Barriers and Facilitators of Physical Activity Participation in Adolescent Girls: A Systematic Review of Systematic Reviews

Background: Persistent low physical activity (PA) levels among adolescent girls constitute a public health concern that calls for immediate and evidence-based policy action. This systematic review (SR) aimed to summarize evidence from SRs examining the barriers and facilitators of PA participation in adolescent girls. The objectives were to provide a synthesis of the available evidence and identify key areas for fostering gender-responsive action and policy implications. Methods: A comprehensive search of relevant SR and meta-analyses were performed in PubMed and Cochrane Library, until February 2021. Studies were included if they were SRs or meta-analyses, included adolescent girls aged between 10 and 19 years, and described barriers or facilitators of PA. Two independent authors performed the screening of potentially eligible studies and both assessed the methodological quality of included studies using the AMSTAR 2 tool. The barriers and facilitators were synthesized at environmental, interpersonal, and individual levels. Results: A total of eight SRs were included in the qualitative synthesis. The most frequent barriers identified were the lack of support from peers, family, and teachers, and the lack of time. The most reported facilitators were weight loss, and support from peers, family, and teachers. Key areas for action and policy implementation include an inclusive approach to curriculum development to address gender norms; adequate training of professionals so they have a range of skills to ensure inclusion of adolescent girls; environmental changes in and out of schools to stimulate participation, to allow adolescent girls to be active in a safe and attractive environment; multistakeholder support at local, regional, and national level in incorporating a gender-responsive approach toward PA participation. Conclusion: The results highlight a variety of factors that influences the PA participation of adolescent girls. For the attainment of effective policies that increase PA levels in adolescent girls, it is essential to engage several stakeholders at different levels in incorporating a gender-responsive approach toward PA participation. Systematic Review Registration: PROSPERO, identifier: CRD42020204023

Implementation requires effort : A project teams’ experiences in implementing an eHealth tool in Southern Sweden.

Noncommunicable disease are the leading cause of death and disability in the majority of theworld, and particularly for Sweden. Modifiable lifestyle behaviors such as smoking, alcohol consumption, unhealthy diets and lack of physical activity are main contributors and risk factors to acquiring these diseases. Despite the evidence linking these risk factors to the diseases, thehealthcare sector has often fallen short in implementing preventive strategies due to severalbarriers and factors within this setting. ICT in the health sector, known as eHealth, cancontribute greatly to relieve the burden in the health systems in implementing new prevention strategies, however eHealth has its own set of barriers hindering implementation that delayadoption of such interventions. In the context of Sweden, emphasis has been made to incorporate increase eHealth initiative to reach their Vision 2025. To investigate how implementing eHealth strategies have been experienced in Sweden, this research has conducted a case study on a specific intervention implemented in the Southern Region of Skåne that incorporated an eHealth tool to aid in the intervention called “health discussions with 40-yearolds” aimed to address the NCD burden. A qualitative case study methodology was taken to investigate how was implementing a new eHealth tool within a prevention and screening of NCDs intervention in the healthcare setting experienced by the project implementation team during its pilot phase. Key challenges and factors for implementing the eHealth tool were extracted from the four interviews and reportcollected on the case to increase understanding of how the implementation was experienced by the program implementors. By focusing on the organizational level of the implementation only, the results from this study aimed to provide insights to key aspects in implementing new eHealth tools within interventions in the healthcare settings with similar organizational structures. Results from the qualitative thematic analysis led to a series of categories subcategories and themes to describe the experiences from the interviewees. The theme to describe the overall experiences was labeled positive but demanding, while the theme for challenges was labeled dintricacies of the health system structure, and the theme for factors was eHealth contingent on the human-social interaction. Core components were summarized for future eHealth implementation implications in this setting and/or similar settings. Challenges faced in this case reflect similar challenges in implementing eHealth in Sweden due to the complex fragmented health system structure. Business modeling and agile project management approaches may aid future health organizational settings eHealth implementation process. Future research isrequired to provide clear frameworks that can be applied in more local fragmented healthsystem