Ecological Predictors of Older Adults' Participation and Retention in a Physical Activity Intervention.

Research is still lacking regarding the question as to how programs to promote healthy ageing should be organized in order to increase acceptance and thus effectiveness. For older adults, ecological factors, such as the physical distance to program sites, might predict participation and retention. Thus, the key aim of this analysis was to examine these factors in a physical activity intervention trial. Adults (N = 8299) aged 65 to 75 years were invited to participate and n = 589 participants were randomly assigned to one of two intervention groups with 10 weeks of physical activity home practice and exercise classes or a wait-list control group. Response, participation, and dropout data were compared regarding ecological, individual, and study-related variables. Kaplan-Meier curves and Cox regression models were used to determine predictors of dropout. In total, 405 participants completed the study. Weekly class attendance rates were examined regarding significant weather conditions and holiday periods. The highest rates of nonresponse were observed in districts with very high neighborhood levels of socioeconomic status. In this study, ecological factors did not appear to be significant predictors of dropout, whereas certain individual and study-related variables were predictive. Future studies should consider these factors during program planning to mobilize and keep subjects in the program.

Nudges used to promote physical activity and to reduce sedentary behaviour in the workplace: Results of a scoping review.

Physical inactivity is one of the most important risk factors for non-communicable diseases. Workplace health promotion is therefore of growing interest to support an active day using nudges. The scoping review aims to (a) analyse how frequently nudges are applied in workplace health promotion to increase physical activity and/or reduce sedentary behaviour, and (b) characterise the nudges used. A systematic database search was conducted for the period 2009 to June 2020. According to predefined inclusion and exclusion criteria, studies promoting physical activity and/or reducing sedentary behaviour using nudges were included. Nudges were classified according to MINDSPACE and TIPPME. A study protocol was previously published. Of the 256 studies identified, 26 used nudges. Most studies were conducted in Europe (n = 12) and the USA (n = 8). N = 18 studies targeted physical activity and n = 8 studies targeted sedentary behaviour. In most studies promoting physical activity, prompts were given to climb stairs (n = 11). Interventions targeting sedentary behaviour were more diverse, using digital interventions or mixed approaches (n = 8). Although nudges can help increase physical activity and reduce sedentary behaviour, there are still gaps in terms of their effective and efficient use. There is a lack of long-term studies that analyse habituation and behavioural changes beyond the intervention period. In addition, the potential of digital and mixed approaches is not yet fully exploited. Further studies from low- and middle-income countries with different climates and working conditions are needed to investigate the feasibility of approaches and advance the fight against physical inactivity.

Requirements for (web-based) physical activity interventions targeting adults above the age of 65 years - qualitative results regarding acceptance and needs of participants and non-participants.

BACKGROUND: It remains unclear how physical activity (PA) interventions need to be designed to reach older adults and to be widely accepted in this target group. The aim of this study was to assess the acceptance of a web-based PA program, including individual intervention components as well as relevant contextual factors, and to specify requirements for future interventions. METHODS: Two hundred sixty-six participants of a PA intervention completed a questionnaire covering individual program components (content, structure, and context). Further, 25 episodic guided interviews focusing on reasons for (non-) participation were conducted with 8 participants and 17 non-participants. Following qualitative content analysis, different requirements were identified and organized based on the social-ecological model, resulting in a profile of requirements. RESULTS: Based on the participants' and non-participants' statements, six different levels of requirements affecting acceptance of and successful participation in a web-based PA intervention were identified. The individual fit was influenced by an interaction of different factors at the intrapersonal, sociocultural, content, spatial, digital and organizational levels. Several age- and gender-specific requirements were noted in the interviewed older adults. Men and women, as well as younger (< 70 years) and older (≥70 years) adults differed in terms of perceived enjoyment and benefits of socializing while exercising together, the time expenditure perceived to be acceptable, previous digital skills, as well as in perceptions that ambience and accessibility of exercise facilities in the neighborhood were important. CONCLUSIONS: To motivate older adults to engage in PA and address different needs in terms of life circumstances and quality of life as well as differences in technical affinity, different requirement profiles should be included in the process of intervention development and implementation. Participatory development loops and modular offer formats are recommended for this.

Using nudges to promote physical activity and to reduce sedentary behaviour in the workplace: a scoping review protocol.

INTRODUCTION: Physical inactivity and sedentary behaviour are associated with numerous health problems and increasing risks of premature morbidity and mortality. Workplace health promotion with a focus on increasing physical activity (PA) and reducing sedentary behaviour is of growing interest. The concept of choice architecture with the use of nudges is a promising approach to influence decision making regarding health behaviours. It can help to understand why people often fail to act in their best interest, to follow well-informed preferences or to achieve their set goals. Nudges, the way the choice is presented, can help to overcome these challenges by using the same habits, biases or boundaries to alter our decision-making in favour of the more preferred behaviour. Aims of the scoping review will be to analyse (a) to what extent the concept of choice architecture is used in workplace health promotion to promote PA and/or to reduce sedentary behaviour and (b) which instruments (nudges) are used to archive that. METHODS AND ANALYSES: Medline, PsychInfo, Web of Science and CINHAL will be searched from 2009 until June 2020. Applying a two-level screening process, title and abstracts will be screened according to a set of predetermined inclusion and exclusion criteria. Included articles will be screened a second time to determine the extent to which choice architecture has been used. Analyses for publication year, location, setting and target group will be provided. Interventions will be analysed presenting the instruments used, number of studies per instrument, combinations of instruments and alteration of the environment. Outcome measures and results will be reported as they occur. ETHICS AND DISSEMINATION: Due to the nature of the scoping review, ethical concerns are minimal. No patient data will be included. Results are published in peer-review journals.

Assessment of campus community readiness for tailoring implementation of evidence-based online programs to prevent risky substance use among university students in Germany.

Research suggests that online interventions preventing risky substance use can improve student health. There is an increasing interest in transferring evidence-based online programs into university health promotion practice. However, little is known about how to best tailor the implementation process to capacities and context of individual universities. The purpose of this study was to assess the level of readiness (capacity) of German universities concerning the implementation of evidence-based online programs for risky substance use prevention employing an adapted Community Readiness Assessment (CRA) and to develop tailored action plans for implementation. The CRA involved 43 semi-structured interviews with key persons at 10 German universities. The interviews addressed five dimensions (knowledge of efforts, leadership, community climate, knowledge of the issue, and resources) at nine possible readiness stages (no awareness-ownership) and additional contextual factors. Overall, readiness for implementing online interventions across universities was rather low. Universities readiness levels ranged between the denial stage with a score of 2.1 and the preplanning stage with a score of 4.4. University-specific readiness was very heterogeneous. On the basis of the results of the CRA, universities received feedback and options for training on how to take the necessary steps to increase readiness and to prepare program implementation. The adapted version of the CRA was well suited to inform future implementation of evidence-based online programs for the prevention of risky substance use at participating universities.

[DEVASYS - Development of an Online Tool to Support Systematic Evaluation of Intervention Projects in Prevention and Health Promotion]. / DEVASYS ­ Entwicklung eines Online-Tools zur Unterstützung der systematischen Evaluation von Interventionsprojekten der Prävention und Gesundheitsförderung.

OBJECTIVES: To date, knowledge about the effects and implementation quality of disease prevention and health promotion projects in Germany is limited. Only a few structured evaluation systems exist that can be easily used and which include features for evaluating research and practice projects. The aim of the current project was to develop and carry out a pilot study of an online evaluation tool that enables structured self-evaluation of projects in disease prevention and health promotion practice and contributes to an improved documentation and cyclical development of projects. METHODS: The mixed-methods approach taken in this project included 2 steps: a) search of literature and database to develop a theoretical framework for the tool and b) adaptation process to test the fit of the tool for practice, including a focus group discussion and a usability test with different disease prevention and health promotion stakeholders (N=12). RESULTS: The resulting documentation and evaluation system (DEVASYS) is comprised of the components "planning", "documentation", and "evaluation" which can be used independently of one another. The conceptual basis of the tool is the RE-AIM framework. To determine the quality of an individual project, dimensions of both the output (reach, acceptance, implementation) and the outcome levels (effectiveness, maintenance) can be documented with the tool. CONCLUSION: DEVASYS is a practice-oriented tool contributing to an improved evaluation of existing practice-related intervention projects and the overall quality of future projects in the area of disease prevention and health promotion. Systematic dissemination and implementation of the tool are the next steps to be taken.

Ready to participate? Using qualitative data to typify older adults' reasons for (non-) participation in a physical activity promotion intervention.

BACKGROUND: A sufficient amount of regular moderate physical activity (PA), at least 2.5 h of moderate to vigorous PA per week as recommended by the WHO, is one of the most important lifestyle factors for maintaining good health in old age. However, less than one in four older adults (65 years or older) in Germany meets this recommendation for PA. Although previous research has found several factors related to participation in PA programmes, little is known about how these factors simultaneously affect participation decisions of older adults and how PA programmes can accommodate these dynamics. Taking an everyday life perspective, this study aimed to identify multidimensional types of PA behaviour among older adults. METHODS: In this qualitative study, 25 episodic interviews were conducted with participants and non-participants (ratio 1:3) of a structured PA intervention for older adults (65 years or older). Direct and indirect recruitment methods (e.g. pick up, gatekeeper) were used in different municipalities in Northwest Germany. The interviews were analysed according to the Grounded Theory methodology and a typology of PA participation behaviour was derived from the responses of the interviewees. RESULTS: Four types of PA participation behaviour were identified based on different activity goals and time management preferences: 'Health designer', 'Flexible function-oriented type', 'Comparison and competition type' and 'Fun and wellness-oriented type'. The results indicate that the structured PA intervention was better able to reach the health designer and the competitive type but was less successful in accommodating the function- or wellness-oriented type. CONCLUSIONS: In order to improve older adults' participation in PA, preventive offers should take various activity goals and the desire for flexible time management in everyday life into account. The typology of PA participation behaviour contributes to a better understanding of the target group and can thus help to improve the development, communication and implementation of tailored PA interventions.