Wirkung und langfristige Verbreitung von community-based participatory research als Ansatz zur Bewegungsförderung bei Frauen in schwierigen Lebenslagen in Deutschland

Numerous studies document the unequal health opportunities and increased prevalence of non-communicable diseases to the disadvantage of persons with low socioeconomic status (WHO 2022). To address this health inequity, a large number of health promotion measures and interventions have been developed and implemented. However, two major challenges (projectism and prevention paradox) often reduce the effectiveness and reach of these measures. Consequently, their public health impact remain low in many cases. Projectism refers to the fact that health promotion is usually only financed in the short term and for a limited period of time. Thus, such measures are rarely continued in the long term or disseminated on a large scale after the funding ends. The global phenomenon of the prevention paradox refers to the problem that health promotion predominantly reach people who already have healthy lifestyle habits and few health risk factors. In contrast, individuals who could particularly benefit from health promotion are considered hard to reach (Finger, Hoebel et al. 2019, Lampert, Hoebel et al. 2019). This dissertation addresses the research question of the extent to which it is possible to address the challenges described above through a setting-based participatory research approach. The research approach used is called community based participatory research (CBPR). In CBPR, researchers and community members are equal partners in the research process, which aims to generate knowledge to initiate social change for the benefit of community health (Wallerstein and Duran 2010, Wright 2021). As a case study, the research in this dissertation relates to the BIG – project (Movement as an Investment in Health). BIG is a CBPR project that aims to promote physical activity among women in difficult life situations and empower them to improve control over their health determinants. The project was developed in 2005 in collaboration between researchers at the Friedrich-Alexander University of Erlangen-Nuremberg and practice partners. Since then, BIG has been transferred to 23 sites in Germany. The results of this dissertation are based on a mixed-method approach, i.e. data from quantitative questionnaire surveys, qualitative interviews and focus groups as well as data from document analyses were evaluated. Research results of this dissertation document that CBPR can succeed in providing, sustain and disseminating effective physical activity promotion among socially disadvantaged individuals. Thus, it is possible to achieve and increase public health impact through CBPR. Success factors are the participation of the addressed persons and other community partners, a committed leader, a local support network, financial stability and political support. Another finding of this work is that public health impact takes time (up to 10 years) to emerge and that the reach of the project can continue to grow beyond that time. However, these efforts are worthwhile, as they succeed in providing more health opportunities to those who are socially disadvantaged in society.Ungleiche Gesundheitschancen und erhöhte Prävalenzen von nicht-übertragbaren Erkrankungen zuungunsten von Personen mit niedrigem sozioökonomischen Status sind durch zahlreiche Studien belegt (WHO 2022). Um dieser gesundheitlichen Ungleichheit zu begegnen, wurde bis heute eine große Zahl an Maßnahmen und Interventionen zur Gesundheitsförderung entwickelt und umgesetzt. Zwei wesentliche Herausforderungen bei der Umsetzung dieser Maßnahmen führen jedoch oftmals dazu, dass deren Wirksamkeit und Reichweite reduziert ist. Somit ist auch der Public Health Impact, sprich der gesellschaftliche Mehrwert dieser Maßnahmen zur Gesundheitsförderung gering. Diese Herausforderungen werden mit den Begriffen „Projektitis“ und „Präventionsdilemma“ bezeichnet. Unter „Projektitis“ ist zu verstehen, dass die Finanzierung von Maßnahmen der Gesundheitsförderung meist in Form kurzfristiger Projekte erfolgt und diese somit nach dem Ende der Förderung selten langfristig fortgeführt und großflächig verbreitet werden. Das weltweite Phänomen des „Präventionsdilemmas“ bezeichnet die Problematik, dass durch gesundehitsfördernde Maßnahmen vorwiegend Personen erreicht werden, die ohnehin gesunde Lebensgewohnheiten und wenig gesundheitliche Risikofaktoren aufweisen. Personen, die besonders von Gesundheitsförderung profitieren könnten, gelten hingegen als „schwer erreichbar“ (Finger, Hoebel et al. 2019, Lampert, Hoebel et al. 2019). Im Rahmen dieser Dissertation wird erforscht, inwiefern es gelingt, den oben beschriebenen Herausforderungen durch einen lebensweltbezogenen, partizipativen Forschungsansatz zu begegnen. Der Forschungsansatz, der dabei angewendet wird, heißt „community based participatory research“ (CBPR). Bei CBPR forschen Wissenschaftler*innen und Community-Mitglieder gemeinsam, um gewonnene Erkenntnisse zu nutzen und gesellschaftliche Veränderungen zum Wohle der Gesundheit der Community anzustoßen (Wallerstein and Duran 2010, Wright 2021). Als Fallbeispiel dient in dieser Arbeit das CBPR-Projekt „BIG“ („Bewegung als Investition in Gesundheit“). BIG ist ein partizipatives Forschungsprojekt, welches das Ziel verfolgt, die Gesundheit von Frauen in schwierigen Lebenslagen zu fördern. Das Projekt wurde 2005 von Wissenschaftler*innen der Friedrich-Alexander Universität Erlangen-Nürnberg in Kooperation mit Praxispartner*innen entwickelt und seitdem auf 23 Standorte in Deutschland übertragen. Die Ergebnisse dieser Dissertation basieren auf einem Mixed-method Ansatz, d.h. es wurden Daten quantitativer Fragebogenerhebungen, qualitativer Interviews und Fokusgruppe sowie Daten aus Dokumentenanalysen ausgewertet. Die Forschungsergebnisse dieser Dissertation belegen, dass es durch CBPR gelingen kann, wirkungsvolle und langfristige Bewegungsförderung bei sozial benachteiligten Personen zu leisten und zu verbreiten. Somit kann durch CBPR ein Mehrwert für die Gesundheit der Gesellschaft (Public Health Impact) erzeugt und gesteigert werden. Erfolgsfaktoren hierfür sind die Partizipation der adressierten Personen und weiterer kommunaler Partner*innen, eine engagierte Führungsperson, ein lokales Unterstützungsnetzwerk, finanzielle Stabilität sowie politische Unterstützung. Ein weiteres Ergebnis dieser Arbeit ist, dass die Entstehung von Public Health Impact Zeit (bis zu 10 Jahre) benötig und dass die Reichweite des Projekts auch über diesen Zeitraum hinaus noch wachsen kann. Diese Anstrengungen sind lohnenswert, da es dadurch gelingt, denjenigen, die in der Gesellschaft sozial benachteiligt sind, mehr Gesundheitschancen zu ermöglichen

Scaling Up Physical Activity Promotion Projects on the Community Level for Women in Difficult Life Situations and Older People: BIG-5 and GET-10—A Study Protocol

Introduction Physical inactivity is a major risk factor for a population's health, especially among socially disadvantaged groups. Many health promotion projects focus on increasing physical activity among their respective target groups. However, because they are mostly developed and implemented under laboratory conditions, they fail when being scaled to real-world settings. The community-based participatory research projects BIG and GESTALT have demonstrated their effectiveness regarding the physical activity promotion in real-world settings by employing a participatory method. Material and Analysis Within the context of the BIG-5 and GET-10 projects, these previously implemented and tested participatory projects are scaled to 15 additional settings in Bavaria, Germany. By applying an overarching mixed-methods evaluation framework, the aim is to gain insights into a) the recruitment of communities for scale-up; b) the specific results of the projects according to the RE-AIM framework. In the recruitment of communities, standardized information on the first contact, the consultation process, the person in charge, and previously implemented health promotion projects are collected. A systematic web search will complete information on each community and their health promotion activities. Results will be compared with information on those communities most in need, here according to the deprivation index of communities in Bavaria, Germany. The scale-up process and its results will be measured using semi-structured interviews with project coordinators. A standardized questionnaire will be used with the course's participants. Applying the RE-AIM framework, the collected data will be analyzed deductively. Discussion We expect the results to be highly relevant for the effective scale-up of any health promotion project. The study will enhance the understanding of how to reach those communities most in need of health promotion projects and will identify the barriers coordinators face in reaching socially disadvantaged groups. Conclusion Although participatory projects are often used as individual projects, little is known about the scaling up of participatory health promotion projects. This cross-cutting evaluation of two projects aims at producing data on the barriers and facilitators for the reach of settings most in need, and those success factors for a durable implementation

The Long-Term Public Health Impact of a Community-Based Participatory Research Project for Health Promotion Among Socially Disadvantaged Women—A Case Study Protocol

Introduction: Community-based participatory research (CBPR) is considered to be of high potential for health promotion among socially disadvantaged groups. However, the long-term implementation and transfer of these approaches remain challenging, and the public health impact they achieve is difficult to study. This also pertains to the potential health effects and cost-effectiveness of CBPR. This study protocol describes the follow-up case study (NU-BIG) after 15 years of the BIG project (movement as investment in health), a project to promote physical activity among socially disadvantaged women. Through a participatory approach, BIG empowers the addressed women to plan and implement low-threshold physical activity offers. Since the project started in 2005, it was transferred to 17 communities in Germany. Materials and Analysis: NU-BIG intends to examine the long-term effects, including economic aspects, of the BIG project on individual and structural levels at all project sites, as well as its long-term implementation and transfer. NU-BIG is a cross-sectional and longitudinal study using a mixed method approach. For the longitudinal section, we re-analyze existing data from former BIG evaluations. For cross-sectional data collection, we use questionnaires and conduct qualitative interviews and focus groups. Women who take part in BIG program offers are part of the research team and will use the photo-voice approach to report on the effects of BIG. The study population consists of about 800 women who participate in BIG project offers and 50 persons involved in the implementation of the BIG project at local sites. Discussion: The expected results from NU-BIG are highly relevant for studying the long-term public health impact of CBPR. In particular, this project intends to answer questions on how the transfer of such projects can succeed and which factors determine if a CBPR project can be sustained at the community level. Eventually, these results can contribute to the further development of participatory approaches to provide effective health promotion among socially disadvantaged groups. Conclusion: Although CBPR is seen of having the potential to reduce health disparities, there is still a lack of research on its long-term effects and public health impact. NU-BIG aims at generating knowledge about the economic effects, reach, efficacy, adoption, implementation, and maintenance of a CBPR project. The expected results could be of high interest for BIG and other CBPR-projects

The Long-Term Public Health Impact of a Community-Based Participatory Research Project for Health Promotion Among Socially Disadvantaged Women—A Case Study Protocol

Introduction: Community-based participatory research (CBPR) is considered to be of high potential for health promotion among socially disadvantaged groups. However, the long-term implementation and transfer of these approaches remain challenging, and the public health impact they achieve is difficult to study. This also pertains to the potential health effects and cost-effectiveness of CBPR. This study protocol describes the follow-up case study (NU-BIG) after 15 years of the BIG project (“movement as investment in health”), a project to promote physical activity among socially disadvantaged women. Through a participatory approach, BIG empowers the addressed women to plan and implement low-threshold physical activity offers. Since the project started in 2005, it was transferred to 17 communities in Germany. Materials and Analysis: NU-BIG intends to examine the long-term effects, including economic aspects, of the BIG project on individual and structural levels at all project sites, as well as its long-term implementation and transfer. NU-BIG is a cross-sectional and longitudinal study using a mixed method approach. For the longitudinal section, we re-analyze existing data from former BIG evaluations. For cross-sectional data collection, we use questionnaires and conduct qualitative interviews and focus groups. Women who take part in BIG program offers are part of the research team and will use the photo-voice approach to report on the effects of BIG. The study population consists of about 800 women who participate in BIG project offers and 50 persons involved in the implementation of the BIG project at local sites. Discussion: The expected results from NU-BIG are highly relevant for studying the long-term public health impact of CBPR. In particular, this project intends to answer questions on how the transfer of such projects can succeed and which factors determine if a CBPR project can be sustained at the community level. Eventually, these results can contribute to the further development of participatory approaches to provide effective health promotion among socially disadvantaged groups. Conclusion: Although CBPR is seen of having the potential to reduce health disparities, there is still a lack of research on its long-term effects and public health impact. NU-BIG aims at generating knowledge about the economic effects, reach, efficacy, adoption, implementation, and maintenance of a CBPR project. The expected results could be of high interest for BIG and other CBPR-projects

Transferring a Community-Based Participatory Research Project to Promote Physical Activity Among Socially Disadvantaged Women—Experiences From 15 Years of BIG

Introduction: Community-based participatory research (CBPR) is an effective approach to health promotion, especially in relation to socially disadvantaged groups. However, the long-term implementation of CPBR-based projects on a broad scale is often challenging, and research regarding the sustainable transfer of participatory research is lacking. This limits the scaling-up and public health impact of CBPR. Therefore, this study examines the mechanisms utilized to transfer and sustain the BIG project, a multifaceted CBPR project aimed at promoting physical activity among women in difficult life situations. Materials and Methods: Borrowing from the RE-AIM framework, we analyzed project documentation and conducted a reflection workshop to investigate methods of transferring BIG to new sites as well as strategies from researchers to support project implementation and the maintenance of program activities at those sites. Moreover, we analyzed the reasons for discontinuing program activities at some former BIG sites and the costs involved in transferring BIG. Results: Since its establishment in 2005, BIG was transferred to and implemented at 17 sites. As of the winter of 2019, the program activities were maintained at eight sites. The average duration of sites that continue to offer program activities was more than 9 years. Discontinued sites maintained project activities for an average of 4 years. According to the study findings, the extent of scientific support, the provision of seed funding, and the local project coordinator, the person managing the project at the site, all have a significant impact on the sustainability of the transfer. A patchwork of funding agencies was needed to finance scientific support and seed funding in BIG. The transfer of BIG projects accrued annual costs of approximately EUR20,000 per site; however, long-term project implementation resulted in a decline in the annual transfer costs of BIG. Discussion and Conclusion: The sustainable transfer of CBPR is challenging but possible, and increased support of research and seed funding can facilitate long-term transfer. Nevertheless, other factors in the implementation setting are beyond scientific control. With scarce financial resources, researchers need to carefully balance the efforts of the sustainability and transfer of CBPR projects. To address this issue, there is a need for further research into the interrelationship of the sustainability and transfer of CBPR projects as well as increased long-term funding

“For me, it's just a piece of freedom”—Increased empowerment through physical activity promotion among socially disadvantaged women

Introduction: Community-based participatory research (CBPR) is an effective health promotion approach for reaching socially disadvantaged groups. However, there is limited evidence on how such interventions and their effects can be reproduced across time and place. The present study examines the effects of BIG (i.e., movement as an investment in health), a long-standing German CBPR project. Since 2005, BIG has aimed to empower women in difficult life situations to increase control over their health determinants and reduce social inequalities by promoting physical activity. One of BIG's key features is its implementation in several German municipalities since 2005. This study explores (a) whether participation could change women's empowerment, and (b) how increased empowerment affects other areas of women's lives. Methods: With a total of 63 interviewees (i.e., 40 participating women, 7 trainers, 3 project coordinators, and 13 stakeholders), we conducted 53 semi-structured qualitative interviews in five BIG communities between 2007 and 2011. Some interviews were conducted with two people simultaneously. The interview guide contained questions on various dimensions of empowerment (e.g., project engagement, increased self-efficacy, and developed competencies). Framework analysis was used for the analytical process. Results: BIG contributed to women's empowerment in various ways, including increased self-efficacy, social network promotion, competency development, and increased motivation to change physical activity behavior. Women who took on added tasks and became more involved in project planning also strengthened their organizational empowerment. Furthermore, increased empowerment had a positive influence on the women's quality of life, family, and professional lives. Conclusion: The novel findings helped in understanding the effects of a complex empowerment-based approach that promoted physical activity among women in difficult life situations. Future research should focus on the long-term effects of these programs and their transferability to other sites. Further effort is necessary in the area of public health policy

Corrigendum: "For me, it's just a piece of freedom"-Increased empowerment through physical activity promotion among socially disadvantaged women.

[This corrects the article DOI: 10.3389/fpubh.2022.867626.]

Development of a questionnaire to measure communities’ capacities in participatory physical activity promotion projects: a think-aloud study

Zusammenfassung Hintergrund Für die Gesundheitsförderung und Prävention hat die Lebenswelt Kommune eine zentrale Bedeutung. Hierbei spielt es eine wichtige Rolle, über welche Kapazitäten eine Kommune verfügt, um Menschen durch Gesundheitsförderung zu erreichen. Wenn es um die Skalierung von Projekten der Bewegungsförderung (BIG [Bewegung als Investition in Gesundheit] und GESTALT [Gehen, Spielen und Tanzen Als Lebenslange Tätigkeiten]) in Kommunen geht, ist es daher wichtig, ein Evaluationstool zu entwickeln, um solche Kapazitäten messbar zu machen. Ziel der Arbeit Im Rahmen dieser Arbeit wurde ein Kapazitätsfragebogen zur eigenständigen Evaluation durch kommunale Akteure entwickelt und im Rahmen einer Think-aloud-Studie überprüft und angepasst. Methode Basierend auf bestehenden Evidenzen wurde ein Kapazitätsfragebogen entwickelt, welcher anschließend in einer Think-aloud-Studie durch 6 Koordinator*innen bearbeitet wurde. Die erhobenen Daten wurden anschließend in einer qualitativen Inhaltsanalyse unter Einbezug der Response-process-Theorie analysiert und der Fragebogen angepasst. Ergebnisse Von den Teilnehmer*innen wurden insgesamt 81 sog. Errors in 4 Kategorien identifiziert: 1) Verständnis („comprehension“), 2) Abruf („retrieval“), 3) Bewertung („judgement“), 4) Antwort („response“). Diese wurden anschließend angepasst. Der finale Fragebogen zur Evaluation durch die kommunalen Akteure umfasst 63 Items in den sechs Themenbereichen „Beteiligung“, „verantwortliche lokale Führung“, „vorhandene Ressourcen“, „Vernetzung und Kooperation“, „Gesundheitsversorgung“ und „BIG-spezifische Fragen“. Schlussfolgerung Der Fragebogen liefert partizipativen Projekten zur Bewegungsförderung im kommunalen Setting eine Möglichkeit zur pragmatischen Messung von Kapazitäten.Background Communities are of crucial importance for health promotion and the prevention of diseases. Local capacities are especially important for the successful implementation of health promotion projects and for reaching the target population. When considering the scale-up of projects with a focus on physical activity promotion (BIG and GESTALT) in the community setting, it is of great importance to develop a tool that can measure those capacities. Objectives A questionnaire for the pragmatic measurement of capacities through local authorities was developed, tested, and revised within a think-aloud study. Methods Based on empirical evidence, we developed a capacity questionnaire which was completed by six project coordinators during a think-aloud study. Data was analyzed using qualitative content analysis and the response-process-theory. Following the analysis, the questionnaire was adapted. Results Participants mentioned a total of 81 errors in four categories, which had been adjusted: 1) comprehension, 2) retrieval, 3) judgement, 4) response. The final questionnaire comprises 63 questions in six areas: participation, local leadership, available resources, networking and cooperation, health care, and BIG-specific questions. Conclusion The questionnaire provides physical activity promotion projects with the opportunity to pragmatically measure capacities in the community setting.Open Access funding enabled and organized by Projekt DEAL.Bundeszentrale für gesundheitliche Aufklärung http://dx.doi.org/10.13039/501100003108Friedrich-Alexander-Universität Erlangen-Nürnberg (1041

Scaling Up a Community-Based Exercise Program for Women in Difficult Life Situations in Germany—The BIG Project as a Case-Study

Scaling up community-based participatory research (CBPR) remains challenging. This case-study reports on how, and under which conditions, a CBPR project aiming at promoting exercise among socially disadvantaged women (BIG) scaled up at four project sites. As part of BIG, researchers support city administrations in implementing a participatory project to reach socially disadvantaged women for exercise. The case study was conducted in winter 2020 in southern Germany and is based on a co-creative process involving city administrators and researchers. Following Kohl and Cooley’s scaling up dimensions, scaling up BIG was investigated at the four sites using a mixed-method approach. Course registrations and offers were analysed, and qualitative interviews (n = 4) with administrative staff members were conducted and analysed using content analysis. The geographical coverage of exercise classes, the addressed groups, and the utilisation of participatory methods by city administrations are described. All four sites managed to scale-up project activities. Three of the four sites reported that further growth of the project was no longer possible due to limited resources. All sites attempted to reach a larger number of, and more diverse, women. One site managed to scale-up the use of participatory methods within the city administration. The following important facilitators for scaling up CBPR projects were reported: advertisements tailored to the needs of the addressed women, utilising participatory approaches, and equipping project coordinators with sufficient resources

The Long-Term Public Health Impact of a Community-Based Participatory Research Project for Health Promotion Among Socially Disadvantaged Women—A Case Study Protocol

Introduction: Community-based participatory research (CBPR) is considered to be of high potential for health promotion among socially disadvantaged groups. However, the long-term implementation and transfer of these approaches remain challenging, and the public health impact they achieve is difficult to study. This also pertains to the potential health effects and cost-effectiveness of CBPR. This study protocol describes the follow-up case study (NU-BIG) after 15 years of the BIG project ("movement as investment in health"), a project to promote physical activity among socially disadvantaged women. Through a participatory approach, BIG empowers the addressed women to plan and implement low-threshold physical activity offers. Since the project started in 2005, it was transferred to 17 communities in Germany. Materials and Analysis: NU-BIG intends to examine the long-term effects, including economic aspects, of the BIG project on individual and structural levels at all project sites, as well as its long-term implementation and transfer. NU-BIG is a cross-sectional and longitudinal study using a mixed method approach. For the longitudinal section, we re-analyze existing data from former BIG evaluations. For cross-sectional data collection, we use questionnaires and conduct qualitative interviews and focus groups. Women who take part in BIG program offers are part of the research team and will use the photo-voice approach to report on the effects of BIG. The study population consists of about 800 women who participate in BIG project offers and 50 persons involved in the implementation of the BIG project at local sites. Discussion: The expected results from NU-BIG are highly relevant for studying the long-term public health impact of CBPR. In particular, this project intends to answer questions on how the transfer of such projects can succeed and which factors determine if a CBPR project can be sustained at the community level. Eventually, these results can contribute to the further development of participatory approaches to provide effective health promotion among socially disadvantaged groups. Conclusion: Although CBPR is seen of having the potential to reduce health disparities, there is still a lack of research on its long-term effects and public health impact. NU-BIG aims at generating knowledge about the economic effects, reach, efficacy, adoption, implementation, and maintenance of a CBPR project. The expected results could be of high interest for BIG and other CBPR-projects