Pilot study of a health promotion intervention in sports clubs / Étude pilote d'une intervention de promotion de la santé au sein de clubs de sport.

Sports clubs (SCs) are an ideal setting for promoting health. However existing health promotion (HP) interventions in SCs mainly target a single health behavior and men who do sports, and evaluations of such interventions provides little information about their deployment. To overcome these limitations, the PROSCeSS intervention was co-constructed based on the theoretical model of the health-promoting SC and multi-level, multi-determinant health strategies. The aim of this pilot study was to evaluate the deployment of the PROSCeSS intervention and identify the factors influencing its deployment. A qualitative study, using recordings of meetings, email and telephone exchanges, and interviews with project leaders of fourteen SC, was carried out. Although a low number of SCs had completed the intervention, they all considered that they have a role to play in helping their members maintain good health. Their ability to develop HP activities and to implement the intervention was influenced by the resources available, the support they received from their sports federation, and the ability of each project leader to get involved in the intervention. The SCs that deployed the intervention implemented several strategies enabling them to integrate health into the organizational, social, economic, and environmental habits of the SCs and to develop new HP activities, such as adapted sports activity sessions and activities to teach members about first aid, nutrition, and good practices for warming up. This study highlights the importance of understanding the specificities of the contexts in which HP interventions are deployed. Having led to a reworking of the intervention steps and the development of an appropriate evaluation design, it also highlights the essential role of pilot studies in the development and evaluation of interventions.

Le club de sport (CS) est un milieu de vie privilégié pour promouvoir la santé. Cependant, les interventions de promotion de la santé (PS) existantes dans les CS ciblent majoritairement un seul comportement de santé et des pratiquants sportifs masculins, et leurs évaluations renseignent peu leurs déploiements. Pour dépasser ces limites, l'intervention PROSCeSS a été co-construite à partir du modèle théorique du CS promoteur de santé et de stratégies multi-niveaux et multi-déterminants de santé. L'objectif de cette étude pilote était d'évaluer le déploiement de l'intervention PROSCeSS et d'identifier les facteurs influençant son déploiement. Une étude qualitative comprenant des enregistrements de réunions, des échanges par e-mails et par téléphone, et des entretiens avec les référents de 14 CS a été réalisée. Même si le nombre de CS qui sont allés au bout de l'intervention est faible, ceux-ci considèrent qu'ils ont un rôle à jouer dans la santé de leurs membres. Leur capacité à développer des activités de PS et à déployer les étapes de l'intervention est influencée par les ressources disponibles, le soutien qu'ils reçoivent de leur fédération sportive et la capacité d'un porteur de projet (référent) à s'impliquer. Les CS qui ont déployé l'intervention ont mis en place plusieurs stratégies qui leur permettent d'intégrer la santé dans les habitudes organisationnelles, sociales, économiques et environnementales du CS et de développer de nouvelles activités de PS, telles que des sessions d'activités sportives adaptées et des activités de sensibilisation à l'échauffement, à l'alimentation et aux gestes de premier secours. Cette étude montre qu'il est important de comprendre les spécificités des contextes dans lesquels les interventions de PS sont déployées. Parce qu'elle a conduit à retravailler les étapes de l'intervention et à développer un nouveau design d'évaluation, elle met en évidence le rôle essentiel des études pilotes pour le développement et l'évaluation des interventions.

Physical activity promotion in French cystic fibrosis centers: capitalizing on experience.

BACKGROUND: Physical activity (PA) provides physical and psychosocial benefits for people with cystic fibrosis (pwCF). However, practice levels remain below recommendations and strategies for promoting PA in specialist centers need to be better identified. The socio-ecological model of health emphasizes the central role of policies and environment in influencing individuals' health behaviors. This model provides a basis for understanding how health professionals perceive the promotion of PA in their centers. OBJECTIVE: The aim of this study was to explore intervention components of PA promotion in specialized CF centers in France that are "experienced" in PA promotion, to identify elements that can be transferable to other centers. METHODS: A descriptive qualitative study was conducted with 16 healthcare professionals and pwCF. Semi-structured interviews were conducted and analyzed using inductive and deductive methods classically used in psychology. RESULTS: Five themes were extracted: the action and its context, the partnerships established around this action to promote physical activity, the evaluation of the action, its reproducibility, and the changes induced by COVID-19. CONCLUSIONS: Some factors emerged as essential for promoting PA among pwCF, notably the dialogue between the health professionals and patients, the presence of adapted PA instructors, and the involvement of partners.

A health promoting sports club framework: strategies from the field.

The application of the settings-based approach to sports clubs requires a context-specific framework to develop and operationalize health promotion interventions. Incorporating top-down and bottom-up perspectives into interventions increases their efficiency, success and sustainability. In 2020, the health promoting sports club (HPSC) model and intervention framework were created, including strategies and intervention components. A subsequent concept mapping study generated 35 statements from sports club stakeholders highlighting their needs when developing health promotion initiatives. This commentary integrates the concept mapping results into the HPSC model and intervention framework. The process added new sports club levels, updated existing and developed new intervention components, then classified them into the framework. The revised HPSC model has seven levels while the revised intervention framework includes 13 strategies and 69 intervention components. This revised HPSC framework provides sports club stakeholders, public health experts and researchers a means to develop and implement targeted health promotion interventions.

Using a socioecological approach to explore healthy lifestyle in elite sport: a qualitative study of French athletes', coaches', and managers' perspectives.

Elite athletes are continually subjected to a range of constraints specific to high performance, and these can have a negative impact on their health. Although many studies have explored the individual factors related to risky behaviours and disorders in elite sport contexts, few have focused on health promotion. Consequently, the interpersonal, institutional, and policy factors of the health-related behaviours of elite athletes are still poorly explored. Based on the socioecological model, this study aimed to identify the factors involved in the health-related lifestyle of elite athletes. Semi-structured interviews were conducted with 45 participants: athletes (N = 32), their coaches (N = 6) and the managers of elite sport centres (N = 7). Both deductive and inductive thematic analyses were performed. Our results highlight the views of the actors. Regarding intrapersonal factors, resilience qualities and health literacy appeared as key factors in influencing the health-related lifestyle of elite athletes. At the interpersonal level, parents and coaches emerged as the main sources of educational support. Regarding institutional factors, the health policies of the elite sport centres were key factors in supporting the athletes' healthy lifestyle. These results encourage the development of health promotion programs at different levels of intervention.

Health promoting sports federations: theoretical foundations and guidelines.

Background: Researchers and policy-makers have highlighted that the potential for organized sports to promote health has been underexploited. Sports clubs have limited capacity to promote health due to their voluntary nature and have called for support from their national sports federations. The present article provides guidelines, based on the theoretical principles of health promoting sports clubs and an analysis of practical tools and proven strategies, to support national sports federations to invest in health promotion (HP). Methods: A qualitative iterative study was undertaken, based on five 2-h meetings of a group of 15 international researchers in HP in sports clubs. Notes and minutes from meetings, as well as shared outputs were analyzed based on the health promoting sports club framework. Results: Guidelines developed for national sports federations to promote health includes a definition of a health promoting sports federation (HPSF), a description of how the settings-based approach to HP adapts to national sports federations, as well as practical applications of health promoting sports club's intervention strategies. The analysis of existing tools also demonstrated that most tools are centered on a single dimension of health (social, mental, physical, spiritual or community), and often on a specific health topic. Furthermore, they do not cover HP as a continuous long-lasting process, but are generally short-term programs. The HPSF clarifies theoretical concepts, their practical implementation via case studies and outlines intervention components and tools useful for sports federations in their implementation of HP. Conclusion: The guidelines developed in this study are intended to facilitate national sports federations to acknowledge/understand, reinforce/underpin and foster current and further investment in HP.

A RE-AIM framework analysis of a sports club health promotion MOOC: the PROSCeSS MOOC.

Acquisition of health promotion (HP) skills and knowledge is essential for interventions development in this field. In sports clubs (SC), little HP training exists even though it was requested by SC actors. In response, the PROSCeSS (PROmotion de la Santé au sein du Clubs SportifS) MOOC (Massive Open Online Course) was developed to support actors of HP in the SC in the development of HP interventions. The present study evaluates the MOOC's effectiveness and learning process. The RE-AIM framework, measuring reach, effectiveness, adoption, implementation and maintenance was used to structure this study. Surveys were sent before and after the MOOC to the 2814 learners. Among the 502 (18%) respondents to the pre-survey, 80% reported belonging to a SC as a coach (35%) or manager (25%). The 14% of pre-survey respondents who completed the post-survey increased their HP knowledge score by 42% and their confidence to implement HP actions by 6%. Results present the strategies considered most important and feasible by the learners and the main barriers to the implementation of HP actions in the SC. This study shows that MOOC appears to be an appealing (93% of learners were satisfied) and effective solution (as long as it is followed) to develop HP knowledge and skills of SC actors in HP, meeting their needs and constraints. Although improvements should be made (especially in terms of promoting adoption), this type of educational format should be encouraged to support the HP potential of SC.

Capitalization of experience of physical activity resumption programs: Lessons learned for adherence and post-program referral.

The benefits of physical activity (PA) in managing chronic diseases are largely demonstrated. To encourage a sustainable PA practice for inactive patients with chronic diseases, France has recently implemented PA resumption programs, in which patients can participate with a medical prescription but which are time-limited. In the literature, the effectiveness of those exercise referral schemes to foster sustainable PA practice is still mixed. The present study aims at capitalizing the experience of eight resumption programs to understand what makes the programs work, adherence mechanisms and the post-program referral scheme. Questionnaires and semi-structured interviews informed those intervention mechanisms analysed using thematic analysis. This study provides insights into expertize in patient management among these programs, currently due to key findings as the employment of adapted PA teachers, their training and the use of mechanisms for program adherence (practice conditions, emphasize progress and feelings generated by exercise, the relational and social aspect of practice). Other key findings are a lack of clarity in program objectives which is an area of improvement, and a broad diversity of referral (transmitting contact details, contacting the club, intervention of a third-party association or physical presence) that need further exploration.

Health promoting sports clubs: from theory to intervention.

INTRODUCTION: Beyond the contribution of sports clubs to physical activity, an important health determinant, sports clubs can embrace the settings-based approach to health promotion, acting as health promoting sports clubs (HPSC). Limited research links the HPSC concept with evidence-driven strategies to provide guidance to develop HPSC interventions. METHODS: An intervention building a research system of the development of an HPSC intervention will be presented, including seven different studies, from literature review to intervention co-construction and evaluation. The different steps and their results will be presented as lessons learnt for settings-based intervention development. RESULTS: First, the evidence base showed a poorly defined HPSC concept, but 14 evidence-driven strategies. Second, concept mapping identified 35 sports clubs needs in regard to HPSC. Third, the HPSC model and intervention framework were designed using a participative research approach. Fourth, a measurement tool for HPSC was validated psychometrically. Fifth, capitalization of experience from eight exemplar HPSC projects was realized to test the intervention theory. Sixth, program co-construction was realized by involving sports club actors. Seventh, intervention evaluation was built by the research team. DISCUSSION: This HPSC intervention development is an example of building a health promotion program, implicating different types of stakeholders, and provide a HPSC theoretical model, HPSC intervention strategies, a program and toolkit, for sports clubs to implement health promotion and fully endorse their role in the community.

Status and Trends of Physical Activity Surveillance, Policy, and Research in 164 Countries: Findings From the Global Observatory for Physical Activity-GoPA! 2015 and 2020 Surveys.

BACKGROUND: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries. METHODS: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years. RESULTS: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved. CONCLUSION: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Effect of Elite Sport on Physical Activity Practice in the General Population: A Systematic Review.

BACKGROUND: Our study investigated the effect of elite sport on physical activity (PA) practice in the general population. METHODS: Structured Boolean searches were conducted across 5 electronic databases (PubMed, JSTOR, Web of Science, SPORTDiscus, and PsycInfo) from January 2000 to August 2021. Peer-reviewed studies in English were included if the effects of hosting elite sport events, elite sport success, and elite sport role modeling on PA/sport practice in the general population were measured. RESULTS: We identified 12,563 articles and included 36 articles. Most studies investigated the effect of hosting elite sport events (n = 27), followed by elite sport success (n = 16) and elite sport role modeling (n = 3). Most studies did not observe a positive effect of hosting elite sport events, elite sport success, or elite sport role modeling on PA/sport practice in the general population. No evidence of a lagged effect of elite sport was observed. No evidence of elite sport effects was observed according to age range and geographical scale. CONCLUSION: There is no evidence supporting the effect of elite sport in increasing PA or sport participation in the general population. Decision makers and policymakers should be aware of this and invest in strategies such as those recommended by the World Health Organization.

Perceptions of barriers to and facilitators of physical activity in adults with cystic fibrosis.

BACKGROUND: Physical activity (PA) is a proven therapeutic tool to increase the quality of life and life expectancy in people with cystic fibrosis (pwCF). Despite this, the PA level of pwCF is lower than recommended. OBJECTIVES: This study was conducted to identify the barriers to and facilitators of PA in adults with CF with heterogeneous severity. METHODS: Twenty adults with CF (mean age = 33.3±11.7 years, mean FEV1% = 50.55±20.4%) were recruited from two specialized centers and interviewed about the factors that limit and facilitate their PA. The collected data were transcribed, coded and analyzed using deductive and inductive methods. RESULTS: Barriers and facilitators were classified into physical, psychological and environmental dimensions. The main barriers were fatigue, breathing difficulties, lack of available facilities, negative perceptions of PA and perceived health risks. The most important facilitators were respiratory benefits, well-being, and social support. CONCLUSION: Although some barriers and facilitators were similar to those found in children with CF or adults from other vulnerable populations, others were specific to adults with CF, such as the risk of cross-contamination and transplant preparation. The comprehensive study of the barriers and facilitators in adults will enhance PA counseling for pwCF and help improve their compliance with PA recommendations.

French validation of the e-PROSCeSS questionnaire: stakeholder perceptions of the health promoting sports club.

The health promoting sports club describes the development of the settings-based approach in sports clubs. Based on this model, a questionnaire was developed to measure health promotion perceptions in sports clubs (e-PROSCeSS). The objective of this study was to assess the psychometric properties of a French version of the e-PROSCeSS measurement tool. The questionnaire includes three scales measuring stakeholder's perceptions of club (macro), managers (meso) and coaches (micro) activities toward promoting health. Five steps were undertaken to assess perceptions. First, scales were translated into French. Second, each item's content clarity was tested in three populations: managers, coaches, sports participants. Third, descriptive statistics were analyzed for each scale. Fourth, confirmatory factorial analysis was used to select items for each level. Predictive validity found positive relationships between health promotion perceptions and managing/coaching positions, and negative relationships with drop-out intentions. Positive relationships were found between sports participants' perceptions of health promotion and their self-rated performance and quality of life, while negative relationships were detected with drop-out intentions. The French e-PROSCeSS subscales showed good psychometric properties in measuring health determinants at multiple levels. However, the tool did not measure health promotion as an overarching concept that questions its applicability in the sports club setting.

Development of a health-promoting sports club's intervention in France applying participatory action research.

The recognition of sports clubs (SC) as health-promoting settings is increasing, as well as the number of health promotion (HP) interventions implemented in this setting. However, minimal understanding of their development process and the persistent gap between theoretical knowledge and real-life practice is a major limitation to their implementation. This article describes a participatory research approach, implicating 29 stakeholders in sports and HP (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations and 8 representatives from SC), leading to the co-construction of a health-promoting SC intervention. Stakeholders were mobilized through four stages: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (iv) beta-testing of a massive open online course (MOOC). A qualitative analysis was carried out on data collected through notetaking, recordings, transcripts, email exchanges and produced documents. This work led to the development of an HP intervention, including an MOOC, as well as a seven-step SC-tailored program. The convergence of theoretical knowledge and contextual real-life practice made it possible to respond to the specific needs and implementation problems encountered by SC actors and to develop acceptable strategies and tools.

Sports clubs (SC) can promote health beyond the offer of physical activity and sport by acting on health determinants (economic, social, environmental and organizational). To this end, interventions can be implemented. This study presents the way in which researchers and field actors can collaborate to develop adapted interventions. Involving 29 sport and health promotion (HP) actors (6 HP researchers, 9 HP professionals, 6 representatives from regional and national sports organizations, and 8 representatives from SC), four stages were set up to develop a Massive Open Online Course (MOOC) and an SC-tailored program: (i) analysis of effective programs, (ii) co-construction workshops, (iii) evaluation of relevance and acceptability, and (4) beta-testing of the MOOC. The results of these stages were qualitatively analyzed and allowed for the development of content, tools and planning consistent with the realities faced by SC. This work presents ways in which field actors and researchers can collaborate to develop acceptable strategies and tools to promote health.

Evaluation of implementation and effects of a health-promoting sports club intervention using a mixed-method design: PROSCeSS protocol.

Public authorities and academics have advocated for applying been advocating for the application of the setting-based approach to sports clubs. However, studies have shown that existing health promotion (HP) interventions in sports clubs poorly understand and apply this approach. Moreover, methods used to evaluate these interventions do not inform their implementation process, limiting the generation effectiveness' proofs. This study aims at evaluating the implementation process and effectiveness of an HP intervention in sports clubs (PROmotion de la Santé dans les ClubS de Spor; PROSCeSS), based on the health-promoting sports club (HPSC) model. A type 3 hybrid design, using a multiphase mixed-method: QUAN→QUAL→ QUAN+QUAL (qual)→QUAL (quan+qual), will be used. Phase A will be a pre-post-quantitative study with one HP officer, five managers and five coaches from 30 sports clubs exploring the effects of the PROSCeSS intervention on HP perceptions and health literacy. Phase B will be focus groups with participants from HP initiatives that the 30 sports clubs will have previously put in place to detect changes in health. Phase C will explain the results of phases A and B by choice of strategies and adherence to standardised steps, measured through semistructured interviews and implementation data collection. Phase D will cross-reference the semistructured interviews, the sports club characteristics questionnaire and the implementation data collection to study the relationships between the context and the implementation process. This protocol will identify 'what works', 'for whom', in 'what context' in terms of HPSC and clarify which intervention components are more effective at improving HP. This evaluation design will help to develop appropriate approaches to evaluate HP interventions.

Costing the economic burden of prolonged sedentary behaviours in France.

BACKGROUND: There is strong evidence showing that sedentary behaviour time increase the risk to develop several chronic diseases and to premature death. The economic consequences of this risk have never been evaluated in France. The aim of this study was to estimate the economic burden of prolonged sedentary behaviour in France. METHODS: Based on individual sedentary behaviour time, relative risk to develop cardiovascular disease, colon cancer, breast cancer and all-causes of premature mortality were identified. From relative risk and prevalence of sedentary behaviour time, a population attributable fraction approach was used to estimate the yearly number of cases for each disease. Data from the National Health Insurance were used to calculate the annual average costs per case for each disease. Disease-specific and total healthcare costs attributable to prolonged sedentary behaviour time were calculated. Indirect costs from productivity loss due to morbidity and premature mortality were estimated using a friction cost approach. RESULTS: In France, 51 193 premature deaths/year appear related to a prolonged daily sedentary behaviour time. Each year prolonged sedentary behaviour cost 494 million € for the national health insurance. Yearly productivity loss due to premature mortality attributable to prolonged sedentary behaviour cost 507 million € and yearly productivity loss due to morbidity cost between 43 and 147 million €. CONCLUSION: Significant saving and many deaths could be avoided by reducing prolonged sedentary behaviour prevalence in France. To address this issue, strong responses should be implemented to tackle sedentary behaviour, complementary to physical activity promotion.

Development of the health promoting sports club-national audit tool.

BACKGROUND: Sports clubs have requested support from national governing authorities to invest in health promotion (HP), by developing policies, guidelines and dedicated funding. This article outlines the development of a national audit tool to review policies development and implementation to support HP in sports clubs. METHODS: A five-step process was undertaken by an international project team: (i) a rapid literature review to identify items assessing policies in physical activity, HP and sports, (ii) a thematic analysis to categorize items, (iii) a Delphi method to analyze item relevance, country specificity, reformulation, validation and organization, (iv) face validity through an online survey and in-depth interviews with expert representatives on physical activity and sports and (v) audit tool finalization though project team consensus. RESULTS: Eight sources were reviewed with 269 items identified. Items were coded into 25 categories with 3 broad themes: policies, actors and settings-based approach. The Delphi study extracted and refined 50 items and categorized them into 10 sections. After revisions from 22 surveys and 8 interviews, consensus was reached by the international project team on 41 items categorized into 11 sections: Role of ministry or department; Policies; Communication; Implementation and Dissemination; Evaluation and Measurement methods; Sub-national-level policies; Funding and Coordination; Participative approach; Actors and Stakeholders; National sporting events; Case studies and Implicated stakeholders. CONCLUSION: To progress HP in the sports club context it is necessary to understand existing national-level policies. This national audit tool will aid in monitoring and assessing national policies for health promoting sports clubs.

Modeling the Development of Local Health-Enhancing Physical Activity Policies from Empirical Data and Policy Science Theories.

Physical inactivity is considered a pandemic, requiring strong policy responses to address this major health issue. However, research on the development of Health-Enhancing Physical Activity policies (HEPA) remains scarce, particularly at the local level. There is a need to produce evidence to better understand the process to develop local HEPA policies. This study aims to model the development of HEPA policy promotion in French municipalities from empirical data and policy science theories. This research was undertaken in three steps: (1) assess the level of development of HEPA policies from 10 French municipalities using a local HEPA analysis tool, (2) provide a brief overview of core political science theories applied in health promotion, and (3) from these empirical and theoretical perspectives, model a conceptual framework to better understand the development of HEPA policy promotion in French municipalities. Based on empirical data and the Multiple Streams, policy cycles and Institutional Rational Choice theories, a conceptual framework of the development of municipal HEPA policy promotion was modeled. This conceptual framework is comprised of five stages describing the development of municipal HEPA policies. This paper contributes to a better understanding of the development of municipal HEPA policies.