Annika Frahsa

Assessment of organizational readiness for health promotion policy implementation: test of a theoretical model

Models explaining the engagement of organizations in different policy sectors in health promotion policy implementation often utilize retrospective data. The current study attempted to model determinants of organizational readiness (goals, resources, obligation, opportunities) in supporting health policy implementation prospectively. Twenty qualitative interviews with representatives of organizations from different policy sectors, levels of government and organizational legal entities were conducted at the beginning of a project for the promotion of physical activity among women in difficult life situations. Organizational support in developing, implementing and disseminating the project was documented over 36 months. Results indicated that in most organizations, determinants were not favorable for health promotion policy action for physical activity among women in difficult life situations. Six organizations did not report any favorable determinant, and two organizations reported four. The other 12 organizations reported positive results for some of the determinants. Project work received support from 6 out of the 20 organizations. A case study of three organizations indicated that engagement or disengagement of organizations in health promotion policy actions might be partly explained by the theoretical model. The prospective assessment of organizational readiness in implementing health promotion policy is highly relevant for health promotion. Considering the proposed theoretical framework may aid in advancing our understanding of factors that are related to organizational engagement in health promotion actions.

Assets for policy making in health promotion: Overcoming political barriers inhibiting women in difficult life situations to access sport facilities ☆

Although the need for intersectoral policy making in health promotion has been commonplace and a high priority for several decades, there is still a lack of appropriate methods available to assess the inputs, processes, and outcomes associated with the effectiveness of such approaches, particularly in relation to sectors outside of health. This paper demonstrates how asset based models to intersectoral policy making in health promotion can improve the effectiveness of projects aiming to improve health and related outcomes. In particular, it summarises how asset based approaches to the planning and implementation of health promotion programmes can be used to develop our methods for assessing intersectorial actions. The paper is based on the findings from a local neighbourhood project based in Erlangen, Germany, aiming to improve the opportunities for physical activity among women in difficult life situations. The neighbourhood was characterised by high rates of unemployment, social welfare recipients, and migrants. Ethnographic methods enabled us to highlight the range of health related assets available in the neighbourhood which could be activated to improve access to and uptake of physical activity amongst the target population. Results indicate that intersectoral policies seeking to improve health outcomes, are more likely to be successful if they maximise the opportunities for making the most of the assets that exist in individuals, communities and organisations. This study demonstrates how the asset model was used to create the supportive environments which facilitated women from the target population to work with policy makers on an equal footing. Their involvement in project planning and implementation helped to achieve the structural changes required to achieve the aims of the project. These included the establishment of a new job position at the city office for sports and improved access to sport facilities for women in difficult life situations.

Differences in individual empowerment outcomes of socially disadvantaged women: effects of mode of participation and structural changes in a physical activity promotion program.

ObjectivesThis study explored the differences in individual empowerment outcomes of a group of socially disadvantaged women participating in physical activity promotion. The outcomes observed were assessed in the context of the women’s mode of participation and the structural organizational and community level changes, which took place during the implementation of the program.MethodsFifteen semi-structured qualitative interviews were conducted and analyzed using qualitative content analysis. Two groups of women participated in the interviews—those involved in the whole process of planning, implementation and evaluation of the program and those who took part in the program activities.ResultsIndividual empowerment outcomes were achieved for all those interviewed, although those participating in the planning, implementation and evaluation of the program achieved the greatest. A number of organizational and community level processes were also identified that supported the individual empowerment of those taking part.ConclusionsThis study supports the use of multilevel empowerment approaches to health as they help to identify the ideal characteristics that organizations and communities should possess and the potential structural changes required to support individual empowerment.

Movement as Investment for Health: integrated evaluation in participatory physical activity promotion among women in difficult life situations.

Movement as Investment for Health (Bewegung als Investition in Gesundheit or BIG) was a multidimensional research study in participatory physical activity promotion among socially disadvantaged women in a deprived neighbourhood in Erlangen, Germany. It aimed at making full use of health-promoting effects of movement and developing integrated evaluation through approaches from different disciplines. We defined the target population through national health survey data, and determined important intervention and evaluation dimensions through meta-analyses. A co-operative planning group of women, researchers, policy-makers, and local experts made decisions on the most appropriate procedures. Integrated evaluation in participatory approaches is promising. It calls for context-specific evaluation, requires adaptation of existing approaches or even development of its own evidence base.

Empowerment von Frauen in sozial benachteiligten Lebenslagen : Das BIG-Projekt

BIG is a project for the promotion of physical activity among women in difficult life situations. Following the main health promotion principles of the WHO, the women shall be enabled or empowered to take control of determinants of their health. A comprehensive participatory approach was applied and women were included in planning, implementing and evaluating the project. For measuring the effects of BIG on the empowerment of participating women, qualitative semi-structured interviews with 15 women participating in BIG were conducted. For data analysis, qualitative content analysis was used. Results showed the empowerment of the women on the individual level as they gained different competencies and perceived self-efficacy. These effects were supported through the empowerment process on the organizational and community levels where women gained control over their life situations and over policies influencing them. Therefore, the participatory approach of BIG is a key success factor for empowerment promotion of women in difficult life situations.

Physical Inactivity and Health Promotion: Evidence and Challenges

The purpose of this chapter is to give an overview of evidence on existing physical activity promotion strategies, to contribute to the development of theories that expand our focus beyond the individual level, and to provide insights about such interactions based on actual research projects. In the first part of this chapter, we review some of the existing evidence relating to physical activity promotion intervention strategies. We argue that there is an urgent need to develop and utilize theories that go beyond dynamics that occur at the individual level. The second section presents such a theoretical built on Giddens’ theory of structuration and on Sewell’s additions to incorporate structural change. The model also integrates Ostrom’s distinction between the operational level (where physical activity practice occurs) and the collective choice level (where physical activity-related policy-making takes place). In the third part of this chapter, we present two case studies for purposes of illustrating the cross-level interplay between structure and agency in health promotion. We conclude that future research should pay special attention to the specific processes at the collective choice level and to the fact that “what works” in public health might be different from “what works” in policy-making. In addition, from a global perspective, selecting appropriate interventions and policies and adapting existing ones to new contexts are questions of central importance. This will require closer investigation of national policy processes and context variables.

Verkehr und Gesundheit – Walkability

Das Kapitel fuhrt die Bedeutung von Gesundheit im Politikfeld Verkehr ein, am Beispiel der Forderung von Walkability, d. h. der bewegungsfreundlichen Gestaltung stadtischer oder kommunaler Raume. Wahrend der Beitrag von Deffner Fus- und Radverkehr aus individueller und sozialer Perspektive betrachtet, wird im vorliegenden Kapitel der Fokus auf die infrastrukturellen und politischen Dimensionen zur Veranderung im Sinne der gesundheitsforderlichen Bewegungsfreundlichkeit einer Kommune gelegt.