Measuring capabilities in health and physical activity promotion: a systematic review.

BACKGROUND: The capability approach by Amartya Sen and Martha Nussbaum has gained increasing attention in the field of public health. As it combines individual, social and structural factors and shifts the focus of attention from the actual behavior towards available options for health behaviors that people can actually choose from, it may help advance our understanding of complex health issues. OBJECTIVES: The aim of this article is to identify and describe tools available to measure capabilities within the context of health, with a specific focus on capabilities for health-enhancing physical activity. METHOD: We conducted a systematic literature review using 11 databases covering scientific journal articles published in English or German between the years 2000 and 2020 with a focus on capabilities for health or physical activity. RESULTS: We found a total of 51 articles meeting our inclusion criteria. Four articles measured capabilities using qualitative methods, one combined qualitative and quantitative methods, while the rest used quantitative methods. We identified a total 11 different capability questionnaires, all showing moderate to good validity/reliability. Only one questionnaire and one interview-based tool specifically dealt with capabilities for health enhancing physical activity. CONCLUSION: Although we were able to identify measurement tools for capabilities in health, this review has shown that there is no generic tool available for the measurement across all population- and age-groups, and tools focusing on physical activity are scarce. However, our results can be used as guide for future projects that aim at measuring capabilities.

[Physical activity and public health]. / Körperliche Aktivität und Public Health.

The article describes existing recommendations and prevalences of physical activity. In addition, different intervention strategies for the promotion of physical activity on the population level and evidence for their effectiveness are discussed. Intervention strategies are categorized in individually adapted approaches, community-based approaches, mass media campaigns, approaches as part of health service delivery, and policy and environmental approaches. Reviews indicate evidence for the effectiveness of individually adapted approaches for physical activity promotion. However, these approaches might not be well suited to reach certain subgroups of populations. For community-based approaches and for mass media campaigns, at this point, conflicting evidence exists. Interventions as part of health service delivery seem to mostly result in short-term effects regarding physical activity. For policy and environmental approaches, reviews indicate effectiveness.

Assessment of organizational readiness for health promotion policy implementation: test of a theoretical model.

Models explaining the engagement of organizations in different policy sectors in health promotion policy implementation often utilize retrospective data. The current study attempted to model determinants of organizational readiness (goals, resources, obligation, opportunities) in supporting health policy implementation prospectively. Twenty qualitative interviews with representatives of organizations from different policy sectors, levels of government and organizational legal entities were conducted at the beginning of a project for the promotion of physical activity among women in difficult life situations. Organizational support in developing, implementing and disseminating the project was documented over 36 months. Results indicated that in most organizations, determinants were not favorable for health promotion policy action for physical activity among women in difficult life situations. Six organizations did not report any favorable determinant, and two organizations reported four. The other 12 organizations reported positive results for some of the determinants. Project work received support from 6 out of the 20 organizations. A case study of three organizations indicated that engagement or disengagement of organizations in health promotion policy actions might be partly explained by the theoretical model. The prospective assessment of organizational readiness in implementing health promotion policy is highly relevant for health promotion. Considering the proposed theoretical framework may aid in advancing our understanding of factors that are related to organizational engagement in health promotion actions.

[Physical activity and prevention of Alzheimer's dementia: current evidence and feasibility of an interventional trial]. / Körperliche Aktivität und Prävention der Alzheimerdemenz: Ubersicht über die aktuelle Evidenz und Uberlegungen zur Machbarkeit einer Interventionsstudie.

There is accumulating evidence from animal and epidemiologic studies that physical exercise is neuroprotective in healthy animals and humans and can prevent cognitive decline in chronic neurodegenerative processes like Alzheimer's dementia. However, data from well-designed interventional, randomized non-pharmacologic trials is lacking in contrast to other areas of medicine like prevention of hypertension, diabetes or the antipsychotic-associated metabolic syndrome. The demonstration of a potential positive effect of physical exercise on preventing dementia using a controlled study design would represent a significant progress in the prevention of dementia and public health, especially as long as other treatments for dementia prevention are lacking.

[Empowerment of women in difficult life situations: the BIG project]. / Empowerment von Frauen in sozial benachteiligten Lebenslagen: Das BIG-Projekt.

BIG is a project for the promotion of physical activity among women in difficult life situations. Following the main health promotion principles of the WHO, the women shall be enabled or empowered to take control of determinants of their health. A comprehensive participatory approach was applied and women were included in planning, implementing and evaluating the project. For measuring the effects of BIG on the empowerment of participating women, qualitative semi-structured interviews with 15 women participating in BIG were conducted. For data analysis, qualitative content analysis was used. Results showed the empowerment of the women on the individual level as they gained different competencies and perceived self-efficacy. These effects were supported through the empowerment process on the organizational and community levels where women gained control over their life situations and over policies influencing them. Therefore, the participatory approach of BIG is a key success factor for empowerment promotion of women in difficult life situations.

Research note: social catalysts in health promotion implementation.

Recent work carried out by WHO has recognised that an assets based approach to health promotion is crucial to support the promotion of population health and to reduce health inequalities. The assets approach was applied in a project aimed at promoting physical activity among women in difficult life situations. Within the participatory and collaborative work of the project, a specific set of assets for health that might initiate social participation and collaboration in health promotion action emerged. These assets are referred to as social catalysts for health promotion implementation. The article describes empowered individuals, informal social networks, mediating social institutions and organisational structures as potential social catalysts for health promotion implementation, and outlines some directions for further research on this topic.

[Regional differences in health behaviour in bavaria - a multilevel analysis of a representative population questionnaire in combination with socioeconomic structural data]. / Regionale Unterschiede des Gesundheitsverhaltens in Bayern - Mehrebenenanalyse einer bevölkerungsrepräsentativen Befragung in Verbindung mit sozioökonomischen Strukturdaten.

OBJECTIVES: There are regional differences in mortality in Bavaria. Although these regional dif-ferences in mortality were associated with behavioural risk factors and socioeconomic factors in a study conducted for this reason, the quantitative effect of behavioural risk factors and socio-economic factors as well as the regional structure on the individual health as a predictor of mortality were not known. METHODS: Persons between the age of 18 and 80 were interviewed with the Behavioral Risk Factor Surveillance System (BRFSS) in two Bavarian regions with high mortality, two Bavarian regions with low mortality and in the capital of Bavaria, Munich. For regional structural data, the INKAR database was used. Data were analysed descriptively, with a multivariable-adjusted logistic regression and with a multilevel analysis. RESULTS: There were lower proportions of persons with a good or very good state of health as well as adverse results for overweight/adipositas, the behavioural risk factors for doing sports, smoking and consuming fruits and vegetables and the socioeconomic factors education and unemployment in the two regions with high mortality "Ostbayerische Grenzregion" and "Oberfranken". In a multivariable adjusted logistic regression, the body mass index, smoking, doing sports, climbing stairs, consuming alcohol, being satisfied with the job and the interaction between education and marital status were found to have an influence on the individual health. The small remaining regional component could be explained in the multilevel analysis by different variables which describe the economical situation of the regions. CONCLUSIONS: In accordance with the study hypotheses, a consistency between behavioural risk factors and regional differences in mortality could be observed. Socioeconomic influences and a small regional component are involved. In addition to specific prevention programmes for the target groups, structural support is also meaningful with regard to its potential health impact.

[Sedentary lifestyles. Classification of different target groups for the promotion of health-enhancing physical activities]. / Bewegungsarme Lebensstile. Zur Klassifizierung unterschiedlicher Zielgruppen für eine gesundheitsförderliche körperliche Aktivierung.

The article investigates different sub-groups of sedentary adults based on their socio-demographic characteristics and perceived barriers to physical activity. Data stem from the Germans Survey of Sedentary Adults (n=10.000) and the data analysis used logistic regressions and cluster analysis. The results indicate that sedentary adults are a diverse group when socio-demographic characteristics and perceived barriers to physical activity are considered. Barriers such as lack of social contacts or time for physical activity are perceived by specific subgroups of this population. In contrast, only few sedentary adults report multiple barriers to physical activity. The results also provide indications for potentially successful strategies to promote physical activity among sedentary adults.

[Sports and physical activity in the elderly: social structural context and relation to health]. / Sport und körperliche Aktivität im Alter: sozialstruktureller Kontext und die Beziehung zur Gesundheit.

OBJECTIVES: The following contribution analyses the socio-structural context of sport as well as the relationship between sport/physical activity and health among older people (> or = 60 years). METHODS: The data are part of a telephone-survey by random sample with 436 realised cases in the independent cities of the Western Ruhr-District and thus represent a situation in highly urbanised areas. RESULTS: In the cardinal question concerning the meaning of sport and physical activity for health a positive relationship was found, in particular between sport intensity and health measured by Advanced Activities of Daily Living (AADL) as well as for sport as hobby, which showed a highly significant relationship with subjective health. With regard to socio-demographic variables results show that sport and physical activity vary with gender and age. Apart from that attitudes like low external control for one's health as well as the value of appearance show strong relationships with sport participation. Stratification variables with the exception of income only show weak effects. CONCLUSIONS: The results, which are partly not congruent, indicate that further research is needed in the field of sport and health among the aged.