Health Policy Development in Flemish Small-Sized Municipalities: A Real-World Intervention.

BACKGROUND: A health promotion institute developed an intervention to support small-sized municipalities (<15,000 citizens; n = 167) in their development of a local health policy. OBJECTIVES: To (1) find out which municipalities showed interest to participate and (2) assess the intervention effects after 1 year. METHOD: The intervention consisted of (1) completing an online tool that generated feedback on the quality level of the health policy (9 scores) and (2) receiving advice (four contacts) from the local-regional support service for health promotion. In total 121 small-sized municipalities agreed to participate (intervention municipalities), and the nonparticipating municipalities (n = 46) were used as a comparison group. Chi-square tests were conducted to compare baseline quality scores between intervention and comparison municipalities and to assess the change (baseline to follow-up) within the intervention group. RESULTS: At baseline, intervention municipalities had significant higher health policy quality scores compared to the comparison municipalities. Municipalities interested in the intervention mostly had already high policy scores. A significant positive shift in the quality levels was found after 1 year in the intervention municipalities. CONCLUSION: The intervention succeeded in improving the quality levels of the local health policy, though municipalities scoring low and possibly benefiting most from the intervention need to be extra-motivated to participate.

Evaluation of a real world intervention using professional football players to promote a healthy diet and physical activity in children and adolescents from a lower socio-economic background: a controlled pretest-posttest design.

BACKGROUND: The increasing rates of obesity among children and adolescents, especially in those from lower socio-economic backgrounds, emphasise the need for interventions promoting a healthy diet and physical activity. The present study aimed to examine the effectiveness of the 'Health Scores!' program, which combined professional football player role models with a school-based program to promote a healthy diet and physical activity to socially vulnerable children and adolescents. METHODS: The intervention was implemented in two settings: professional football clubs and schools. Socially vulnerable children and adolescents (n = 165 intervention group, n = 440 control group, aged 10-14 year) provided self-reported data on dietary habits and physical activity before and after the four-month intervention. Intervention effects were evaluated using repeated measures analysis of variance. In addition, a process evaluation was conducted. RESULTS: No intervention effects were found for several dietary behaviours, including consumption of breakfast, fruit, soft drinks or sweet and savoury snacks. Positive intervention effects were found for self-efficacy for having a daily breakfast (p < 0.01), positive attitude towards vegetables consumption (p < 0.01) and towards lower soft drink consumption (p < 0.001). A trend towards significance (p < 0.10) was found for self-efficacy for reaching the physical activity guidelines. For sports participation no significant intervention effect was found. In total, 92 pupils completed the process evaluation, the feedback was largely positive. CONCLUSIONS: The 'Health Scores!' intervention was successful in increasing psychosocial correlates of a healthy diet and PA. The use of professional football players as a credible source for health promotion was appealing to socially vulnerable children and adolescents.

Evaluation of a workplace intervention to promote commuter cycling: a RE-AIM analysis.

BACKGROUND: Originating from the interdisciplinary collaboration between public health and the transportation field a workplace intervention to promote commuter cycling, 'Bike to Work: cyclists are rewarded', was implemented. The intervention consisted of two cycling contests, an online loyalty program based on earning 'cycling points' and the dissemination of information through folders, newsletters, posters and a website. The study purpose was to evaluate the dissemination efforts of the program and to gain insights in whether free participation could persuade small and middle-sized companies to sign up. METHODS: The RE-AIM framework was used to guide the evaluation. Two months after the start of the intervention a questionnaire was send to 4880 employees. At the end of the intervention each company contact person (n = 12) was interviewed to obtain information on adoption, implementation and maintenance.Comparison analyses between employees aware and unaware of the program were conducted using independent-samples t-tests for quantitative data and chi-square tests for qualitative data. Difference in commuter cycling frequency was assessed using an ANOVA test. Non-parametric tests were used for the comparison analyses between the adopting and non-adopting companies. RESULTS: In total seven of the twelve participating companies adopted the program and all adopting companies implemented all intervention components. No significant differences were found in the mean number of employees (p = 0.15) or in the type of business sector (p = 0.92) between adopting and non-adopting companies. Five out of seven companies had the intention to continue the program. At the individual level, a project awareness of 65% was found. Employees aware of the program had a significantly more positive attitude towards cycling and reported significantly more commuter cycling than those unaware of the program (both p < 0.001). Participation was mainly because of health and environmental considerations. CONCLUSIONS: The results of the dissemination study are promising. The adoption and implementation rates indicate that the 'Bike to Work: cyclists are rewarded' program seems to be a feasible workplace intervention. At the individual level, a higher score of commuter cycling was found among the employees aware of the program. Nevertheless, more evidence regarding long term effectiveness and sustainability of the intervention is needed.

'10 000 Steps Flanders': evaluation of the state-wide dissemination of a physical activity intervention in Flanders.

The aim of the study was to evaluate the impact of the state-wide dissemination of a physical activity (PA) intervention in Flanders. In 2011, a random sample was taken of the entire adult (25-75 years) population of Flanders. Data of the Flemish sample were compared with baseline data of the intervention and control group of '10 000 Steps Ghent' (2005). In total, data of the International Physical Activity Questionnaire were available of 2556 respondents (1675 of the comparison sample and 881 of the Flemish sample). Pedometer data were obtained by 269 respondents of the Flemish sample and by 1236 respondents of the comparison sample. Compared with the comparison sample of 2005, the Flemish sample reported more walking (P < 0.001), moderate (P < 0.001), vigorous (P < 0.001), work-related (P < 0.001), leisure time (P = 0.01) and household PA (P = 0.03). Step count analyses revealed that the Flemish sample took more pedometer-based daily step counts (P < 0.001) than the comparison sample. Furthermore, a higher proportion of respondents reaching the 10 000 steps/day goal (P = 0.005) was found in the Flemish sample. A positive effect of '10 000 Steps Flanders' was found. Results indicate that a state-wide approach based on socio-ecological models is an effective strategy to promote PA in a large population.