Maja Bertram

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.

Contextually tailored interventions can increase evidence-informed policy-making on health-enhancing physical activity: the experiences of two Danish municipalities

BackgroundThe present study aims to test out contextually tailored interventions to increase evidence-informed health-enhancing physical activity policy-making in two Danish municipalities.MethodsThe study was performed as experiments in natural settings. Based on results from a pre-intervention study defining the needs and contexts of the two settings, the interventions were developed based on logical models. The interventions aimed at increasing the use of knowledge in policy-making, primarily via strengthening intersectoral collaboration. The interventions were evaluated via pre-, post- and 12-month follow-up questionnaires and qualitative interviews were carried out prior to the intervention start.ResultsThe use of knowledge changed in several ways. In one municipality, the use of stakeholder and target group knowledge increased whereas, in the other municipality, the use of research knowledge increased. In both municipalities, the ability to translate knowledge to local context, the political request and the organisational procedures for use of knowledge increased during the interventions. There was some variation between the two settings, which shows the importance of tailoring to context. Most of the changes were diminished at the 12-month follow-up.ConclusionContextually tailored interventions have the potential to increase evidence-informed policy-making on health-enhancing physical activity. However, this finding needs to be tested in larger samples and its sustainability must be strengthened.

More questions regarding the Danish health puzzle

We have read with interest the paper of Bakah and Raphael on the “Danish health puzzle” [1]. We want to thank the authors for their engagement and work on this subject. Yet, we have some issues to raise, which may lead to a broader discussion or even to new research. The authors start their analysis by presenting differences in life expectancy for Denmark and the other Nordic countries. The authors lacked a country-specific comparative perspective, which made it difficult to follow their argumentation. In fact, Finnish males have the same low life expectancies compared to Danes (FI 78.4 and DK 78.8, Sweden (SE) 80.4 and Norway (NO) 80.1 in 2015); however, among females there are different life expectancies between Denmark and the other Nordic countries (DK 82.8, FI 84.1, Sweden (SE) 84.2 and Norway (NO) 84.2 in 2015). These overall gender differences as well as the similarity between the life expectancies of Danish and Finnish men could be used to find potential reasons for the low Danish life expectancy. We suggest, therefore, that research explaining the low life expectancy in Denmark should be gender-specific. Furthermore, life expectancy is in actuality a statistical construct, depending on age-specific mortality and early life mortality. Overall infant mortality is very low in Denmark, but it is still higher than in other Nordic countries. Further research should point out age-specific mortality rates to clarify the population under risk when comparing Denmark’s low life expectancy with other Nordic countries. Such research should take into account the difficult task of establishing a causal relation between policy and life expectancy, between macro level indicators and life expectancy. Additionally, we would like to point out the role of healthcare systems. The authors are concerned with developments in the Danish system. We are aware that health expenditure is not the only measure to assess differences in healthcare. However, in comparing health expenditures in Denmark with the other Nordic countries, Danish per capita health expenditures in EURO purchase power parity (PPP) were placed in the middle of the five Nordic countries after Norway and Sweden [2]; in terms of health expenditures as a percentage of GDP, Denmark was second [2]. Of course, this is only one year and a trend analysis would provide more information. Yet, according to these data, the difference is unlikely to be due to healthcare systems and expenditures. More analytical, welldesigned studies are needed to clarify the role of different determinants of health on life expectancy differences including the role of health systems. Decentralization in the field of healthcare systems has, until the structural reform of 2007, influenced freedom of choice and local differences in health services. It has been hard to standardize health services across the country. Until the beginning of the 2000s large regional differences existed and made it more difficult to develop a common priority and standard. One reason might be a lack of organization of inter-institutional cooperation between the three levels; the state, region and municipalities. Therefore, it is important to compare life expectancies between different regions taking into account differences in regional healthcare More questions regarding the Danish health puzzle?

Health Promotion Challenges in Healthy Lifestyles: Can We Transfer Lessons Learned Across Contexts?

The increasing overweight and obesity problems with their health consequences around the world are alarming. The problem is hardly lack of knowledge on the determinants of healthy lifestyle. Most people (in developed countries) know that eating less, eating more vegetables and fruit and less meat and carbohydrates, and being physically active, are the basic ways to avoid weight gain. Why is this knowledge not transferred into practice then?

Adaption of Knowledge and Participation of Stakeholders in Three Public Health Interventions at Local Government Level in Denmark

Background:When implementing public health interventions in practice, it is recommended to use research evidence and to include relevant stakeholders. This should ensure effective interventions but it can be challenging. This study investigates the use of knowledge and inclusion of stakeholders in three different public health interventions at the local government level in Denmark and discusses strategies for future improvements in the use of research evidence. Method:Based on a previous assessment of all public health interventions in Varde Municipality using the European Community Health Promotion Indicator Development Model (EUHPID model), three different types of interventions (one Health Promotion, one Health Protection, and one Disease Prevention) were chosen for a case study analysis. The data consisted of document reviews and interviews. Data were analysed by content analysis using a framework for Evidence Based Practice as a guiding tool. Discussion of strategies for future improvements was based on experiences from previous studies. Results:In the Health Promotion and Disease Prevention interventions, knowledge of community characteristics and knowledge based on practitioners’ expertise were the most applied types of knowledge. In the Health Protection intervention, evidence from research was also used. Various stakeholders were included in all interventions. Barriers for the use of research evidence were lack of access to reported research, lack of time and competences to identify, adapt and apply the most relevant research evidence. The perceived facilitators for using evidence from research were access to summaries of research results or guidelines based on research and collaboration with researchers. Conclusion:Very limited knowledge on how to improve the use of research evidence in such interventions exists, however it seems like an active collaboration between research and practice is a promising strategy. There is a need for more research on this topic taking the role of various stakeholders into account.