassen groeien gewoon in de grond. Toch zijn er nog andere manieren. Het programma 'Teelt de grond uit' onderzocht de verschillende mogelijkheden zoals telen op water, substraten en op een afgedichte ondergrond. Tijdnes een informatiedag in Venray werd de stand van zaken tot nu toe toegelicht. Er zijn mogelijkheden, maar vervolgonderzoek is gewenst. En dat komt er.
Approaches and methods for monitoring and evaluation
Mierlo, B.C. van - \ 2011
Syscope Magazine 2011 (2011)summer. - p. 31 - 33.
systeeminnovatie - programma-evaluatie - evaluatie - programmaontwikkeling - projectcontrole - netwerken - multi-stakeholder processen - landbouwontwikkeling - system innovation - program evaluation - evaluation - program development - project control - networks - multi-stakeholder processes - agricultural development
The aim of many agricultural innovation networks is to realize a system innovation. With system innovation, whole production and consumption systems change, including social relationships, division of roles, formal rules and values, and the technical artefacts and infrastructure. This type of innovation takes place when stakeholders learn from each other in a process of thinking and acting together. In order to get to grips with these learning processes, it is increasingly common to use monitoring and evaluation methods. What are the methods that can be used, what are the most significant differences between them and to what degree are the methods from the different approaches of use in evaluating and managing innovation projects?
Networks learn from learning histories
Zaalmink, W. - \ 2011
Syscope Magazine 2011 (2011)summer. - p. 34 - 37.
netwerken - programmaontwikkeling - projectcontrole - programma-evaluatie - kennisoverdracht - veehouderij - networks - program development - project control - program evaluation - knowledge transfer - livestock farming
The research programme Networks in Animal Husbandry began in 2004 without any concrete final objectives. The programme did have to contribute in all sorts of ways: by making “knowledge from the shelf” applicable, to making animal farming more robust, stimulating new knowledge arrangements and even to system innovations. It did all that – and more – in its facilitating role in the networks of animal farmers and other stakeholders in the sector. The programme began in effect as a big experiment.
Meer draagvlak voor beleid met werkmethode omgevingsscenario's
Noorduyn, L. - \ 2007
Syscope Magazine (2007)14. - p. 18 - 20.
diergezondheid - landbouwbeleid - duurzaamheid (sustainability) - programmaontwikkeling - systeeminnovatie - participatieve methoden - animal health - agricultural policy - sustainability - program development - system innovation - participation methods
Mariëtte Klein had, als projectleider diergezondheid bij LNV, de taak een Nationale Agenda Diergezondheid op te stellen. Met de grote uitbraken van vogelpest, MKZ en varkenspest vers in het geheugen was inmiddels duidelijk dat zo’n agenda niet alleen de professionele dierhouders aangaan, maar ook de rest van maatschappij. Van recreanten die niet meer overal mogen komen, hobbydierhouders die ook hun kippen moet ophokken tot burgers in de stad die geconfronteerd worden met beelden van grote grijpers die dode biggen afvoeren
KB-WOT Fisheries Research : programme for 2007
Dickey-Collas, M. ; Beek, F.A. van - \ 2007
IJmuiden : Centrum voor Visserijonderzoek (CVO) (CVO report no. 07.006) - 53
visserij - visserijbeleid - visserijbeheer - toegepast onderzoek - programmaontwikkeling - programma's - budgetten - mariene ecologie - nederland - aquatische ecosystemen - fisheries - fishery policy - fishery management - applied research - program development - programs - budgets - marine ecology - netherlands - aquatic ecosystems
LNV programma 406 omvat de wettelijke taken die door DLO uitgevoerd worden en betrekking hebben op de visserij. Binnen dit programma is er een Kennisbasis budget dat bedoeld is voor het ontwikkelen en onderhouden van expertise om dit programma uit te kunnen voeren. Dit rapport beschrijft hoe het budget voor 2007 (€ 621000) aan onderzoeksprojecten is toegekend. Van ieder onderzoeksproject wordt een beschrijving gegeven. De projecten zijn onderverdeeld in vijf thema’s: 1) invloed van veranderende leefomgeving op mariene ecosystemen, 2) impact van visserij op ecosysteem, 3) visserijbeheer, 4) onderhoud sleutelexpertise en 5) kleine onderzoeksprojecten. Het rapport geeft bovendien een doorkijk naar de behoefte aan Kennisbasis budget voor de periode van 2008-2010