L.H. Engbers

What is actually measured in process evaluations for worksite health promotion programs: a systematic review

BackgroundNumerous worksite health promotion program (WHPPs) have been implemented the past years to improve employees’ health and lifestyle (i.e., physical activity, nutrition, smoking, alcohol use and relaxation). Research primarily focused on the effectiveness of these WHPPs. Whereas process evaluations provide essential information necessary to improve large scale implementation across other settings. Therefore, this review aims to: (1) further our understanding of the quality of process evaluations alongside effect evaluations for WHPPs, (2) identify barriers/facilitators affecting implementation, and (3) explore the relationship between effectiveness and the implementation process.MethodsPubmed, EMBASE, PsycINFO, and Cochrane (controlled trials) were searched from 2000 to July 2012 for peer-reviewed (randomized) controlled trials published in English reporting on both the effectiveness and the implementation process of a WHPP focusing on physical activity, smoking cessation, alcohol use, healthy diet and/or relaxation at work, targeting employees aged 18-65 years.ResultsOf the 307 effect evaluations identified, twenty-two (7.2%) published an additional process evaluation and were included in this review. The results showed that eight of those studies based their process evaluation on a theoretical framework. The methodological quality of nine process evaluations was good. The most frequently reported process components were dose delivered and dose received. Over 50 different implementation barriers/facilitators were identified. The most frequently reported facilitator was strong management support. Lack of resources was the most frequently reported barrier. Seven studies examined the link between implementation and effectiveness. In general a positive association was found between fidelity, dose and the primary outcome of the program.ConclusionsProcess evaluations are not systematically performed alongside effectiveness studies for WHPPs. The quality of the process evaluations is mostly poor to average, resulting in a lack of systematically measured barriers/facilitators. The narrow focus on implementation makes it difficult to explore the relationship between effectiveness and implementation. Furthermore, the operationalisation of process components varied between studies, indicating a need for consensus about defining and operationalising process components.

Evaluation of Neural Networks to Identify Types of Activity Using Accelerometers

PURPOSE To develop and evaluate two artificial neural network (ANN) models based on single-sensor accelerometer data and an ANN model based on the data of two accelerometers for the identification of types of physical activity in adults. METHODS Forty-nine subjects (21 men and 28 women; age range = 22-62 yr) performed a controlled sequence of activities: sitting, standing, using the stairs, and walking and cycling at two self-paced speeds. All subjects wore an ActiGraph accelerometer on the hip and the ankle. In the ANN models, the following accelerometer signal characteristics were used: 10th, 25th, 75th, and 90th percentiles, absolute deviation, coefficient of variability, and lag-one autocorrelation. RESULTS The model based on the hip accelerometer data and the model based on the ankle accelerometer data correctly classified the five activities 80.4% and 77.7% of the time, respectively, whereas the model based on the data from both sensors achieved a percentage of 83.0%. The hip model produced a better classification of the activities cycling, using the stairs, and sitting, whereas the ankle model was better able to correctly classify the activities walking and standing still. All three models often misclassified using the stairs and standing still. The accuracy of the models significantly decreased when a distinction was made between regular versus brisk walking or cycling and between going up and going down the stairs. CONCLUSIONS Relatively simple ANN models perform well in identifying the type but not the speed of the activity of adults from accelerometer data.

Characteristics of a population of commuter cyclists in the Netherlands: perceived barriers and facilitators in the personal, social and physical environment

BackgroundDaily cycling to work has been shown to improve physical performance and health in men and women. It is very common in the Netherlands: the most recent data show that one quarter of commuting journeys are by bicycle. However, despite the effort going into campaigns to promote commuter cycling, about 30% of commuter journeys up to 5 kilometers are still by car. The question is how to stimulate commuter cycling more effectively. This article aims to contribute to a better understanding of the perceived barriers and facilitators of cyclists/non-cyclists and personal factors associated with commuter cycling.MethodsA random sample of 799 Dutch employees (response rate 39.6%) completed an internet survey, which comprised two parts. One part of the questionnaire focused on the determinants of cycling behavior including equal numbers of personal, social factors and environmental factors. The other component focused on assessing data on physical activity (PA) behavior. Descriptive and logistic regression analyses were used to analyze factors associated with commuter cycling.ResultsMeeting the physical activity guideline was positively associated with commuter cycling. Television viewing and working full-time were negatively associated. Twenty-six percent of the participants met the PA guideline simply by cycling to work, with health as the main reason. The main barriers for non-cyclists (60%) were perspiration when arriving at work, weather and travelling time. Shorter travelling times compared with other transportation modes were an important facilitator. Environmental factors were positively related to more frequent and more convenient commuter cycling, but they were hardly mentioned by non-cyclists.ConclusionsThis study shows that a relatively large group fulfils the PA recommendations merely by cycling to work. Personal factors (i.e., perceived time and distance) are major barriers to commuter cycling and should be targeted in cycling campaigns, especially in subgroups living within cycling distance to work. Targeting environmental determinants in such campaigns seems to be less important in the Netherlands.

The design of a real-time formative evaluation of the implementation process of lifestyle interventions at two worksites using a 7-step strategy (BRAVO@Work).

BackgroundWorksite health promotion programs (WHPPs) offer an attractive opportunity to improve the lifestyle of employees. Nevertheless, broad scale and successful implementation of WHPPs in daily practice often fails. In the present study, called BRAVO@Work, a 7-step implementation strategy was used to develop, implement and embed a WHPP in two different worksites with a focus on multiple lifestyle interventions.This article describes the design and framework for the formative evaluation of this 7-step strategy under real-time conditions by an embedded scientist with the purpose to gain insight into whether this this 7-step strategy is a useful and effective implementation strategy. Furthermore, we aim to gain insight into factors that either facilitate or hamper the implementation process, the quality of the implemented lifestyle interventions and the degree of adoption, implementation and continuation of these interventions.Methods and designThis study is a formative evaluation within two different worksites with an embedded scientist on site to continuously monitor the implementation process. Each worksite (i.e. a University of Applied Sciences and an Academic Hospital) will assign a participating faculty or a department, to implement a WHPP focusing on lifestyle interventions using the 7-step strategy. The primary focus will be to describe the natural course of development, implementation and maintenance of a WHPP by studying [a] the use and adherence to the 7-step strategy, [b] barriers and facilitators that influence the natural course of adoption, implementation and maintenance, and [c] the implementation process of the lifestyle interventions. All data will be collected using qualitative (i.e. real-time monitoring and semi-structured interviews) and quantitative methods (i.e. process evaluation questionnaires) applying data triangulation. Except for the real-time monitoring, the data collection will take place at baseline and after 6, 12 and 18 months.DiscussionThis is one of the few studies to extensively and continuously monitor the natural course of the implementation process of a WHPP by a formative evaluation using a mix of quantitative and qualitative methods on different organizational levels (i.e. management, project group, employees) with an embedded scientist on site.Trial RegistrationNTR2861

The Implementation of Multiple Lifestyle Interventions in Two Organizations: A Process Evaluation

Objective: To evaluate the implementation of a multicomponent lifestyle intervention at two different worksites. Methods: Data on eight process components were collected by means of questionnaires and interviews. Data on the effectiveness were collected using questionnaires. Results: The program was implemented partly as planned, and 84.0% (max 25) and 85.7% (max 14) of all planned interventions were delivered at the university and hospital, respectively. Employees showed high reach (96.6%) and overall participation (75.1%) but moderate overall satisfaction rates (6.8 ± 1.1). Significant intervention effects were found for days of fruit consumption (&bgr; = 0.44 days/week, 95% CI: 0.02 to 0.85) in favor of the intervention group. Conclusions: The study showed successful reach, dose, and maintenance but moderate fidelity and satisfaction. Mainly relatively simple and easily implemented interventions were chosen, which were effective only in improving employees’ days of fruit consumption.

Bewegen gemeten: verschillende cijfers door gebrek aan gouden standaard

SamenvattingIn het verlengde hiervan is ook de vraag toegenomen naar valide en betrouwbare methoden voor het meten van sport en bewegen op verschillende niveaus, voor verschillende doelen en doelgroepen. Voor het formuleren en evalueren van beleidsdoelen is het van belang dat informatie over de ontwikkelingen met betrekkng tot sport en bewegen zo eenduidig mogelijk is. In de huidige situatie komen echter verschillende, schijnbaar tegenstrijdige cijfers met betrekking tot sport en bewegen naar voren.In dit artikel wordt aan de hand van een aantal voorbeelden nader ingegaan op verklaringen voor verschillen in cijfers over bewegen, toegespitst op de NNGB. Tevens wordt een voorstel gedaan voor het adresseren van lacunes en knelpunten op dit gebied.AbstractAssessing physical activity: different findings due to lack of a gold standardThere is conflicting information on the physical activity level of different Dutch population groups. The differences can partly be explained by the lack of a gold standard for assessing physical activity at different levels (i.e., national, regional, local, and individual), for different epidemiological purposes (e.g., trend monitoring, effect evaluation, and screening), and in different target populations (e.g., youth, adults, and elderly). In order to support national policymaking on physical activity, it is essential to reach consensus on which questionnaires and/ or objective instruments are the preferential method to assess physical activity per level, purpose, and target population.