Evaluation of a Community-Based Physical Activity Program for Socially Disadvantaged Groups

1. Evaluation design for a community-based physical activity program for socially disadvantaged groups: Communities on the Move 20thEASM Conferende, 2012-09-2012Marion Herens Annemarie Wagemakers, Johan van Ophem, Lenneke Vaandrager, Maria Koelen

2. Content • Trend in physical activity • Rationale Communities on the Move approach (CoM) • Key principles of CoM • Research aims (cost)effectiveness CoM • Research questions • Evaluation design CoM

3. Physical activity in the Dutch adult population 2000-2009 (Hildebrandt et al, 2010) Figure 1 Persons (%) of 18 years of age and older meeting the Dutch Healthy Physical Activity guidelines

4. Rationale CoM • Persistent health and physical activity inequalities despite policy actions and active health and physical activity promotion in the Netherlands (Van der Lucht et al, 2010; Van Oort et al, 2004) • Inactivity among Dutch adults stabilises since 2005 (5,5 %). Groups not meeting guidelines generally people in poor(er) socio-economic conditions (Hildebrandt et al, 2010) • Physical inactivity has been identified as the fourth leading risk factor for global mortality by WHO causing an estimated 3.2 million deaths globally (WHO-GAPA, 2012)

5. NISB: Development of CoM2002-2012

6. Environment Fun being active active Social network Principle based approach: Seven key principles matter... Participant level: • socialnetwork approach: findpeoplewherethey meet • activeparticipation: participants part of decision making • Fun factor: the fun of beingactiveandplay • Involvement of socialandphysicalenvrionment Organisational level: • Group coaching • Intersectoral collaboration & networks • Localsustainability

7. Human ecology CoM Implemeningorgansisation CoM Community CoMgroup

8. Research aims • Overall: Development of a context-sensitive monitoring and evaluation approach in order to measure the effectiveness and cost-effectiveness of community-based physical activity programs at distinct impact levels: individual, group, program, and communityBased on: ”What is it about this approach that works, for whom, in what context, and why?”(Pawson & Tilly, 1997) • Test the design in the field through action research Challenge to develop a research approach which has both practical and scientific relevance

9. Research questions (1) Specific research questions: • Individual level - Which effects can be documented with respect to physical activity behaviour and health, quality of life and life satisfaction? • Group level – How do active participation and group learning support behavioural change with respect to changes in physical activity and habitual behaviour?

10. Research questions (2) • Program level - Which mechanisms explain the successes and failures of Communities on the Move? • Overall - How can results be interpreted in terms of costs and benefits and what combination of economic evaluation methods and tools is most appropriate to evaluate a community-program on cost-effectiveness?

11. Study design effectiveness and cost-effectiveness of CoM Multiple case study • Cohort – 16 groups/locations; monitored 18 months, 4 moments of measurement (t0-t3) Multi level • quantitative data collection (measurements and questionnaires) at participant level (min. n=240) • qualitative data collection at group, community and organisational level (interview, focus group, document analysis) • 4 locations in depth study (interview, focus group, observation, document analysis)

14. Outputs of the (cost)effectiveness study of CoM Overall: Recommendations for improving the health of low SES groups through physical activity. Further research results include: • An elaborated monitoring and evaluation design for participatory community health and physical activity promotion • Assessment of CoM’s (cost-) effectiveness at the individual, program, and community level • The facilitation of wider implementation of CoM at both national and local level

15. Challenges • Feasibilitycomprehensiveinterventionand research approach: making practiceand research worktogether • Combining M&E paradigms: results, learning & reflectionorientation • Tools and research strategydevelopment in relationto target groupsandtheircompetences

16. References • Hildebrandt VH, Chorus AMJ, & Stubbe JH (2010) Trendrapport bewegen en gezondheid 2008/2009. 2010, TNO Kwaliteit van Leven Leiden. • WHO-Global AdvocacyforPhysicalActivity (2012) Position Statement #2 Support for the inclusion of a global target on physicalinactivity, GAPA. 2012, WHO - GAPA. • Van Oort FVA, van Lenthe FJ, & Mackenbach JP (2004) Co-occurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study.PreventiveMedicine, 39(6), 1126-1134. • Van der Lucht F, Polder JJ (2010) Van gezond naar beter; Kernrapport van de Volksgezondheid Toekomstverkenning. 2010, Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Bilthoven. • PawsonR & TilleyN (1997) Realistic evaluation, Thousand Oaks, CA US: Sage Publications, Inc.

17. Thank you for your attention Marion Herens PhD Candidate M: 06 31753714  T: +31(0)317 483670 E: marion.herens@wur.nl www.hso.wur.nl Project supervision: Maria Koelen, Annemarie Wagemakers, Johan van Ophem, Lenneke Vaandrager