Group-based principles for action in communitybased physical activity programs: What do participants have to say about it?

Transcription

1 Group-based principles for action in communitybased physical activity programs: What do participants have to say about it? EPH Milan, 17 October 2015 Marion Herens, Annemarie Wagemakers, Lenneke Vaandrager, Maria Koelen

2 Rationale community-based physical activity programs Physical inactivity in the Netherlands is most common in socially vulnerable groups (Hildebrandt et al. 2013). Dutch policy targets these high risk groups through community-based physical activity (CBPA) programs (Ministry of Health, Welfare and Sport, 2012). CBPA programs aim to empower socially vulnerable groups by improving participants health and wellbeing through physical activity.

3 Challenges for evaluation CBPA programs for socially vulnerable groups are: Grounded in an ecological perspective on human health (Herens et al, 2013). Revolve around principles for action, addressing multilevel interdependencies (WHO, 2013). Group-based approaches.

4 Research aims Identify indicators for group-based principles for action in CBPA programs Explore participants appreciation of group-based principles for action

5 Exploratory design Part of comprehensive evaluation study covering 7 on-going CBPA programs targeting socially vulnerable groups (Herens et al, 2013). Purposive sampling. Review of scientific and grey literate in search for indicators and methods addressing group-based principles for action. Development and pre-test of evaluation approach (Herens et al, 2015). Ten focus groups (5-11 p), reaching 76 respondents ( ).

6 Group-based principles for action operationalised Active participation: 1) participation in group formation, 2) participation in program content decision making (tailoring), and 3) participation in community initiatives. Enjoyment of physical activity: 1) expressions of enjoyment (physical, verbal and nonverbal), and 2) safe environments. Fostering group processes: 1) social support, group composition and structure, 2) role of the exercise trainer, and 3) learning achievements.

7 The active participation, enjoyment and fostering group processes (APEF) tool Indicators translated into 8 statements. For example, for participation in group formation, we used: We, as exercise group, choose who participates in the exercise group. Individual appreciation of each statement scored on a three-point scale with coloured poll cards: agree (green card with ); neither agree nor disagree (yellow card with ) or disagree (red card with ). Opinions further discussed in the focus group. Analysis thematic and data driven.

8 Respondent characteristics (n=76) Majority women (84%) Nearly 50% non-dutch origin (representing 15 different countries) Mean age: 61.6 (sd: 13.2) 65% active for 6 months or more in CBPA program Low incomes (50% < 1350/month) and low education (42% no or only primary education)

9 Number of responents Overall scores across groups % 6% 50% 67% 3% 9% 4% 5% 27% 19% 5% 8% 21% Disagree Not agree/disagree Agree % 44% 16% 88% 69% 77% 95% 71% 10 20% 17% 0 Active participation Enjoyment Fostering group processes

10 Active participation Participation in: group formation only in on-going groups when group maintenance becomes a shared interest of members and trainer. Tailoring: most respondents indicated that they did not decide on program activities. Community initiative: occasional involvement i.e. physical activity events - induced by the exercise trainer. Well, maybe we have something to say about it, but we just leave that job to the exercise trainer.

11 Enjoying physical activity Unanimously perceived as a positive outcome and individual driver of group exercise, related to program satisfaction. Mostly expressed as physical and nonverbal experiences, such as feel the energy, feel your body move, laughter, sense of freedom and relaxation. Different opinions about safety: environmental as well as emotional. I had a different kind of safety in mind. I thought to myself, here I am dancing with my fat ass and I m doing everything wrong and I just don t care.

12 Fostering group processes Social support: forming partnerships, complimenting and helping one another. Relies on shared group norms, going beyond group boundaries. Enforced by organising time and opportunity for socialising. Trainer: role model, responsive leadership, professionally trained, competent and enthusiastic. She is a trainer as well as a friend Learning: direct benefits vs. long-term returns, selfmanagement and self-organisation, regain of physical abilities. He knows about my complaints and he ll tell me; you re doing it wrong, you have to do it like this.

13 In conclusion... CBPA programs thrive on participants having fun together and exercise trainers leadership skills. Fostering group processes is an overarching principle, conditional for the spin-off in terms of enjoyment and active participation. Responsive leadership is found as an additional principle for action. A professional, competent, responsive exercise trainer plays a key role in the organisation and maintenance of CBPA programs.

14 Strengths Study highlights that group-based principles for action are not demarcated entities, but represent a range of intertwined values and principles to organise (group) processes. Development of a systematic way to assess participant appreciation of group-based principles for action within and across groups. The APEF tool proved useful in engaging a meaningful dialogue in highly diverse groups.

15 Matters of debate Focus groups varied in (cultural) composition and size, necessitating the use of Dutch as common language. Group setting: possibility of socially desirable responses. Lack of standardisation across literature in relation to how group dynamics strategies are applied in physical activity programs.

16 Thank you for your attention

17 References Hildebrandt V, Bernaards C, Stubbe J (2013): Trend report physical activity and health 2010/2011. TNO Innovation for Life, Leiden. Ministry of Health, Welfare & Sports (2012): Sport en Bewegen in de Buurt [Sport and Physical Activity in the Neighbourhood]. Ministry of Health, Welfare & Sports, The Hague. Herens M, Wagemakers A, Vaandrager L, Van Ophem J, Koelen M. Evaluation design for community-based physical activity programs for socially disadvantaged groups the case of Communities on the Move. JMIR Res Protoc. 2013; 2:e20. WHO (2013): Physical activity promotion in socially disadvantaged groups: principles for action. WHO Regional Office Europe, Copenhagen. Herens, M, Wagemakers A, Den Besten H, Bernaards C (2015): Welke factoren zijn van invloed op duurzaam beweeggedrag bij vrouwen van niet-westerse herkomst? [Which factors influence physical activity maintenance in women of non-western origin?] Tijdschr. Gezondheidswetensch 93(3):