What makes community sports programs successful? A group concept mapping study to identify effective elements.

Adults in socially vulnerable positions can benefit from participation in community sports programs. However, there is a lack of knowledge about the effective elements of these programs. To identify these elements, we consulted three groups of stakeholders: social sports coaches, program coordinators, and social workers. The effective elements were systematically arranged by means of group concept mapping (GCM), a mixed-methods approach for organizing thoughts. The social sports coaches (n = 14) mentioned 152 effective elements, the program coordinators (n = 5) mentioned 81 effective elements and the social workers (n = 8) mentioned 115 effective elements. Overlapping effective elements were mentioned by all three stakeholder groups, such as the role of the social sports coach, a safe sports climate, and structure of sports programs. However, the sport-specific knowledge and skills of coaches were mentioned only by program coordinators. Moreover, only the social workers provided elements that were protective in nature, such as not overburdening the participants. Average importance scores differed for these elements within groups and between groups. In conclusion, various effective elements were deemed necessary for community sports programs to be successful. Moreover, GCM appeared a successful tool to systematically identify effective elements of an intervention from the perspective of relevant stakeholders.

What is needed to facilitate healthy dietary behaviours in pregnant women: A qualitative study of Dutch midwives' perceptions of current versus preferred nutrition communication practices in antenatal care.

OBJECTIVE: The aim of this paper was to explore midwives' perceptions of current and preferred nutrition communication practices in antenatal care, and to identify what is needed to achieve their preferred practices. DESIGN: A qualitative descriptive design was used. Semi-structured interviews were conducted with twenty Dutch midwives working in primary care or secondary care settings across the Netherlands. To create a positive atmosphere, interviews were based on the principles of Appreciative Inquiry. FINDINGS: Opportunities identified in current practices included midwives' sense of responsibility, their skills and experience, availability of resources, and group consultations. Barriers were the precarity and lack of prioritization of the topic, and the current focus on food safety (risks). Ideally, midwives envisioned nutrition communication as a continuous trajectory, in which not only reliable and consistent information is provided, but also more personalized and positive communication, to empower pregnant women. KEY CONCLUSIONS: Midwives favour nutrition communication practices characterized by continuity of care and woman-centeredness. Opportunities to realize such practices in antenatal care are the use of innovative tools to support nutrition communication, more sustainable collaborations with dietitians, and better nutrition education for midwives. IMPLICATIONS FOR PRACTICE: Midwives could act as facilitators and gatekeepers in nutrition communication, requiring limited time and expertise from midwives, and empowering pregnant women.

Opportunities for dietitians to promote a healthy dietary intake in pregnant women with a low socio-economic status within antenatal care practices in the Netherlands: a qualitative study.

BACKGROUND: A healthy dietary intake during pregnancy is important for maternal and child health. However, pregnant women with a low socio-economic status often fail to meet dietary guidelines and requirements for healthy nutrition. Dietitians may play an important role in providing nutritional advice during pregnancy because midwives often experience a lack of nutritional knowledge, time and skills to provide adequate advice. However, there is limited research on the support that dietitians can offer in antenatal care practices for pregnant women. Therefore, this study aims to explore the opportunities for dietitians to support pregnant women with a low socio-economic status in concurrent antenatal care practices in the Netherlands. METHODS: In-depth interviews were conducted with 14 pregnant women with a low socio-economic status and 13 dietitians to identify barriers for healthy eating for pregnant women and the associated opportunities for dietitians to support these women in making healthy dietary changes. RESULTS: Four opportunities for dietitians to support pregnant women in making dietary changes could be discerned: (1) creating awareness of healthy and unhealthy eating patterns, (2) providing reliable and personally relevant information, (3) help identifying barriers and solutions for healthy eating and (4) making healthy eating manageable. Dietitians indicated that supporting pregnant women with a low socio-economic status in consuming a healthy diet requires the investment of sufficient time, effort and money. CONCLUSIONS: Dietitians are trained and well-equipped to provide extensive support to pregnant women to promote a healthy dietary intake, especially when the complex interplay of barriers that pregnant women with a low socio-economic status experience for healthy eating needs to be addressed. In addition, there is a strong need for strengthening the collaboration between dietitians and midwives because midwives are the primary care provider for pregnant women in the Netherlands, but they often lack sufficient opportunities to provide adequate nutrition support. Strengthening this collaboration could promote that nutrition becomes a recurring and standard topic in antenatal care.

Healthy eating strategies for socioeconomically disadvantaged populations: a meta-ethnography.

Purpose: In developed countries, diet-related health inequalities between people with different levels of socioeconomic advantage persist. However, there is limited qualitative evidence to inform the design of effective healthy eating (HE) strategies in socioeconomically disadvantaged populations (SDPs). The purpose of this review was to explore the characteristics influencing HE strategies for SDPs and develop a new understanding of how and why they influence their success.Methods: A qualitative evidence synthesis using a systematic meta-ethnographic approach. The twelve studies included were conducted in the USA, Canada, Australia, and UK.Results: The studies described a range of HE strategies, including nutrition education programs, food vouchers, and community gardens. Personal values and sense of pride and autonomy were found to have an influence on participants' attitudes towards HE strategies. Similarly, social characteristics such as level of social support and opportunities for shared benefits influenced participants' engagement. Structural characteristics such as the affordability and accessibility of healthy foods determined strategy acceptability and success. Finally, organizational characteristics such as flexibility influenced how well strategies supported the circumstances of participants.Conclusions: These overlapping characteristics may be used to inform the development, implementation, and evaluation of strategies to improve healthy eating in SDPs.

Individual, social and national coping resources and their relationships with mental health and anxiety: A comparative study in Israel, Italy, Spain, and the Netherlands during the Coronavirus pandemic.

Employing the salutogenic model, we asked how individuals in different countries cope with the COVID-19 crisis and stay healthy. We were interested in exploring the individual (i.e. sense of coherence) as well as the social and national resources (i.e. social support, sense of national coherence, and trust in governmental institutions) that could explain levels of mental health and anxiety during the outbreak of the pandemic. Data collection was conducted via convenience sampling on online platforms, during the end of March and the beginning of April 2020. The data included four samples: 640 Israeli participants (319 males), 622 Dutch participants (177 males), 924 Italian participants (338 males) and 489 Spanish participants (117 males); age range of 18-88 years. The questionnaires included standard tools (MHC-SF, GAD-7, SOC, SONC). Several questions were adapted to the context of coronavirus and measured levels of exposure to COVID-19, trust in governmental institutions, and social support. The results significantly confirmed the suggested salutogenic model regarding the contribution to individual and national coping resources to anxiety levels and mental health. The patterns of the coping resources in explaining anxiety and mental health were similar in the four samples, and SOC was the main predictor these outcomes. Despite these similarities, a different pattern and also different magnitudes of the predictive value of the coping resources were found for the two different reactions: anxiety vs. mental health. While SOC and situational factors (like financial threat) were significant in explaining anxiety levels, the SOC and national resources were found as significant in explaining mental health levels. The findings support the salutogenic approach in studying reactions during pandemic time. They also shed some light on the difference between pathogenic and salutogenic measures in studying psychological reactions to stressful situations.

The Relationship Between Individual, Social And National Coping Resources And Mental Health During The Covid-19 Pandemic In The Netherlands.

BACKGROUND: The COVID-19 pandemic has a potential negative impact on mental health. Adopting the salutogenic model of health, this study examined the predictive value of personal (sense of coherence), social (social support, trust in institutions), and national (sense of national coherence) resources for mental health in the Netherlands during the COVID-19 pandemic. PARTICIPANTS AND PROCEDURE: An online survey was administered in the Netherlands (N = 622) in April 2020. A multiple regression analysis was performed to test the predictive value of the resources for mental health. RESULTS: Mental health was significantly predicted by the sense of coherence, social support and sense of national coherence, but not by trust in institutions. The results showed that personal and social resources were most strongly related to mental health. CONCLUSIONS: The results suggest that mental health is predicted by various resources. Hence, strengthening resources seems vital in promoting mental health in times of crisis.

A salutogenic perspective on sport-for-development research.

RATIONALE: Research on positive youth development through sport is confronted with a number of limitations: it lacks a clear theoretical basis of mechanisms underlying life skill development through sport, it has a narrow focus on the sports setting thereby neglecting the interplay between life domains in reaching positive youth development, and the mechanisms underlying the transfer process of newly acquired skills and competences from the sports setting to other life domains are unclear. OBJECTIVE: This study aims to advance research in in this field by applying theoretical insights from the salutogenic model of health to address the aforementioned limitations. INNOVATION: The salutogenic model of health describes how health and well-being develops in challenging or stressful situations and offers an interesting perspective on the mechanisms underlying youth developmental processes while simultaneously aligning well with the tenets of the positive youth development approach. The application of the salutogenic model of health offered a number of interesting theoretical insights to further understand 1) the mechanisms underlying positive youth development through sport (i.e., enhancing comprehensibility, manageability and meaningfulness), 2) that youth development arises in the interaction between an individual's stressors, resources and sense of coherence across different life domains, and 3) the central role of both generalized and resistance resources and sense of coherence in the transfer of life skills between life domains. Given that sense of coherence plays a vital role in the healthy development of individuals and the transfer of life skills across life domains, it would make sense to strengthen the sense of coherence of youths in sports programs. CONCLUSION: Based on this theoretical analysis, several recommendations and considerations for further research on positive youth development through sport are provided.

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.

Understanding empowerment for a healthy dietary intake during pregnancy.

Purpose: In order for health professionals to encourage pregnant women with a low socioeconomic status (SES) to move towards empowerment for a healthy dietary intake, crucial steps are to understand the perspectives of pregnant women of food and eating and to identify opportunities for empowerment. This study aimed to examine the perspectives of pregnant women on food and eating and to identify the opportunities for empowerment towards a healthy dietary intake. Methods: This was a qualitative participatory study. Thirteen semi-structured interviews were conducted with low SES pregnant women in the Netherlands and analysed using an inductive approach. Results: Five perspectives on food and eating emerged: 1) health-promoting foods and products, 2) challenges in healthy eating, 3) risky products, 4) strategies for healthy eating, and 5) motivational aspects. Opportunities for empowerment were: searching balanced and personalized information, developing strategies to implement healthy diets, navigating the social environment, and dealing with different motivations. Conclusion: Pregnant women hold diverse perspectives regarding food and eating, signalling the need to adjust dietary support from health-care professionals. Professionals in antenatal care could optimize their interactions by engaging in pregnant women's empowerment processes to make healthy modifications to their dietary intake.

Dietary Interventions for Healthy Pregnant Women: A Systematic Review of Tools to Promote a Healthy Antenatal Dietary Intake.

Maternal nutrition is essential for the development and lifelong health of the offspring. Antenatal care provides unique opportunities for nutrition communication, and health promotion tools (e.g., guidelines, instruments, packages, or resources) might help to overcome several concurrent barriers. We conducted a systematic literature review to map tools that are available for the promotion of a healthy dietary intake in healthy pregnant women in Western countries, and to identify what makes these tools feasible and effective for these women and their healthcare providers. Seventeen studies were included, evaluating tools with various delivery modes, content, and providers. Nine studies employed multiple, complementary delivery methods and almost all studies (n = 14) tailored the content to varying degrees, based on the individual characteristics and lifestyle behaviors of the participants. We found that the feasibility of a tool was dependent on practical issues, time investment, and providers' motivation, skills, and knowledge, while the effectiveness was related more to the type of provider and the content. Most effective interventions were provided by dietitians and nutritionists, and were highly tailored. Based on the results of this review, we believe that custom tools that are sensitive to inequalities are needed to support all women in obtaining or maintaining a healthy diet during pregnancy.

Optimizing Low-Socioeconomic Status Pregnant Women's Dietary Intake in the Netherlands: Protocol for a Mixed-Methods Study.

BACKGROUND: Although the importance of maternal nutrition is evident, adherence to dietary guidelines is limited in pregnant women, especially in those with a low socioeconomic status. Promotion of a healthy diet in midwifery practice is promising, as prenatal diet affects both maternal and child health, pregnant women are open to dietary changes during this critical transition, and midwives are their first and most important source of information. Unfortunately, nutrition communication by Dutch midwives is limited. OBJECTIVE: The objective of this study is to optimize the dietary intake of low-socioeconomic status pregnant women by contributing to the further development and adjustment of a tool or toolbox to support midwives in providing nutrition communication. METHODS: This interdisciplinary, mixed-methods study includes 2 phases, in which quantitative and qualitative research are complementary. In phase 1, we will conduct a literature study and interviews to gain insight into midwives' knowledge, needs, and practice. We will obtain data on the dietary intake of low-socioeconomic status pregnant women and factors influencing this intake from another literature study, an interviewer-administered meal-based food frequency questionnaire, and qualitative interviews with pregnant women. We will identify the availability of suitable tools to improve pregnant women's dietary intake from the literature, interviews, focus groups, and expert meetings. In phase 2, we shall adapt an existing tool or develop a new tool(box), depending on the results of phase 1, and implement it in 5 midwifery practices. Ultimately, a process evaluation will provide insight into barriers and facilitating factors playing a role in the implementation of the tool(box). RESULTS: The main outcome of this study will be a tool(box) to optimize the dietary intake of Dutch pregnant women. We anticipate that the developed or adjusted tool(s) will be available in February 2020. After we implement the tool(s) and evaluate the implementation process, the final results should be available by February 2021. CONCLUSIONS: This study is scientifically and socially relevant, as we will study low-socioeconomic status pregnant women's contextual dietary intake in-depth from an ecological perspective on health. The results obtained will lead to recommendations for multidisciplinary strategies to promote a healthy maternal dietary intake in low-socioeconomic status populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14796.

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).

A Systematic Review of Life Skill Development Through Sports Programs Serving Socially Vulnerable Youth.

PURPOSE: Despite the strong belief in sports programs as a setting in which socially vulnerable youth can develop life skills, no overview exists of life skill development in sports programs serving this youth group. Therefore, the present systematic review provides an overview of the evidence on life skill development in sports programs serving socially vulnerable youth and, insofar as it was investigated in the included studies, of the conditions conducive to life skill development in these sports programs. METHOD: Potentially relevant studies published during 1990 to 2014 were identified by a search in 7 electronic databases. The search combined terms relating to (a) sport, (b) youth AND socially vulnerable, and (c) life skills. Eighteen of the 2,076 unique studies met the inclusion criteria. RESULTS: Each included study reported that at least 1 life skill improved in youth who participated in the studied sports program. Improvements in cognitive and social life skills were more frequently reported than were improvements in emotional life skills. Only a few of the included studies investigated the conditions in the studied sports programs that made these programs conducive to life skill development. CONCLUSIONS: Sports programs have the potential to make a difference in the life skill development of socially vulnerable youth. This conclusion needs to be treated with some caution, because the studies experienced many challenges in reducing the risk for bias. Several alternative research strategies are suggested for future studies in this field.

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.

A weak sense of coherence is associated with a higher mortality risk.

BACKGROUND: Sense of coherence (SOC) is a health-promoting resource within the salutogenic theory that reflects an individual's coping ability. The association between SOC and mental health has been confirmed, but its association with mortality is less clear. We examined the association between SOC and all-cause mortality in an adult Dutch population. METHODS: Between 1996 and 1998, a postal questionnaire, including the three-item SOC scale, was completed by 12 024 men and women aged 20-65 years, who had participated in a health examination (MORGEN project) 6 months to 3 years earlier. Vital status was recorded up to November 2011; in total, 603 deaths were registered (5%). The participants were divided into three groups with a weak (21.1%), intermediate (60.3%) or strong (18.6%) SOC. Cox proportional hazard models were used with an intermediate SOC as the reference group. Adjustments were made for sex, age, socioeconomic factors, indicators of health status and lifestyle. RESULTS: A weak SOC, as compared with an intermediate SOC, was associated with a higher all-cause mortality risk after, on average, 13.5 years of follow-up and adjusted for sex and age (HR=1.40, 95% CI 1.14 to 1.70). After additional adjustments, the higher all-cause mortality risk remained statistically significant (HR=1.27, 95% CI 1.01 to 1.59). Mortality risk for the strong SOC group did not differ from that for the intermediate group. CONCLUSIONS: A weak SOC was associated with a higher risk of all-cause mortality. Health promotion focusing on strengthening SOC may be a promising new strategy, potentially affecting not only mental health but also mortality.