Health Promotion in Socially Vulnerable Youth: Sports as a Powerful Vehicle?

Community sport has emerged in the past decades and uses sports as a lever to improve health and well-being among socially disadvantaged youth. Despite this premise, we do not know whether and to what extent health promotion aims are achieved within community sports practice. Measurable actions are needed, but it can be hard for researchers or practitioners to know how to approach this. This study aimed at developing a health-promoting intervention targeting youth attending community sports. To this aim, we used a planned approach for intervention design within a community-based participatory research design. The result is a group-based program promoting health-supportive behavior among community sport coaches, as we found coaches to be quintessential in fostering motivation toward health behavior change in vulnerable youth attending community sports. The design of such a complex intervention is difficult, yet tractable, when using a planned approach. Of importance, community engagement was the core of our work and we provide the reader with detailed examples on the combined use of participatory research and planned intervention design. This article provides an exemplar of how to approach the development of a health-promoting intervention in hard-to-reach populations.

How community sport programs may improve the health of vulnerable population groups: a program theory.

BACKGROUND: Groups at risk of exclusion from society appear to have a lower health status and more health-related problems. Prevention efforts in these groups are not always successful, and new ways have to be sought by which health messages can be delivered. Many agree on low-threshold sport activities, also called 'community sports', to be a powerful tool to target socially vulnerable groups. Until now, it has not been investigated how and when such sport initiatives may be able to impact health outcomes in socially vulnerable populations. This study aims at developing a program theory that clarifies the mechanisms and necessary conditions for sport programs to be effective in health promotion. Such a program theory may constitute a backbone for developing health promotion initiatives within a sport for development setting. METHODS: We developed a program theory using a realist research design. We build on an extensive data set consisting of the insights of key stakeholders and participants of various community sport organizations at the one hand, and on relevant theoretical frameworks at the other hand. Data were collected through participatory observations of soccer trainings and related group activities, interviews with key stakeholders and participants, document analysis and two focus groups with stakeholders from associated social partnership organizations. RESULTS: The health promoting effect of community sport on socially vulnerable groups seems not to result from an improved physical condition or sport-technical skills as such, but from processes of experiential learning among peers, incremental responsibility-taking and reflexivity. On the condition that participants feel safe, are stimulated to reflect and enabled to become actor of themselves and their situation, these processes are likely to lead to increased self-esteem, self-efficacy and motivation to set and pursue personal (health) goals. The key-influencing factor in these processes is the coach, who therefore needs to be adequately skilled in, for example, social vulnerability, motivational coaching and group dynamics. CONCLUSIONS: The program theory developed in this study offers insights in the mechanisms proper to, and necessary conditions for community sport to be a lever for health promotion in socially vulnerable groups. Motivational processes at individual level and group connectivity are at the basis of personal health goal-setting. One of the necessary conditions is that these processes are guided by community sport coaches skilled in the meaning and impact of social exclusion, and capable of connecting with the target group.

"To mean something to someone": sport-for-development as a lever for social inclusion.

BACKGROUND: Socially excluded groups are at higher risk of low well-being and poor health. The link between social exclusion and health inequities is complex, and not being involved in society makes it difficult to be reached by standard prevention programs. Sport-for-development (SFD) programs are low-threshold and may be promising settings for inclusive actions. We explore the underlying mechanisms through which SFD might have an impact on social inclusion and examine the necessary conditions that work as a catalyst for these underlying mechanisms. METHODS: A realist evaluation approach was adopted. A non-profit SFD organization in a middle-large city in Flanders, Belgium, formed the setting for a single case study. Document analysis, participatory observations, interviews, and a focus group, were sources for identifying necessary context elements and essential mechanisms through which SFD could promote its participants' health and wellbeing. RESULTS: Among the most efficient mechanisms triggered by the Foundation's activities are learning by fun, connecting with peers (of whom some serve as role model) and engaging as a volunteer with some responsibilities. Building trust in oneself and in others is a necessary process throughout all these mechanisms. Facilitating context factors include the activities' accessibility and unconditional approach (creating a sense of safety), the popularity of the first division football team the Foundation is associated with (leading to a sense of belonging), a steady network of social partners and a strongly positive relationship with the SFD coach(es). CONCLUSIONS: Our findings demonstrate that a SFD setting may be a vehicle for engaging hard-to-reach population groups. It enhances socially vulnerable persons' sense of competence and connectedness, leading to opportunities to improve life and work skills transferrable outside SFD settings. Based on these findings, suggestions are provided that may enhance the field and help to develop feasible (policy-led) interventions designed to promote social inclusion.

Maternal and Child Health Services in the Context of the Ebola Virus Disease: Health Care Workers' Knowledge, Attitudes and Practices in Rural Guinea.

The objective of this study was to document maternal and child health care workers' knowledge, attitudes and practices on service delivery before, during and after the 2014 EVD outbreak in rural Guinea. We conducted a descriptive cross-sectional study in ten health districts between October and December 2015, using a standardized self-administered questionnaire. Overall 299 CHWs (94% response rate) participated in the study, including nurses/health technicians (49%), midwives (23%), managers (16%) and physicians (12%). Prior to the EVD outbreak, 87% of CHWs directly engaged in managing febrile cases within the facility, while the majority (89% and 63%) referred such cases to another facility and/or EVD treatment centre during and after the EVD outbreak, respectively. Compared to the period before the EVD outbreak when approximately half of CHWs (49%) reported systematically measuring body temperature prior to providing any care to patients, most CHWs reported doing so during (98%) and after the EVD outbreak (88%). The main challenges encountered were the lack of capacity to screen for EVD cases within the facility (39%) and the lack of relevant equipment (10%). The majority (91%) of HCWs reported a decrease in the use of services during the EVD outbreak while an increase was reported by 72% of respondents in the period following the EVD outbreak. Infection prevention and control measures established during the EVD outbreak have substantially improved self-reported provider practices for maternal and child health services in rural Guinea. However, more efforts are needed to maintain and sustain the gain achieved.

Switching the poles in sexual and reproductive health research: implementing a research capacity-strengthening network in West and North Africa.

Health research capacities have been improved in Africa but still remain weak as compared to other regions of the World. To strengthen these research capacities, international collaboration and networking for knowledge and capacity transfer are needed. In this commentary, we present the Network for Scientific Support in the field of Sexual and Reproductive Health in West and North Africa, its priority research topics and discuss its implementation process. Established in January 2014, the Network aims at generating human rights and gender-based research fully carried out and driven by South based institutions. It is composed of 12 institutions including the Institute of Tropical Medicine of Antwerp (Belgium) and 11 institutions from eight Francophone West and North African countries. The key areas of interest of this network are health policies analysis and health system research in family planning, HIV prevention among vulnerable groups, quality of care and breast cancers. Since it started, seventeen research proposals based on locally relevant research questions have been developed. Among the seventeen proposals, eleven have been implemented. Several research institutions enhanced linkages with local representations of international partners such as UNFPA. The network is committed to strengthening methodological research capacities and soft skills such as fundraising, advocacy and leadership. Such competencies are strongly needed for developing an effective South-based leadership in Sexual and Reproductive Health research, and for achieving the Sustainable Development Goals.

Evaluation of a program targeting sports coaches as deliverers of health-promoting messages to at-risk youth: Assessing feasibility using a realist-informed approach.

Unequal access to health promotion resources and early prevention services is a major determinant of health inequity among youth. Initiatives that improve the access to and adoption of health promotion messages are important undertakings, e.g., sport. Sport-for-development (SFD) programs are seen as valuable delivery tools, in which coaches are used as change agents to increase health awareness and behavior among at-risk youth. The delivery of such messages requires specific knowledge and skills that can be attained through training; however, the effectiveness of such training requires assessment. In this study, we evaluated the feasibility of such a training program for SFD coaches using process evaluation from a realist perspective, and views from multiple stakeholders, among other sources. We also clarified the inner workings of the training and investigated how context shaped the training outcomes. Increased health awareness and a sense of responsibility from acting as a role model for at-risk youth were among the perceived training outcomes. Building a safe environment for learning, engagement, and bonds of trust increased the confidence to learn, and resulted in a sense of critical self-reflection and self-development of SFD coaches towards health and prevention messages. Importantly, the unique situations (or context) of SFD coaches and SFD in general presented challenging variables, e.g., a precarious life history or living conditions, mental health issues, or low educational skills, that hampered the impact of the mechanisms put in place by the training. Here, we present a process in which the development of the 'right mind-set,' engagement and bonds of trust, in combination with the right settings are key elements for SFD coaches to learn how to convey health-promoting messages and take responsibility as role models for at-risk youth.

"They Are After Quantity, Not Quality": Health Providers' Perceptions of Fee Exemption Policies in Morocco.

BACKGROUND: A free obstetric care policy (FOCP) has been implemented in Morocco in 2008 in order to further decrease maternal mortality. METHODS: Through in-depth interviews we explored the perceptions of health professionals in public Moroccan hospitals with regard to fee exemption policies. We tried to understand what drives health professionals to ignore, modify or apply a health policy as formulated. RESULTS: Respondents express significant influences of such policies on their work environment (higher workload and scarcity of resources) and on the patient/provider relationship, both of which may cause a negative effect on health workers' motivation. A mix of motivational determinants incites health workers in their turn to influence policy implementation. CONCLUSION: Understanding the motivational determinants of health workers may optimize policy implementation at the point of service delivery.