Ien van de Goor

Environmental determinants of outdoor play in children: a large-scale cross-sectional study.

BACKGROUND Outdoor play is a cheap and natural way for children to be physically active. PURPOSE This study aims to identify physical as well as social correlates of outdoor play in the home and neighborhood environment among children of different age groups. METHODS Cross-sectional data were derived from 6470 parents of children from 42 primary schools in four Dutch cities by means of questionnaires (2007-2008). Multivariate sequential Poisson GEE analyses were conducted (2010) to quantify the correlation between physical and social home and neighborhood characteristics and outdoor play among boys and girls aged 4-6 years, 7-9 years, and 10-12 years. RESULTS This study showed that next to proximal (home) environmental characteristics such as parental education (RR=0.93-0.97); the importance parents pay to outdoor play (RR=1.32-1.75); and the presence of electronic devices in the childs own room (RR=1.04-1.15), several neighborhood characteristics were significantly associated with childrens outdoor play. Neighborhood social cohesion was related to outdoor play in five of six subgroups (RR=1.01-1.02), whereas physical neighborhood characteristics (e.g., green neighborhood type, presence of water, diversity of routes) were associated with outdoor play in specific subgroups only. CONCLUSIONS Neighborhood social cohesion was related to outdoor play among children of different age and gender, which makes it a promising point of action for policy development. Policies aimed at improving physical neighborhood characteristics in relation to outdoor play should take into account age and gender of the target population.

Adolescents and alcohol: an explorative audience segmentation analysis

BackgroundSo far, audience segmentation of adolescents with respect to alcohol has been carried out mainly on the basis of socio-demographic characteristics. In this study we examined whether it is possible to segment adolescents according to their values and attitudes towards alcohol to use as guidance for prevention programmes.MethodsA random sample of 7,000 adolescents aged 12 to 18 was drawn from the Municipal Basic Administration (MBA) of 29 Local Authorities in the province North-Brabant in the Netherlands. By means of an online questionnaire data were gathered on values and attitudes towards alcohol, alcohol consumption and socio-demographic characteristics.ResultsWe were able to distinguish a total of five segments on the basis of five attitude factors. Moreover, the five segments also differed in drinking behavior independently of socio-demographic variables.ConclusionsOur investigation was a first step in the search for possibilities of segmenting by factors other than socio-demographic characteristics. Further research is necessary in order to understand these results for alcohol prevention policy in concrete terms.

Evaluation of an assertive outreach intervention for problem families: intervention methods and early outcomes

Families who experience a chronic complex of socio-economic and psycho-social problems are hard to reach with mainstream care. Evidence exists that the core of this problem lies in a problematic interaction between this type of family and current systems of care. The adults and children involved have needs in multiple domains, while the care system is fragmented and highlights well-defined requests for help. To improve access to this target group, an assertive outreach intervention was implemented into the preventive child healthcare system in The Netherlands. Evaluation research was carried out to get a detailed insight into the content of this intervention. Also, early outcomes were examined. Information was gathered by interviews, attending meetings on method development, analysing registration forms and a survey on client satisfaction. Five intervention stages were identified: case finding, making contact, sustaining contact, developing a family plan and linking (arranging for services to be delivered). Practical support was used to build rapport and clear the way to the uptake of follow-up help. The professionals delivering the intervention need a broad range of competencies to establish a working relation with the families and to link them to care and services. A good care network across professionals from various organisations must exist to provide a variety of linking options. Early outcomes indicate that professionals were able to get in touch with the families within a mean of 13.2 days. Goals of the intervention were mainly practical support (73%), starting new assistance for a child (63%) and starting new assistance for a parent (43%). Linking to care and services was attained in the majority of the cases and parents expressed satisfaction. The findings indicate that the studied intervention is a promising one. Some potent components can be indicated: the outreach approach, practical support, maximising participation of the family and building bridges between the family and (in)formal support and assistance.

Integrating research evidence and physical activity policy making-REPOPA project

Evidence shows that regular physical activity is enhanced by supporting environment. Studies are needed to integrate research evidence into health enhancing, cross-sector physical activity (HEPA) policy making. This article presents the rationale, study design, measurement procedures and the initial results of the first phase of six European countries in a five-year research project (2011-2016), REsearch into POlicy to enhance Physical Activity (REPOPA). REPOPA is programmatic research; it consists of linked studies; the first phase studied the use of evidence in 21 policies in implementation to learn more in depth from the policy making process and carried out 86 qualitative stakeholder interviews. The second, ongoing phase builds on the central findings of the first phase in each country; it consists of two sets of interventions: game simulations to study cross-sector collaboration and organizational change processes in the use of evidence and locally tailored interventions to increase knowledge integration. The results of the first two study phases will be tested and validated among policy makers and other stakeholders in the third phase using a Delphi process. Initial results from the first project phase showed the lack of explicit evidence use in HEPA policy making. Facilitators and barriers of the evidence use were the availability of institutional resources and support but also networking between researchers and policy makers. REPOPA will increase understanding use of research evidence in different contexts; develop guidance and tools and establish sustainable structures such as networks and platforms between academics and policy makers across relevant sectors.

Towards quality criteria for regional public health reporting : Concept mapping with Dutch experts

Background: In the Netherlands, municipal health assessments are carried out by 28 Regional Health Services, serving 418 municipalities. In the absence of guidelines, regional public health reports were developed in two pilot regions on the basis of the model and experience of national health reporting. Though they were well received and positively evaluated, it was not clear which specific characteristics determined ‘good public health reporting’. Therefore, this study was set up to develop a theoretical framework for the quality of regional public health reporting in The Netherlands. Methods: Using concept mapping as a standardized tool for conceptualization, 35 relevant reporting experts formulated short statements in two different brainstorming sessions, describing specific quality criteria of regional public health reports. After the removal of duplicates, the list was supplemented with international criteria, and the statements were sent to each participant for rating and sorting. The results were processed statistically and represented graphically. The output was discussed and interpreted, leading to the final concept map. Results: The final concept map consisted of 97 criteria, grouped into 13 clusters, and plotted in two dimensions: a ‘product’ dimension, ranging from ‘production’ to ‘content’, and a ‘context’ dimension, ranging from ‘science’ to ‘policy’. The three most important clusters were: (i) ‘solution orientation’, (ii) ‘policy relevance’ and (iii) ‘policy impact’. Conclusion: This study provided a theoretical framework for the quality of regional public health reporting, indicating relevant domains and criteria. Further work should translate domains and criteria into operational indicators for evaluating regional public health reports.

Challenges of Ethical Clearance in International Health Policy and Social Sciences Research: Experiences and Recommendations from a Multi-Country Research Programme

AbstractBackground: Research ethics review practices vary considerably across countries and this variability poses a challenge for international research programmes. Although published guidelines exist, which describe underlying principles that should be considered and pragmatic approaches that could be followed in seeking ethics approval, most have roots in biomedical and clinical research. The result is that there is generally less clarity around institutional and/or country-level structures for ethics review of health policy and social sciences research. This is an important gap that needs to be addressed in order to ensure ethical practices in multi-country research programmes. Context and purpose: This paper explores research ethics requirements for a multicountry health policy research programme and provides recommendations based on experiences in seeking ethics approval. The context for this paper is a five-year, cross-country, European Commission-funded international programme: Research into Policy to enhance Physical Activity (REPOPA). Results: Ethics requirements and review processes for health policy and social sciences research varied considerably across the seven REPOPA countries. Specifically, requirements and infrastructure for ethics approval have been influenced by how the purpose and domain of health research are defined in legislation, what types of research have been most prominently funded, and international requirements for ethics approval by external funders and journal editors. Significance: Multi-country research programmes provide an opportunity to enhance and build transparent ethics review practices and to strengthen ethics review structures at all levels. Such programmes also enable reciprocal learning about relevant practices and processes for the ethical conduct of research.

Feasibility of multi-sector policy measures that create activity-friendly environments for children: results of a Delphi study

BackgroundAlthough multi-sector policy is a promising strategy to create environments that stimulate physical activity among children, little is known about the feasibility of such a multi-sector policy approach. The aims of this study were: to identify a set of tangible (multi-sector) policy measures at the local level that address environmental characteristics related to physical activity among children; and to assess the feasibility of these measures, as perceived by local policy makers.MethodsIn four Dutch municipalities, a Delphi study was conducted among local policy makers of different policy sectors (public health, sports, youth and education, spatial planning/public space, traffic and transportation, and safety). In the first Delphi round, respondents generated a list of possible policy measures addressing three environmental correlates of physical activity among children (social cohesion, accessibility of facilities, and traffic safety). In the second Delphi round, policy makers weighted different feasibility aspects (political feasibility, cultural/community acceptability, technical feasibility, cost feasibility, and legal feasibility) and assessed the feasibility of the policy measures derived from the first round. The third Delphi round was aimed at reaching consensus by feedback of group results. Finally, one overall feasibility score was calculated for each policy measure.ResultsCultural/community acceptability, political feasibility, and cost feasibility were considered most important feasibility aspects. The Delphi studies yielded 16 feasible policy measures aimed at physical and social environmental correlates of physical activity among children. Less drastic policy measures were considered more feasible, whereas environmental policy measures were considered less feasible.ConclusionsThis study showed that the Delphi technique can be a useful tool in reaching consensus about feasible multi-sector policy measures. The study yielded several feasible policy measures aimed at physical and social environmental correlates of physical activity among children and can assist local policy makers in designing multi-sector policies aimed at an activity-friendly environment for children.

Bridging the Gap between Science and Practice: Do Applied Academic Centres Contribute to a Solution? A Plea for International Comparative Research

This article refers to the worldwide gap between research and practice. The use of so-called applied academic centres as a possible way to bridge this gap is proposed. Within academic centres, the university, on the one hand, and treatment and (public) health and social welfare services, on the other, together invest in a long-term partnership. A long-term research program and a knowledge-exchange structure are developed. The authors have established these kinds of centres in different fields such as, among others, the field of public health, the field of mental health and the field of social welfare. These centres may differ in important characteristics including the number of organisations involved and the form in which the collaboration is organised. These differences make valuable comparisons possible. A plea is made for further research towards the usefulness of applied academic health centres in promoting evidence-based work within treatment and public health and social work services.

Screening for psychopathology in the clinical practice

Different instruments are used in clinical practice to assess comorbid psychopathology in addicted individuals. This study is aimed at comparing two of those instruments. In total, 327 heroin- and methadone-addicted individuals were interviewed in three treatment settings and outside treatment. Instruments used are the Addiction Severity Index (ASI) and the Composite International Diagnostic Interview (CIDI). The former instrument results in a general measure of severity of psychopathology, while the latter results in categorical DSM-III-R diagnoses. A comparison of the results show, however, that the two types of data do not agree to a large extent. By using the DSM-III-R data as golden standard, it appeared that a part of the psychopathology cases was missed out by the ASI severity measures. The results, that are especially of interest for clinicians using the ASI, are presented for various disorders.

Medische Advisering Ziekgemelde Leerling door de jeugdarts (M@ZL)

Sociaal economische gezondheidsverschillen kunnen worden gereduceerd door het verminderen van gezondheidsrisico’s en het verhogen van onderwijskansen. Bij dit laatste is omvangrijk schoolverzuim een risicofactor. Door aandacht te besteden aan schoolverzuim wegens ziekte levert de jeugdgezondheidszorg een bijdrage aan de gezondheid, het welbevinden en de onderwijskansen van jongeren en daarmee aan het terugdringen van sociaal economische gezondheidsverschillen. De GGD West-Brabant heeft in een pilot de interventie M@ZL (Medische Advisering Ziekgemelde Leerling) voor de aanpak van ziekteverzuim door scholieren in het voortgezet onderwijs ontwikkeld. In dit artikel worden methodiek en pilotresultaten beschreven. Van de leerlingen met omvangrijk ziekteverzuim werd 98% bereikt door de jeugdarts of de leerplichtambtenaar; 50% had lichamelijke klachten, veel leerlingen hadden psychosociale problemen. Bij 63% van de leerlingen die in het begeleidingstraject kwamen nam de verzuimomvang af. Het ziekteverzuim op schoolniveau nam af met gemiddeld 1,1 ziektedagen per leerling per schooljaar. Uit de pilot wordt voorlopig geconcludeerd dat de interventie M@ZL veelbelovend is voor het terugdringen van ziekteverzuim op het voortgezet onderwijs. Er worden aanknopingspunten voor verdere ontwikkeling gegeven.ABSTRACTMedical advice for the sick reported student in secondary school by the youth health care physician (M@ZL): development of an intervention. Socio-economic health differences can be reduced by decreasing health risks and increasing educational opportunities. In the latter substantial school absenteeism is a crucial risk factor. By addressing school absenteeism for medical reasons, youth health care makes a positive contribution to health, welfare and educational opportunities for young people and thereby to reduction of socio-economic health differences. The Regional Public Health Service (RPHS) West Brabant has developed M@ZL (medical advice for the sick reported student) to address school absenteeism for medical reasons by secondary school students. We present you with a description of M@ZL and data from the pilot study. Almost all students (98%) that missed a substantial number of schooldays due to illness were reached by the youth health care physician or school attendance officer. Half of the latter group showed physical symptoms, for many students psychosocial problems appeared to be the main cause for health-related absenteeism. The size of medical absence decreased in 63% of the students receiving guidance while on the school level it was reduced with 1,1 schooldays per student per year. It is concluded that M@ZL is a promising intervention for reducing secondary school medical absenteeism, leads for further development are therefore given.