Development of a Framework for Scaling Up Community-Based Health Promotion: A Best Fit Framework Synthesis.

Community-based health promotion with a focus on people with social disadvantages is essential to address persistently existing health inequities. However, achieving an impact on public health requires scaling up such approaches beyond manifold funded pilot projects. The aim of this qualitative review is to provide an overview of scaling-up frameworks in health promotion and to identify key components for scaling up community-based health promotion. First, we conducted a systematic search for scaling-up frameworks for health promotion in PubMed, CINAHL, Scopus, Web of Science, PsycInfo, and SportDiscus. Based on the included frameworks, we created an a priori framework. Second, we searched for primary research studies in the same databases that reported scaling-up processes of community-based health promotion. We coded the data using the a priori framework. From 80 articles, a total of 12 frameworks were eligible, and 5 were included for data extraction. The analysis yielded 10 a priori defined key components: "innovation characteristics"; "clarify and coordinate roles and responsibilities"; "build up skills, knowledge, and capacity"; "mobilize and sustain resources"; "initiate and maintain regular communication"; "plan, conduct, and apply assessment, monitoring, and evaluation"; "develop political commitment and advocacy"; "build and foster collaboration"; "encourage participation and ownership"; and "plan and follow strategic approaches". We further identified 113 primary research studies; 10 were eligible. No new key components were found, but all a priori defined key components were supported by the studies. Ten key components for scaling up community-based health promotion represent the final framework. We further identified "encourage participation and ownership" as a crucial component regarding health equity.

Supportive environments for physical activity, community action, and policy in 8 European Union Member States: comparative analysis and specificities of context.

BACKGROUND: A multilevel theoretical framework of physical activity (PA) promotion that addresses supportive environments, PA behavior, community action, and PA promoting policies is related to research and development in an international comparative study. METHODS: Most-different and most-similar case selection was applied to data from 8 European Union Member States. Data from semistructured key informant qualitative interviews, focus group interviews with experts and policy-makers, as well as document analysis were linked to corresponding Eurobarometer data. RESULTS: The framework on the interplay of environment, PA behavior, community action and policies appears to be working across most different countries. Comprehensive systems of PA infrastructures are interlinked with relatively high levels of PA prevalence. These countries implement comprehensive national policies on PA promotion and show a positive perception of related local governments' engagement. Less comprehensive systems of infrastructures interplay with lower levels of PA prevalence, less community action and fewer policies. Differences between similar cases are linked to country-specific contexts. CONCLUSIONS: Framework application and comparative analysis indicates how to relate theory to empirical research and complex data sets. In-depth analysis of country-specific contexts and longitudinal observation on changes within and between countries might advise on how to integrate the framework into intervention research.

Response Conversion for improving comparability of International Physical Activity data.

BACKGROUND: Many questionnaires for measuring physical activity (PA) exist. This complicates the comparison of outcomes. METHODS: In 8 European countries, PA was measured in random samples of 600 persons, using the IPAQ as a 'bridge' to historical sets of country-specific questions. We assume that a unidimensional scale of PA ability exists on which items and respondents can be placed, irrespective of country, culture, background factors, or measurement instrument. Response Conversion (RC) based on Item Response Theory (IRT) was used to estimate such a common PA scale, to compare PA levels between countries, and to create a conversion key. Comparisons were made with Eurobarometer (IPAQ) data. RESULTS: Appropriateness of IRT was supported by the existence of a strong first dimension established by principal component analysis. The IRT analysis resulted in 1 common PA scale with a reasonable fit and face validity. However, evidence for cultural bias (Differential Item Functioning, DIF) was found in all IPAQ items. This result made actual comparison between countries difficult. CONCLUSIONS: Response Conversion can improve comparability in the field of PA. RC needs common items that are culturally unbiased. Wide-scale use of RC awaits measures that are more culturally invariant (such as international accelerometer data).