Intersectoral collaboration in a Dutch community health promotion programme: building a coalition and networks.

In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. A health broker role is recognized as being helpful in connecting the coalition with the broader network, and participatory action research (PAR) is deemed supportive because it facilitates evaluation, reflection, learning and action. However, there is a lack of insight into how processes that affect collaboration develop over time. Therefore, this study aimed to provide insights into the coalition's processes that facilitate building and maintaining intersectoral collaboration within a HPP coalition and network and how these processes contribute to the coalition's ambitions. As part of PAR, the coalition members used the coordinated action checklist (CAC) and composed network analysis (CNA) in 2018 and 2019. The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on pro-gress and future planning. Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership and the importance of visibility and trust leading to investment in continuation. The combined research instruments and group sessions supported discussion and reflection, sharing visions and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.

In this study, we explored collaboration between professionals working in different sectors within and outside healthcare. We looked at the processes that facilitate the building and maintenance of intersectoral collaboration within a coalition that developed a health promotion programme together with a network of contacts in the community. Participatory action research (PAR) was used, which means that results from research tools like questionnaires and interviews were discussed with workers and inhabitants involved, so that they could adjust their working strategy and ambitions. The most important processes appeared to be the organization of the coalition, how the members of the coalition interacted with the context and built the network, and how they publicized their activities. Important findings concerned the health broker's role, the programme coordinator's leadership and the importance of visibility and trust. The collaboration in this programme delivered the following achievements: increased capacities of group members, health promoting activities, a broader and strengthened network and a shift in community workers' thinking about health, resulting in the involvement of the municipality, which provided budget to invest in the continuation of the programme. We concluded that PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.

Qualitative evaluation of a Salutogenic Healthy Eating Programme for Dutch people with type 2 diabetes.

The salutogenic model of health (SMH) is a health-promoting theory that focuses on resources, strengths, and coping capacities in everyday life as a way to improve health and wellbeing. The SMH was applied to develop a programme for enabling healthy eating practices among people with type 2 diabetes mellitus (T2DM): the SALUD programme. This study aims to gain insight in how participants with T2DM experienced the content and meaning of the SALUD programme. Three focus groups with participants (six to eight participants/group) that finished the SALUD programme were conducted. The focus groups were video-recorded, transcribed ad verbatim and thematically analysed. The SALUD programme was perceived by the participants as a positive, meaningful learning experience. Key factors why the participants described the programme as positive were that they felt a sense of social-belonging and (emotionally) safe (theme 1). The SALUD programme's positive encouraging approach presented by the coach invited participants to join an active learning process (theme 2). Performing trial-and-error experiments and weekly reflecting on goals is what characterized active learning. The meaningfulness of the learning process (theme 3) was derived from (i) positive self-confrontation; (ii) exploring mind-body connections and perceiving improved health and (iii) noticing positive changes in their social environment (theme 3). To conclude, the study uncovered that the SALUD programme incited a positive, meaningful learning process for healthy eating and the contextual factors important in this. Potential leads to further improve the SALUD programme are discussed in order to maximize the chance of inciting an inclusive, active learning process.

Bariatric surgery stigma from the perspective of patients: A scoping review.

AIMS: To explore the experiences and consequences of bariatric surgery stigma from the perspective of bariatric surgery patients and to identify knowledge gaps in the literature. DESIGN: A scoping review. DATA SOURCES: Studies published between December 2002 and January 2022 were identified from the following databases: PubMed, Web of Science, PsycINFO and MEDLINE. REVIEW METHODS: We screened 3092 records and included 28 studies. Findings were grouped thematically using the health stigma discrimination framework. RESULTS: Patients experienced several types of stigmas, including perceived, experienced, anticipated and internalized stigma, related to undergoing bariatric surgery. Patients were confronted with negative comments and judgement from others when they disclosed their decision to have surgery or when they revealed that they had undergone surgery. These experiences led to conflicts in the decision-making process, such as delaying the choice for surgery, seeking surgery abroad or opting out. Patients who internalized stigma often reported feelings of shame and embarrassment for choosing surgery and felt the need for secrecy or selective disclosure. Stigma experiences were influenced by gender and differed between different subgroups of patients. CONCLUSION: The stigma surrounding bariatric surgery has detrimental consequences for eligible individuals and bariatric surgery patients. However, the evidence from patients' perspective remains limited. More research into patient's experiences is needed to improve patient care and further educate healthcare professionals. In addition, to better understand the nature and implications of bariatric surgery stigma, future research should be founded on stigma theories and distinguish between the different types of stigmas. IMPACT: This scoping review contributes to a better understanding of the implications the stigma surrounding bariatric surgery has for bariatric surgery patients before and after surgery. The knowledge generated by this review can inform improvements in the education and management of people living with obesity and bariatric surgery patients. REPORTING METHOD: The scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution. PROTOCOL REGISTRATION: A protocol was not registered for this scoping review.

The positive impact of a care-physical activity initiative for people with a low socioeconomic status on health, quality of life and societal participation: a mixed-methods study.

BACKGROUND: Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may improve participants' lifestyles and thereby lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, was offered free of charge to participants, and included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. Here, we study the impact of X-Fittt 2.0 on health, quality of life (QoL) and societal participation using a mixed-methods design. METHODS: Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), one year (t2) and two to three years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using a linear mixed-model analysis (corrected for gender, age at t0, height, education level and employment status at the different time points), while we used descriptive statistics for the categorical variables. Qualitative data were analysed using a thematic analysis. RESULTS: Body weight was significantly lower at all three post-initiative time points compared with the baseline, with a maximum of 3.8 kg difference at t2. Body Mass Index, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks. A positive trend regarding paid work was observed, while social visits decreased. The latter might be explained by the COVID-19 pandemic, as lockdowns limited social life. Furthermore, participants reported increased PA (including sports) and a few stopped smoking or drinking alcohol. Participants mentioned feeling healthier, fitter and more energetic. Additionally, participants' self-esteem and stress levels improved, stimulating them to become more socially active. However, the participants also mentioned barriers to being physically active, such as a lack of money or time, or physical or mental health problems. CONCLUSIONS: X-Fittt 2.0 improved the 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. More complete data are needed to confirm the findings.

What works for vulnerable families? Interpretations of effective health promotion.

Under the umbrella of the Healthy Futures Nearby programme, 46 small-scale projects were funded to promote changes in health-related behaviours (smoking, alcohol, diet and exercise) and to improve perceived health among vulnerable families in the Netherlands. The evaluation of these health-related multiple project programmes is often based on funder-defined outcomes and strategies. However, within the funded projects, assumptions about improving the health of vulnerable families based on local knowledge and experiences will also shape the project outcomes and strategies. These additional outcomes and strategies are project-specific interpretations of effective health promotion. Knowing these interpretations is crucial for the policy related and scientific relevance of the evaluation. Therefore, we aimed to determine the interpretations of each project and how they translate into relevant inputs for the overall evaluation of the programme. Based on 46 semi-structured group interviews with local project stakeholders, we produced a list of assumptions about what health promotion for vulnerable families should look like and then identified five main clusters: (i) strategies of offering pre-defined, health (behaviour)-related activities to families, (ii) actively involving vulnerable families in the initiative, (iii) assumptions about how health promotion should start with or include non-health-related topics, (iv) assumptions on how one should build on what already exists in the local context of the families and (v) assumptions on the role of the (health) professional in health promotion among vulnerable families. These project interpretations of effective health promotion provide inputs and priorities for the HFN programme's overall evaluation.

Qualitative, longitudinal exploration of coping strategies and factors facilitating infant and young child feeding practices among mothers in rural Rwanda.

BACKGROUND: Mothers in low-income countries face many challenges to appropriately feed their children in the first year such as poverty, food insecurity and high workloads. However, even in the lowest income families there are mothers who succeed to feed their children according to the recommendations. In this paper, we explored the coping strategies that facilitate appropriate breastfeeding and complementary feeding practices among rural Rwandan mothers from birth to one year of a child's life. METHODS: This qualitative longitudinal study recruited a purposive sample of 17 mothers who followed the infant and young child feeding recommendations (IYCF). They were selected from a larger study of 36 mothers. In-depth interviews were conducted with mothers of the total group (36 mothers) within the first week, at 4th, 6th, 9th and 12th months postpartum. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. RESULTS: Coping strategies included improving mothers' own diet for adequate breastmilk production, prioritizing child feeding over livelihood chores, livelihood diversification and mothers' anticipatory behaviors such as preparing child's food in advance. Some of those coping strategies were shifting overtime depending on the development of the children. Personal factors such as breastfeeding self-efficacy, religious beliefs and perceived benefits of breastfeeding were among the facilitating factors. Additionally, social support that mothers received from family members, other mothers in the community, Community Health Workers (CHWs) and health professionals played an important role. CONCLUSION: In challenging contextual conditions, mothers manage to follow the recommended breastfeeding and complementary feeding practices through the interplay of active coping strategies, feeling to be in control and social support. Nutrition promotion interventions that aim to improve IYCF should consider strengthening mothers' capability in gaining greater control of their IYCF practices and the factors facilitating their appropriate IYCF practices.

A multilevel transition perspective on embedding intersectoral action in local health policies.

Intersectoral action is advocated as a social practice that can effectively address health inequalities and related social issues. Existing knowledge provides insight into factors that may facilitate or hinder successful intersectoral action, but not much is known about how intersectoral action evolves and becomes embedded in local health policies. This is where this study aims to make its contribution, by adopting the multilevel perspective on transitions, which is increasingly used to study social innovation in sustainability transitions but has not yet been applied to public health and health promotion. Through this perspective, it was unravelled how intersectoral action between youth-care organizations and community sports clubs became embedded in local health policies of Rotterdam, a large city in the Netherlands. A single explorative case study was conducted based on content analysis of policy documents and 15 in-depth interviews with policy officers, managers and field workers operating in the fields of youth and sports in Rotterdam. The findings showed that intersectoral action between community organizations and policymakers evolves through congruent processes at different levels that changed institutional logics. Moreover, it emerged that policymakers and other actors that advocate novel social practices and act as boundary spanners can adopt multiple strategies to embed these practices in local health policy. The multi-level perspective adds value to earlier approaches to research intersectoral collaboration for health promotion as it allows to better capture the politics involved in the social innovation processes. However, further sharpening and more comprehensive application of transition concepts to study transitions in public health and health promotion is needed.

Development of a salutogenic intervention for healthy eating among Dutch type 2 diabetes mellitus patients.

Healthy eating can be challenging for type 2 diabetes mellitus (T2DM) patients. The theory of salutogenesis, which focuses on the resources required to organize behavioural changes in everyday life, was used to develop an intervention for healthy eating. The aim was to describe the development, structure and content of this salutogenic intervention. The development consisted of two phases that were based on the operationalization of important key principles of salutogenesis. In Phase 1 (Exploration and synthesis), a systematic review and three qualitative studies were performed to explore important characteristics to enable healthy eating in everyday life. The results were used to develop the draft intervention. In Phase 2 (Validation and adjustment), interviews and workshops were conducted with T2DM patients, healthcare providers and scientists. Based on this, the draft intervention was modified into its final form. The developmental process resulted in a 12-week, group-based intervention that aimed to enable important resources for healthy eating via self-examination, reflection, setting goals and sharing experiences. Attention was also paid to disease information, disease acceptance, food literacy, stress management, self-identity and social support. The group sessions began following an individual intake session, with a booster session held 3 months after the intervention. The researcher's translation of the stakeholders' priorities into an intervention was corrected for and approved by the stakeholders concerned. This comprehensive salutogenic intervention was developed based on practical and scientific evidence. Providing transparency in developmental processes and content is important because it determines the scientific integrity and credibility of an intervention.

Healthy eating can be difficult for people with the disease type 2 diabetes. This article describes how a programme aimed at helping type 2 diabetes patients to eat healthily was developed. The draft version of the programme was based on a theoretical framework that aims to understand what creates health in everyday life, and on conversations with type 2 diabetes patients and healthcare providers. The draft programme was adjusted based on the feedback of type 2 diabetes patients, healthcare providers and scientists. This resulted in a 12-week, group-based programme that enables people to think about who they are and what they want by setting health goals and sharing experiences. Attention was also paid to disease knowledge, disease acceptance, nutritional skills, dealing with stress, self-identity and social support. The group sessions began following an individual intake session, with a booster session held 3 months after the intervention. By involving everybody, we were able to develop a programme that takes into account the preferences, needs and priorities of all stakeholders. It is important to describe the development and the content of programmes encouraging healthy eating to determine their quality and effectivity.

Life course learning experiences and infant feeding practices in rural Rwanda.

Most studies about infant and young child feeding (IYCF) practices are often perceived as an individual choice depending on mothers' or caregivers' knowledge or attitudes and are focused on mothers' failure rather than successes in adequately feeding their children. However, the role of life course experiences in IYCF is less investigated. Applying a Salutogenic Model of Health, this study on 14 mothers looks at women's life course learning experiences shaping appropriate IYCF practices during the first year of child's life in a rural district of Rwanda. Transcripts from in-depth interviews were analysed using thematic analysis. Results indicate that positive social interaction with parents or grandmothers during childhood such as sharing meals, parental role models for dietary choices and cooking skills gained by participating in household food preparation played a role in shaping appropriate IYCF practices. Negative experiences during childhood also had a positive influence on IYCF practices for some participants by converting life course constraints into learning opportunities. Motherhood increased mothers' sense of responsibility over their children's health and nutrition. Moreover, mothers' participation in community cooking classes and role modelling approach were strong avenues that enabled their learning through positive interactions and encouragement. Nutrition promotion interventions should consider tailoring nutrition advice to the complexity of mothers' life course experiences by creating opportunities for positive learning experiences of appropriate IYCF practices.

Study protocol: evaluation of a community health promotion program in a socioeconomically deprived city district in the Netherlands using mixed methods and guided by action research.

BACKGROUND: Voorstad on the Move (VoM) is a community health promotion program implemented in a socioeconomically deprived city district in the Netherlands. Based on exploration of the health situation, concurrent views on health promotion, and insights from literature, VoM is grounded in a social-ecological perspective and puts three action principles center core: citizens' participation, intersectoral collaboration, and a health supportive environment. VoM aims to improve the health of inhabitants, mostly low socioeconomic status (SES) families, and to realize changes in the social and physical environment. This current research, as part of the wider VoM project, aims to study the impacts and action principles of VoM. The main research questions concern the inhabitants' perceptions on health and health supportive environments, the perceived benefits of citizen participation in terms of health literacy and empowerment, and the factors and mechanisms that contribute to citizen participation and intersectoral collaboration. METHODS: The study has a mixed methods design, including process evaluation and monitoring, and combines qualitative and quantitative data. Research activities include literature study, in-depth interviews, focus group discussions, concept and capacity mapping, document analysis, and health survey data. A prominent strategy is action research, which aims to involve all stakeholders, capturing the different perspectives of citizens and professionals, and engaging low SES groups. The principle of triangulation is continuously applied to optimize the reliability of this study, using multiple methods and multiple sources. Internal validity is enhanced by triangulation of methods and resources. Other verification techniques will also be used, such as expert consultation. DISCUSSION: The design of the study, with a strong focus on action research, facilitates the involvement of all stakeholders and contributes to the development of capacities, learning, and empowerment, and thus contributes to health. The VoM program is innovative because it adopts an open approach in which activities evolve from citizens' needs, with a focus on action elements. This study will unravel the mechanisms of the action elements at community level, thereby helping to find ways to reduce health inequities. The findings will further elucidate what works and why it works for low SES groups.

Poverty-related diseases: factors that predict coping in two Cameroonian settings.

In this paper, we explore the connection between poverty and health (poverty-related diseases: PRDs) by investigating the factors that play a role in how two groups of people in Cameroon cope with health challenges: workers in a large agro-industrial organization (living in 'camps') and students in two major universities (living on 'campuses'). We investigated factors reported in the literature as being associated with coping, summarized under the 'salutogenic umbrella', as well as demographic, social and environmental factors. A total of 509 respondents from camps and campuses participated in this study. We used a combination of standardized and un-standardized survey instruments to measure coping. We used χ2 and ANOVA tests to investigate bivariate differences and multiple logistic regression analysis to determine which significant survey factors predicted coping. Our results showed expected and unexpected differences between the settings. Individual dispositional factors such as sense of coherence (SOC), self-efficacy (SE), subjective wellbeing and self-rated health differed significantly between the settings. Expected coping resources such as income and SE did not differ between non-copers and copers. Two factors emerged as predictors of coping: living environment (setting) and SOC. Our results highlight the need for a multidimensional perspective on poverty and also the need to apply the salutogenic approach in PRD research. In particular, the emphasis this approach puts on stressors and the capacity to employ a variety of resources to overcome stressors is a fruitful way to better understand PRDs and the importance of location-specific circumstances where poverty, health and diseases are connected.

Examining the relationship between sports participation and youth developmental outcomes for socially vulnerable youth.

BACKGROUND: Research has shown that sports participation is positively related to youth developmental outcomes, but it is still unknown if sports participation relates to these outcomes among socially vulnerable youth. Hence, this research aimed to examine the relationship between sports participation and youth developmental outcomes (i.e., problem behaviour, pro-social behaviour, school performance, subjective health, well-being, self-regulation skills, and sense of coherence) for socially vulnerable youth. In addition, the stability of the relationship between sports participation and the youth developmental outcomes were investigated with a six-month interval. METHODS: Two identical questionnaires were administered with a six-month interval by youth professionals from four youth organisations, measuring the youth developmental outcomes and sports participation rates of socially vulnerable youth. In total, 283 socially vulnerable youths (average 14.68 years old) participated at baseline and 187 youths after six months. RESULTS: The results showed that sports participation was positively related to pro-social behaviour, subjective health, well-being, and sense of coherence at both measurements. We found no evidence for the relationship between sports participation and problem behaviour and the self-regulatory skills. In addition, sports participation was only positively related to school performance at the first, but not at the second, measurement. CONCLUSIONS: The results of this study show that there are positive relationships between sports participation and several youth developmental outcomes. Based on the current data no conclusions can be drawn about the causal relationship between sports participation and youth developmental outcomes. Given the focus of policymakers and health professionals on sport as a means to achieve wider social and educational outcomes for young people, including in the Netherlands, further research is needed to shed light on the relationship between sports participation and youth developmental outcomes for socially vulnerable youth, with a special focus on this group's heterogeneity. TRIAL REGISTRATION: Trialregister.nl NTR4621 Date of Registration: 2 June 2014 (retrospectively registered).

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.

Food stories: Unraveling the mechanisms underlying healthful eating.

The biomedical model of health (BMH) studies the causes and origins of disease. When applied to nutrition research, eating is studied as a behavior that supports physical health. However, the lack of attention the BMH pays to social and historical circumstances in which health behaviors are constructed has been widely addressed in literature. When people are studied without considering contextual influences, the relevance to everyday life is limited. As a result, how individuals actively deal with their context to manage healthful eating is poorly understood. This research applies a complementary model, salutogenic model of health (SMH), and uses life course research methodology to study a group of healthy eaters. The purpose of this research is to unravel how healthful eating develops in everyday life. Healthy eaters (n = 17) were identified and recruited from the NQplus research panel at Wageningen University, the Netherlands. Life course experiences were examined through narrative inquiry. Participants recalled and visually explored life experiences with food and health using timelines. Results indicate that healthful eating results from exposure to individual- and context-bounded factors during childhood and adulthood and involves specific mental and social capacities relevant to coping including amongst others, critical self-awareness; flexibility, craftiness, and fortitude. Through life-course learning moments, participants were able to develop proactive coping strategies which strengthened their sense of agency and helped them in overcoming stressors and challenges. Findings show that nutrition strategies should not only focus on strengthening food-specific factors like cooking skills and nutrition knowledge, but other factors like stress management, empowerment, and participation. Such factors support the development of adaptive skills and behaviors, enable individuals to deal with the demands of everyday life, and are building blocks for health promotion.

Exploring the impact of the care sport connector in the Netherlands.

BACKGROUND: Regular physical activity (PA) is deemed to contribute to the primary and secondary prevention of several chronic diseases, like diabetes mellitus, cancer, cardiovascular diseases, and osteoporosis. In 2012, Care Sport Connectors (CSC), to whom a broker has been ascribed, were introduced in the Netherlands to stimulate PA and guide primary care patients towards local sport facilities. The aim of this study was to explore which structural embedding is the most promising for CSCs' work. METHODS: In three rounds of interviews, 13 CSCs were followed for 2 years in their work. In these interviews, a network survey was used to identify organisations in the CSCs' network, whether they collaborated with these organisations, and the role of the organisations in the connection. Data from the network survey were analysed using the RE-AIM framework and disaggregated into how CSCs were structurally embedded (Type A: only PA sector; Type B: different sectors; Type C: partnership). A related samples Wilcoxon signed rank test was performed to study how the CSCs' network developed between 2014 and 2016. RESULTS: All CSCs established a connection between the primary care and the PA sector in which the average number of organisations with which CSCs collaborated increased significantly between 2014 (8.3) and 2016 (19.8) (p = 0.002). However, differences were identified in the way CSCs were structurally embedded and in the way they established the connection. Type A CSCs established the connection mostly around their own activities, supported PA organisations with their activities, and collaborated with primary care and welfare professionals around their own activities. Type B and Type C CSCs established the connection by organising, supporting, and implementing different kinds of activities targeting different kinds of audiences, and collaborated mostly with primary care professionals around the referral of professionals' patients. CONCLUSIONS: The results of this study suggest that adopting an integral approach (Type B and C) for the structural embedding of the CSC is more promising for reaching the desired outcomes. Whether CSCs really improve the target groups' PA level and health needs to be further studied. TRIAL REGISTRATION: Dutch Trial Register NTR4986 . Registered 14 December 2014.

The connection between the primary care and the physical activity sector: professionals' perceptions.

BACKGROUND: To stimulate physical activity (PA) and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC), to whom a broker role has been ascribed, were introduced in 2012 in the Netherlands. The aim of this study is to assess perceptions of primary care, welfare, and sport professionals towards the CSC role and the connection between the primary care and the PA sector. METHODS: Nine focus groups were held with primary care, welfare and sport professionals within the CSC network. In these focus groups the CSC role and the connection between the sectors were discussed. Both top-down and bottom-up codes were used to analyse the focus groups. RESULTS: Professionals ascribed three roles to the CSC: 1) broker role, 2) referral, 3) facilitator. Professionals were enthusiastic about how the current connection was established. However, barriers relating to their own sector were currently hindering the connection: primary care professionals' lack of time, money and knowledge, and the lack of suitable PA activities and instructors for the target group. CONCLUSIONS: This study provides further insight into the CSC role and the connection between the sectors from the point of view of primary care, welfare, and sport professionals. Professionals found the CSC role promising, but barriers are currently hindering the collaboration between both sectors. More time for the CSC and changes in the way the primary care and PA sector are organized seem to be necessary to overcome the identified barriers and to make a success of the connection. TRIAL REGISTRATION: Dutch Trial register NTR4986 . Registered 14 December 2014.

Exploring participant appreciation of group-based principles for action in community-based physical activity programs for socially vulnerable groups in the Netherlands.

BACKGROUND: Physical inactivity is a core risk factor for non-communicable diseases. In the Netherlands, socially vulnerable groups are relatively less active than groups with higher socio-economic status. Community-based health-enhancing physical activity (CBHEPA) programs aim to empower socially vulnerable groups by improving participants' health and wellbeing through physical activity. CBHEPA programs often revolve around group-based principles for action, such as active participation, enjoyment, and fostering group processes. As such principles are rarely made explicit, our study aims to identify which of the group-based principles for action are considered important by participants. METHODS: Respondents (n = 76) from ten focus groups scored their individual appreciation of group-based principles for action - active participation, enjoyment, and fostering group processes - on a three-point, statement-based scale. Opinions were further discussed in the focus group. Focus group discussions were transcribed and analysed by a team of investigators. The coding procedures, identifying elements appreciated in group-based principles for action, were thematic and data driven. RESULTS: Statements about participatory programming generated much less consensus in appreciation among respondents than statements about enjoyment and fostering group processes. To some extent, group members participated in the development of program content. Participation in group formation or community initiatives was less frequently perceived as something within group members' control. Enjoyment, expressed as physical and emotional experiences, was found to be an individual driver of group exercise. Fostering group processes, expressed as social support, was found to contribute to enjoyment and learning achievements. Responsive leadership, ensuring responsive guidance, by an enthusiastic exercise trainer acting as a role model, were identified as additional necessary principles for action. CONCLUSIONS: Group-based principles for action in CBHEPA programs are not clearly demarcated. Fostering group processes is an overarching principle, conditional for the spin-off in terms of enjoyment and active participation. This, in turn, leads to a sense of ownership among participants, who take up responsibility for the exercise group as well as their individual activity behaviour. CBHEPA programs thrive on participants having fun together and exercise trainers' leadership skills. A professional, competent, responsive exercise trainer plays a key role in the organisation and maintenance of CBHEPA programs.

Beyond bridging the know-do gap: a qualitative study of systemic interaction to foster knowledge exchange in the public health sector in The Netherlands.

BACKGROUND: Despite considerable attention currently being given to facilitating the use of research results in public health practice, several concerns remain, resulting in the so-called know-do gap. This article aims to identify the key tensions causing the know-do gap from a broad perspective by using a systemic approach and considering the public health sector as an innovation system. METHODS: An exploratory qualitative design including in-depth semi-structured interviews was used, with 33 interviewees from different actor categories in the Dutch public health innovation system. The analyses employed an innovation system matrix to highlight the principal tensions causing the know-do gap. RESULTS: Seven key tensions were identified, including: research priorities determined by powerful players; no consensus about criteria for knowledge quality; different perceptions about the knowledge broker role; competition engendering fragmentation; thematic funding engendering fragmentation; predominance of passive knowledge sharing; and lack of capacity among users to use and influence research. CONCLUSIONS: The identified tensions indicate that bridging the know-do gap requires much more than linking research to practice or translating knowledge. An innovation system perspective is crucial in providing information on the total picture of knowledge exchange within the Dutch public health sector. Such a system includes broader stakeholder involvement as well as the creation of social, economic, and contextual conditions (achieving shared visions, building networks, institutional change, removing financial and infrastructural barriers), as these create conducive factors at several system levels and induce knowledge co-creation and innovation.

Profiling healthy eaters. Determining factors that predict healthy eating practices among Dutch adults.

Research has identified multiple factors that predict unhealthy eating practices. However what remains poorly understood are factors that promote healthy eating practices. This study aimed to determine a set of factors that represent a profile of healthy eaters. This research applied Antonovsky's salutogenic framework for health development to examine a set of factors that predict healthy eating in a cross-sectional study of Dutch adults. Data were analyzed from participants (n = 703) who completed the study's survey in January 2013. Logistic regression analysis was performed to test the association of survey factors on the outcome variable high dietary score. In the multivariate logistic regression model, five factors contributed significantly (p < .05) to the predictive ability of the overall model: being female; living with a partner; a strong sense of coherence (construct from the salutogenic framework), flexible restraint of eating, and self-efficacy for healthy eating. Findings complement what is already known of the factors that relate to poor eating practices. This can provide nutrition promotion with a more comprehensive picture of the factors that both support and hinder healthy eating practices. Future research should explore these factors to better understand their origins and mechanisms in relation to healthy eating practices.

Enhancing life prospects of socially vulnerable youth through sport participation: a mixed methods study.

BACKGROUND: Sport participation has been associated with improved life prospects such as academic performance and employability prospects. As such, promoting sport participation might be a way to increase life prospects, especially for socially vulnerable youth because they are less physically active than their peers. However, the evidence for the causal effect of sport participation on these outcomes is still limited and little is known about factors that play a role in this possible effect. The aim of this study is four-fold. First, the causal effect of sport participation on life prospects is studied and the underlying mechanisms of this relation are explored. Secondly, the life experiences of the youngsters in the sport context, that may contribute to skill development, are studied. Thirdly, social conditions for a positive effect are explored, as sport is likely to have a positive effect under specific conditions. Fourthly, this study aims to provide insights on the elements of successful partnerships between youth care organisations and local sport clubs. METHODS AND DESIGN: This protocol reports on a mixed method study. An intervention that aims to increase the sport participation of socially vulnerable youth, between 12-23 years old, is implemented in three regions of a Rotterdam youth care organisation. The youngsters in the two control regions receive care-as-usual. The main outcome variables, collected via questionnaires, are the life prospect, sense of coherence and self-regulation skills of the youngsters after 6 and 18 months of follow-up. The Motivational Climate Scale is administered to explore the social conditions for a positive effect and interviews are conducted with sport coaches to explore their role in skill development. Interviews with the youngsters are conducted to gain insight on the life experiences that may lead to skill development. The elements of successful partnerships are collected during interviews with youth care professionals, sport coaches and other stakeholders in the sport context. DISCUSSION: The results of this study can support efforts of youth care organisations and local sport clubs to improve the life prospects of socially vulnerable youth through sport participation. TRIAL REGISTRATION: Trialregister.nl NTR4621 Date of Registration: 2 June 2014.