Settings apprach t sprts clubs and HEPA Sami Kkk, PhD Research Center fr Health Prmtin University f Jyväskylä, Finland SANTE Final Cnference, 18 20 March 2011, Prague, Czech Republic
Cntents 1) Settings-based Health Prmtin a review 2) Sprts club as a setting fr health prmtin Obligatins in Health Prmtin Opprtunities in Health Prmtin 3) Health Prmting Sprts Club (HPSC) study 4) Sprts Club fr Health (SCfrH) Prject 5) Final wrds
1) Settings-based Health Prmtin a review
HP was equal t individual disease preventin thrugh individual health behavirs, like PA, mediated thrugh individual factrs, like knwledge f PA, mtivatin etc. Settings-based Health Prmtin Expanded as ne f the key appraches f health prmtin tday Started t evlve after the Ottawa Charter (1986) Previusly peple s lifestyle decisins were seen as depending n individual chices and decisin-making that were freely made withut any influence f the cntext r living cnditins This meant, that individuals health r the ppsite diseases that threaten the health were in centre
Settings-based Health Prmtin Tday realized that peple s health, alng with individually fcused factrs, is mediated thrugh settings e.g. envirnmental factrs As an example, ne f the latest definitins f HP The main determinants f health are peple s cultural, scial, ecnmic and envirnmental living cnditins, and the scial and persnal behavirs that are strngly influenced by thse cnditins (IUHPE and CCHPR 2007) Settings-based factrs are dependent n the setting in questin, each setting is riginal within and between settings
Settings-based Health Prmtin At general-level... Setting apprach strives fr changes in the structure and eths f a setting, like sprts clubs and in the light f HEPA T be mre exact It is a questin f cultural, scial, ecnmic and envirnmental cnditins within the setting in questin! like in sprts clubs and relative t HEPA The key questins are What kind f precnditins the setting in questin (sprts club) ffers fr individuals t make a psitive decisins cncerning HEPA? What des the setting (sprts club) d befre the individual chice?
Settings-based Health Prmtin Persnal skills are always needed, since the final decisin relies n individual Persnal skills are seen thrugh the cncept f health literacy, which cnsist f knwledge, attitudes, mtivatin, behaviral intentins, persnal skills and self-efficacy. T cnclude s far Individuals behavirs and pssible changes within it remain as the ultimate aim, but there is an rientatin t act n a wider frnt i.e. thrugh settings Here ne can als ask, what shuld/culd sprts rganizatins t d t ffer sprts clubs the best pssible precnditins t execute PA, HEPA r HP?
Dimensins f Settings-based Health Prmtin - Wrksite as an example Fundamental questin here is: Which are the cultural, scial, ecnmic and envirnmental determinants f health/hepa in a wrkplace setting? Cultural determinants f HEPA Relate e.g. t the psitin f HEPA Has there been any previus HEPA activities in the wrkplace in questin? What kind f an attitude the management has twards HEPA i.e. what is the value f HEPA, has the management realized a link between HEPA and wrkplaces crebusiness? Scial determinants f HEPA Pertain t the atmsphere (verall) in wrkplace twards HEPA Is HEPA scially accepted?
Dimensins f Settings-based Health Prmtin - Wrksite as an example Ecnmic determinants f HEPA Interlink t the financial (mney and time) resurces t realize HEPA develpment wrk and at individual-level HEPA Is HEPA prmtin and exercise resurced enugh? Envirnmental determinants f HEPA Relate t envirnmental cnditins t execute HEPA, but als t crprate structures t enhance HEPA Is there prper built spaces and equipments? (and prvided by whm?) Is it pssible t increase HEPA during a wrkday r befre r after it? The size and cmplexity f a wrkplace in questin - Hw easy/difficult this develpment wrk is t get started? Health prmtin has becme r shuld becme as integral part f the wrkplace culture This means that instead f health r PA/HEPA prfessinals cming utside the wrkplace and try t cnduct (PA/HEPA) prgrams, it is a questin f emplyees and management cllectively aspirating t change the wrkplace as Health Prmting r Active setting, with a help f PA/HEPA prfessinals and Active Wrkplace cncept
Settings-based Health Prmtin There are many settings in which settings apprach has been realized Healthy Cities since 1986 (e.g. Awfes 2003; de Leeuw 2001) Healthy r Health Prmting Schl since 1986/87 (e.g. Rwe et al. 2007; St.Leger 2001) Health Prmting Wrkplace since end f 1990 s (e.g. Chu et al. 2000; Nblet 2003) Health Prmting Hspital since 1991 (e.g. Grene 2005; Pelikan et al. 2001) Healthcare? (e.g. Jhnsn 2000) Health Prmting Prisn since 1995 (e.g. Department f Health (UK) 2002, Gatherer et al. 2005) Health Prmting University since 1998 (e.g. Tsurs et al. 1998; Xiangyang et al. 2003) Several new-cmers intrduced: Health Prmting Sprts Club since 2004 (e.g. Kkk et al. 2006, 2009) Healthy Stadia since 2004 (e.g. www.healthystadia.eu) Health Prmting Farm since 2005 (e.g. Thurstn & Blundell-Gsselin 2005) Etc.
Settings-based Health Prmtin Despite f many setting-specific factrs, such as target grup r duratin f the initiative, there are als shared characteristics Cmplex entities Grunds in the Ottawa Charter Emphasis n envirnmental factrs Primary targeting n rganizatinal change, secndary n individual behaviurs Key actins determined as standards r alike Expansin after a link between settings-based health prmtin and cre-business f a setting in questin recgnised Impact and effectiveness evaluatin challenging and s far nly partly successfully develped
Settings and sub-settings a city and thers What is an Active City? Active City is a setting that values HEPA Creates and prvides precnditins fr sub-settings t enhance HEPA and citizens t execute HEPA There are several sub-settings underneath a city-setting
Settings and sub-settings a city and thers Sub-settings rely n the HEPA-related definitin f plicies f the city in questin e.g. General value and atmsphere twards HEPA HEPA strategy Urban planning cncerning cmmute HEPA Expertise advisry help in HEPA HEPA facilities HEPA financing What a City can ffer t sub-settings and vise versa? There is ften a win-win situatin Frm the city perspective sub-settings are clear settings, which reach certain target grup Frm a sub-settings perspective tgether with helping t achieve the cmmunity-level public health (HEPA) aims, increase in HEPA has benefits t the individuals and ultimately t its cre-business Furthermre, sub-settings may cperate twards mutual gals e.g. sprts clubs and wrkplaces
2) Sprts club as a setting fr health prmtin
Sprts Club There are varius sprts systems and characteristics f sprts clubs arund the Eurpean cuntries Still, sprts clubs can be generalized t be the implementatin part f the sprts systems. In ther wrds, settings were children and adlescents cncretely g in fr sprts and were caches and ther adults cntribute t them by their actins Thus, the basis fr Health Prmtin within sprts club activities rely n vluntary participatin f children and adlescents rather than rganizatinal/peratinal frm f sprts clubs
Dimensins f health, sprts club activity and health effects/benefits Scial *Scial netwrks *Interactin *Cmmunality *Participatin Scial capital Scial health Physical *Physical activity *Duratin *Intensity *Pwer level Physical fitness Physical health Mental *Experiences in general *Experiences f success *Meaningfulness *Jy Mental resurces Mental health
Health Prmting Sprts Club (HPSC) Why? Arund the millennium natinwide schl-based surveys undermined the myth f healthy lifestyle amng sprts club participating yuth Sprts club participating yuth + are mre physically active (e.g. Sallis et al. 2000; Vuri et al. 2004) + smke less (e.g. Haukkala et al. 2006; Melnick et al. 2001) - use mre frequently ral snuff /smkeless tbacc (e.g. Kannas et al. 2002; Rlandssn and Hugsn 2001) - binge-drink mre (e.g. Kski 2000; Kannas et al. 2002) - Use mre supplements and/r perfrmance-enhancing drugs (e.g. Bents et al. 2004; Calfee and Fadale 2006; Dickinsn et al. 2005) Despite, there is sme incnsistency in these finding, the main message is that yuth sprts clubs des nt have autmatic psitive cntributin t the health behavirs f their participants Als, sme practical tls were claimed by the practitiners
Sprts clubs bligatins in health prmtin 1) Financial supprt fr federatins by the state and fr clubs by the municipalities Semi-fficial status f the sprts federatins and clubs (Heikkala 1998) 2) Fundamentals f vluntary activities and the histry f Finnish sprts clubs Vluntary activities shuld cntribute t the needs f its participants Des nt always happen cmpetitin versus recreatin Many clubs were funded under sme ther assciatins like temperance r labr assc. 3) Often heard argument (health)educatin is nt a respnsibility f sprts clubs is false, because every institutin (hme, schl, club) has its share f respnsibility in educatin and als in health educatin, when yuth are under its activities
Sprts clubs bligatins in health prmtin 4) Paradx between peratinal principles f the clubs and health behavirs f participating yuth 81% f the clubs stated, that healthy lifestyle is ne f the main bjectivies f the club activities (Kski 2009) 5) Risk f sprts injuries When the level f PA increaces, the risk f injuries increaces (depending f the discipline etc.) Injuries, especially serius nes, are physical, but als scial and mental crisis fr yung athletes Thus, sprts clubs have, at least, mral bligatin t injury preventin and cmprehensive care
Sprts clubs pprtunities in health prmtin 1) Sprts club activities attain a lt f children and adlescents Over 40% (43% 2010) f children and adlescents (3-18 y) participate t sprts club activities in Finland Even 60% f 11-years ld bys participate It has als been estimated that 70-80% f certain age grup participate t sprts club activities at sme pint befre the age f 20 (Kski & Tähtinen 2005; Lämsä & Mäenpää 2002) 2) Educatinal nature f sprts club activities is infrmal Children and adlescents participate t activities n vluntary-basis They participate, because they are interested f the sprts in questin This creates an pprtunity t HP, when health-issues are represented thrugh sprts
Sprts clubs pprtunities in health prmtin 3) Caches imprtant authrity figures At sme pint f the puberty even the mst influential Caches influence n health can be either cnscius r uncnscius, but is it there whether a cach wishes it r nt There has been fund cntradictin between caches rientatin t cmprehensive athlete 4) Health prmtin within yuth sprts club activities benefit bth public health and sprt itself The health literacy f the yuth develps (united frnt tgether with hmes and schls) Scietal pressure f public health is recgnized, but first and fremst Yuth, wh has balanced diet, sleeps enugh, has balance f exertin and rest, des nt use substances, etc., als develp and perfrm better in sprt Als ther way arund, unhealthy habits / verall ill-being cntribute t sprts perfrmance!
Psitin f a setting i.e. sprts club in health prmtin Psitin f the setting Characteristics f the mdel Examples f activity Passive educatin mdel Passive, prviding access t the target grup desired Health educatin riented, specific risk behaviur, individual targeted and external expert Specific health educatin lessns, use f leaflets and ther health educatin materials Kkk and Vuri 2004, cf. Whitelaw et al. 2001 Club based educatin mdel Smewhat active, carries ut supprtive actins Individuals as primary fcus, measures f supprt by the club Individual-level; supprt n behaviural change Club-level; educatin f actrs like caches, guidelines fr actins Club sciety develpment mdel Main fcus n rganizatinal change i.e. culture and eths Primary gal (lng-term) n changes in the club peratins, secndary gal (shrt-term) n individual health behaviurs, emphasis f activity n envirnmental factrs Frm single health tpic prgrams t changes in club plicies, regulatins and peratinal principles, bth plicy and practice level changes
3) Health Prmting Sprts Club (HPSC) study
Health Prmting Sprts Club (HPSC) the research Study prcess started at 2004 Theretical backgrund (article 1 Liikunta & Tiede in Finnish, English versin in a bk Beynd Health Literacy ) Standards fr HPSC were created at 2005-2006 The Delphi-study (article 2 Health Prmtin Internatinal 2006) Finnish yuth sprts clubs health prmtin activities Data cllectin at 2007 Health prmtin prfiles 2007-2008 (article 3 Health Prmtin Internatinal 2009) Clubs guidance activity 2009 (article 4 Health Educatin submitted) Dctral dissertatin 01/2010 Health prmtin within caching practice (within dissertatin) Health prfiles effect n guidance activity (within dissertatin)
HPSC guidelines fr Yuth Sprts Clubs On the basis f the research results f HPSC study and fllwing the general principles f health prmtin planning and evaluatin 14 guidelines fr yuth sprts clubs can be represented 8 n plicy-level 6 n practice-level There can be fund hierarchy in the guidelines The ultimate aim f these guidelines is, that health prmtin wuld becme integral part f sprts club activities and/r wuld prduce new permanent ways f actin Under every guideline, it is als prtrayed the reasning and practical example In the dissertatin, there are als sme guidelines fr ther sprts rganizatins, like sprts federatins
4) Sprts Club fr Health (SCfrH) Prject
Sprts Club fr Health (SCfrH) prject Sprts Club fr Health (SCfrH) prject is ran by the Finnish Sprts fr All assc. started at 2008 First wrkshp in Helsinki by FSfA and TAFISA/ESFAN became a HEPA Eurpe prgram at 2008 received EU sprt unit (DG EAC) funding at 2010 as ne f the preliminary actins in sprt 2009
There were tw essential aims fr the SCfrH prject: 1) aim was t update and develp initial stage SCfrH guidelines (1.0) 2) aim was t develp netwrking in the area f health-enhancing PA with special fcus n sprts clubs WP 1 Prject management crdinatin and ecnmy WP 2 Develpment f SCfrH guidelines and netwrking WP 3 Mdel certificate system fr the assessment f SCfrH WP 4 Health prfile f different sprts WP 5 The leadership and management f SCfrH WP 6 Funding system fr SCfrH WP 7 Evaluatin f the SCfrH Jrma Savla Sami Kkk Herbert Hartmann Ari Heinnen - Pasi Kski Stjepan Heimer 1) 1 st draft f the develped SCfrH guidelines (2.0) 2) Eurpean-level netwrking bdies (EFCS, ENGSO, HEPA Eurpe, ISCA, TAFISA/ESFAN) participated t cncluding sympsium 1) Final versin f SCfrH guidelines (2.0) will be published during spring 2011 2) Prgressin f Eurpean-level netwrking depends n mutual interest yet t be seen
5) Final wrds
Final wrds Settings apprach emphasizes the precnditins the settings prvide fr cmmunities and individuals cncerning their health-related chices Fr example the precnditins a wrkplace prvides fr HEPA develpment wrk and HEPA executin f the emplyees Cultural, scial, ecnmic and envirnmental determinants f health prmtin need t be recgnized and addressed Thus, health prmtin in sprts clubs des nt nly rely n PA, but t wider recgnitin f a sprts situatin and a setting and theirs dimensins f health prmtin the same may be applied t HEPA prmtin When lking HEPA frm an individual perspective, peple are mving frm ne setting t anther all the time Thus, PA/HEPA shuld be prmted in all f the settings
Final wrds Bth sprts clubs bligatins and pprtunities give supprt the idea, that HP is a part f sprts club activities Indeed, there is a win-win situatin fr bth public health and sprts itself The HPSC guidelines highlighted the steps and issues a club need t address, if it desires t develp its activities in the light f health prmting setting idelgy The SCfrH guidelines ffer als the steps and issues fr sprts clubs, but t develp a health-riented sprts prgram
THANK YOU! sami.p.kkk@jyu.fi
HPSC guidelines fr Yuth Sprts Clubs plicy-level Guideline 1. Determine the current state f will t health prmtin in yur club. Guideline 2. Determine the health prmtin aims, turn thse in a written frm and cnvert the aims in the language f sprts. Guideline 3. Priritise the mst relevant health prmtin aims. Guideline 4. Cnsider bth financial and human resurces that can be invested in the health prmtin develpment wrk. Guideline 5. Mandate a certain persn t lead the develpment prcess. Guideline 6. Engage all the participating club fficials in. Guideline 7. Cllabrate with ther clubs. Guideline 8. Evaluate the feasibility f health prmtin aims regularly.
HPSC guidelines fr Yuth Sprts Clubs practice-level Guideline 9. Create an actin plan fr implementing plicy-determined aims. Guideline 10. Invest in internal rganisatinal cmmunicatin i.e. guidance activity. Guideline 11. Mtivate the caches f the imprtance f health prmtin. Guideline 12. Educate caches and ther club fficials. Guideline 13. Mnitr health prmtin activities in daily practice. Guideline 14. Evaluate practices with relatin t plicies.
References HPSC: Theretical grunds: Kkk S. (2005) Sprts clubs as a setting fr yuth health prmtin. In Hikkala, T., Hakkarainen, P. and Laine, S. (eds.) Beynd health literacy. Yuth cultures, preventin and plicy. Finnish yuth research netwrk / Finnish yuth research sciety publicatins 52, 338-354. Standards: Kkk S., Kannas L. and Villberg J. (2006) The health prmting sprts club in Finland a challenge fr the settings apprach. Health Prmtin Internatinal, 21, 219-229. Health Prmtin Prfiles: Kkk S., Kannas L. and Villberg J. (2009) Health prmtin prfile f yuth sprts clubs: Club fficials and caches perceptins. Health Prmtin Internatinal, 24, 26-35. Open access versin. Guidance Activity: Kkk S., Kannas L. and Villberg J. (2011) Health prmtin guidance activity f yuth sprts clubs. Health Educatin, Submitted. Caches Activity: Kkk S. (2010) Health Prmting Sprts Club Yuth sprts clubs health prmtin prfiles, guidance, and assciated caching practice, in Finland. University f Jyväskylä. Studies in Sprt, Physical Educatin and Health 144. Available als in the internet: https://jyx.jyu.fi/dspace/bitstream/handle/123456789/22710/9789513937935.pdf?sequence=1 References SCfrH: Sprts Club fr Health Guidelines (1.0): Kkk S., Kski P., Savla J., Alen M. and Oja P (2009) The reprt The Guidelines fr Sprts Club fr Health (SCfrH) Prgrams. Publicatin f The Assciatin Fr Internatinal Sprt fr All (TAFISA), HEPA Eurpe and Finnish Sprt fr All Assciatin. Helsinki: Helsinki University Press, 46 pages. Available als in the internet: http://www.kunt.fi/@bin/290648/the+report_scfrh_sprts+club+fr+health+prgramme.pdf