Development of a framework to guide research into policies promoting physical activity and healthy diets in the European context: the system-based Policy Evaluation Network (PEN) framework

Background The Policy Evaluation Network (PEN) is a multidisciplinary Pan-European research consortium focussing on policies affecting dietary intake, physical activity and sedentary behaviour. At the start, the PEN consortium expressed the need for an overarching, system-based framework covering the complexities between the different domains of the policy process (design, implementation and outcomes) in order to execute all research activities in a coherent way. This article describes the PEN framework itself and its development process. Methods A staged approach to the development of a system-based framework was executed between February 2019 and February 2022. We started with a point-of-departure framework, made use of existing models, collected PEN outputs at different project stages (through online meetings, e-mail exchanges and workshops with PEN researchers) and drew updated versions of the framework, which resulted in the system-based PEN framework. Results The system-based PEN framework depicts the policy process as a complex system, visualizing the dynamic interrelations between and within policy domains (i.e. policy design, policy implementation and policy outcomes), the ways they interact with the context, and how to assure a focus on equity in each domain. Conclusions The system-based PEN framework may guide researchers and professionals involved in the evaluation of health- or sustainability-related policies to consider their evaluation in a comprehensive picture, including domain interactions, contextual influences and equity considerations, as these can have important implications for the scope of their research. The stage-based process as applied for the development of the PEN framework can serve as a template for other research projects wishing to develop their own framework

Reaching consensus on definitions for food and physical activity policies: experience from the Policy Evaluation Network

Background - An upsurge in policy evaluation research within public health sciences has led to multi-disciplinary research networks like the ‘Policy Evaluation Network’ (PEN). This multi-disciplinary collaboration highlighted the need for consensus on clear, common terminology and definitions to facilitate the multi-disciplinary research. This article outlines the development process of the PEN definitions glossary tool, with a focus on the key domains of policy design, implementation and outcomes as they apply to physical activity, sedentary behaviour and dietary behaviours. Methods - A project specific participatory process was undertaken, involving PEN researchers (n = 48) from seven European countries across various disciplinary backgrounds. All involved researchers were invited to identify and collate definitions that were commonly used in their research field. Terms and definitions were discussed and debated during three online workshops. Subsequently, the definitions were discussed and refined until consensus was reached. Results - Consensus definitions for 93 terms related to the evaluation of policy design, implementation and outcomes are provided. Consensus was reached on a range of terms where the terms were understood and used differently across represented disciplines (e.g. ‘Outcome’ and ‘Impact’). A conceptual ‘Inter-relations in policy-related concepts’ diagram was developed to enable navigation through an online database with key terms. Conclusions -The definitions resulting from this participatory process has supported PEN researchers and practitioners across disciplines to reach a shared understanding of different terms related to policy evaluation. Thus, providing a platform for avoiding conflicting use of the same terms in differing contexts over the course of the PEN work programme, facilitating clear and consistent communication, and allowing for clarity within collaborative multi-disciplinary projects and in public-facing messages

advancing the evidence base for public policies impacting on dietary behaviour physical activity and sedentary behaviour in europe the policy evaluation network promoting a multidisciplinary approach

Abstract Non-communicable diseases (NCDs) are the leading cause of global mortality. As the social and economic costs of NCDs have escalated, action is needed to tackle important causes of many NCD's: low physical activity levels and unhealthy dietary behaviours. As these behaviours are driven by upstream factors, successful policy interventions are required that encourage healthy dietary behaviours, improve physical activity levels and reduce sedentary behaviours of entire populations. However, to date, no systematic research on the implementation and evaluation of policy interventions related to these health behaviours has been conducted across Europe. Consequently, no information on the merit, gaps, worth or utility of cross-European policy interventions is available, and no guidance or recommendations on how to enhance this knowledge across European countries exists. As part of the Joint Programming Initiative "A Healthy Diet for a Healthy Life" (JPI HDHL), 28 research institutes from seven European countries and New Zealand have combined their expertise to form the Policy Evaluation Network (PEN). PEN's aim is to advance tools to identify, evaluate, implement and benchmark policies designed to directly or indirectly target dietary behaviours, physical activity, and sedentary behaviour in Europe, as well as to understand how these policies increase or decrease health inequalities. Using well-defined evaluation principles and methods, PEN will examine the content, implementation and impact of policies addressing dietary behaviour, physical activity levels and sedentary behaviour across Europe. It will realise the first steps in a bespoke health policy monitoring and surveillance system for Europe, and refine our knowledge of appropriate research designs and methods for the quantification of policy impact. It will contribute to our understanding of how to achieve successful transnational policy implementation and monitoring of these policies in different cultural, demographic or socioeconomic settings. PEN will consider equity and diversity aspects to ensure that policy actions are inclusive and culturally sensitive. Finally, based on three policy cases, PEN will illustrate how best to evaluate the implementation and impact of such policies in order to yield healthy diets and activity patterns that result in healthier lives for all European citizens

The effects of a sugar-sweetened beverage tax and a nutrient profiling tax based on Nutri-Score on consumer food purchases in a virtual supermarket: A randomised controlled trial

Objective: To investigate the effects of a sugar-sweetened beverage (SSB) tax and a nutrient profiling tax on consumer food purchases in a virtual supermarket. Design: A randomised controlled trial was conducted with a control condition with regular food prices (n 152), an SSB tax condition (n 130) and a nutrient profiling tax condition based on Nutri-Score (n 112). Participants completed a weekly grocery shop for their household. Primary outcome measures were SSB purchases (ordinal variable) and the overall healthiness of the total shopping basket (proportion of total unit food items classified as healthy). The secondary outcome measure was the energy (kcal) content of the total shopping basket. Data were analysed using regression analyses. Setting: Three-dimensional virtual supermarket. Participants: Dutch adults aged ≥18 years are being responsible for grocery shopping in their household (n 394). Results: The SSB tax (OR = 1·62, (95 % CI 1·03, 2·54)) and the nutrient profiling tax (OR = 1·88, (95 %CI 1·17, 3·02)) increased the likelihood of being in a lower-level category of SSB purchases. The overall healthiness of the total shopping basket was higher (+2·7 percent point, (95 % CI 0·1, 5·3)), and the energy content was lower (-3301 kcal, (95 % CI-6425,-177)) for participants in the nutrient profiling tax condition than for those in the control condition. The SSB tax did not affect the overall healthiness and energy content of the total shopping basket (P > 0·05). Conclusions: A nutrient profiling tax targeting a wide range of foods and beverages with a low nutritional quality seems to have larger beneficial effects on consumer food purchases than taxation of SSB alone

Time-use and environmental determinants of dropout from organized youth football and tennis

Background: Many adolescents drop out of organized sports. Lack of motivation and competing priorities are known as important reasons for dropout. However, time use factors as well as environmental determinants have been largely neglected in the current literature on dropout from youth sports. The aim of this study is to investigate how (changes in) time use and characteristics of the physical environment determine dropout from football and tennis among adolescents. Methods: Data on time use and background characteristics were collected through online surveys in 2015 and 2016 among adolescents aged 13-21 (N = 2555), including both the dropped outs and those who still continued membership of their football or tennis clubs. Physical environmental determinants (travel distance to the sports club, and neighbourhood density) were measured objectively. Binary logistic regression analyses were carried out for football and tennis separately to examine the associations between time use (time spent on various activities and changes related to the school and job situation), and environmental factors on the probability of dropping out from sports. Results: Time spent on sports outside the context of the sports club, and time spent on social or voluntary activities at the sports club was positively associated with continuing being football and tennis members. Tennis players who changed schools or participated in two sports at the same time had a higher probability of dropping out, whereas tennis players who travelled greater distances from home to the tennis club were less likely to drop out. Conclusions: Determinants of dropout differed between football and tennis. However, time use variables were important predictors of dropout from football as well as tennis, whereas environmental determinants hardly contributed to the prediction of dropout. To keep youths involved in organized sports, this study recommends that sports professionals should: 1) offer flexibility in training and competition schedules, 2) stimulate participation in social activities and voluntary work at the sports club, 3) pay special attention to their needs and preferences, and 4) encourage possibilities to practice and play sports outside of regular training hours, for instance at the sports club or at playgrounds or parks in the neighbourhood

Sports participation in sport clubs, gyms or public spaces : How users of different sports settings differ in their motivations, goals, and sports frequency

Background: To develop targeted policy strategies to increase sports participation, more insight is needed into the behavioural patterns and preferences of users of different club-organized (i.e., sports clubs) and non-club organized (i.e., gyms, health centres or swimming pools) or informal sports settings such as public spaces. This study investigates 1) how users of different settings differ regarding self-determined motivations and goals, and sociodemographic and sports-related characteristics, and 2) how the association of motivations and goals with sports participation may differ between users of different sports settings. Methods: Data were collected through online surveys among Dutch adults aged 18-80 years (N = 910). Ordinal regression analyses were used to investigate the effects of sports settings, the level of self-determined motivations and goals, and interaction effects of motivations and goals with different sports settings, on sports frequency. Results: Users of different sports settings differed in their personal characteristics, motivations and goals. In general, controlled motivations were negatively associated with sports frequency (B = -0.46). However, among club members, extrinsic goals related to image (B = 0.44), as well as intrinsic goals related to skill development (B = 0.40) and social affiliation (B = 0.47) had significant positive associations with sports frequency. Health-related goals significantly increased sports frequency among users of informal settings, such as public spaces. Conclusion: The association of motivational variables with sports participation differs between settings. This implies that sports frequency is higher when participants engage in settings that better fit their motivations and goals. Because of the growing importance of informal and flexible settings and health goals, professionals in the sports and health domains should take into account the motivations, goals and needs of different target groups who (want to) use unorganized, informal sports settings including public spaces

Time-use and environmental determinants of dropout from organized youth football and tennis

Background: Many adolescents drop out of organized sports. Lack of motivation and competing priorities are known as important reasons for dropout. However, time use factors as well as environmental determinants have been largely neglected in the current literature on dropout from youth sports. The aim of this study is to investigate how (changes in) time use and characteristics of the physical environment determine dropout from football and tennis among adolescents. Methods: Data on time use and background characteristics were collected through online surveys in 2015 and 2016 among adolescents aged 13-21 (N = 2555), including both the dropped outs and those who still continued membership of their football or tennis clubs. Physical environmental determinants (travel distance to the sports club, and neighbourhood density) were measured objectively. Binary logistic regression analyses were carried out for football and tennis separately to examine the associations between time use (time spent on various activities and changes related to the school and job situation), and environmental factors on the probability of dropping out from sports. Results: Time spent on sports outside the context of the sports club, and time spent on social or voluntary activities at the sports club was positively associated with continuing being football and tennis members. Tennis players who changed schools or participated in two sports at the same time had a higher probability of dropping out, whereas tennis players who travelled greater distances from home to the tennis club were less likely to drop out. Conclusions: Determinants of dropout differed between football and tennis. However, time use variables were important predictors of dropout from football as well as tennis, whereas environmental determinants hardly contributed to the prediction of dropout. To keep youths involved in organized sports, this study recommends that sports professionals should: 1) offer flexibility in training and competition schedules, 2) stimulate participation in social activities and voluntary work at the sports club, 3) pay special attention to their needs and preferences, and 4) encourage possibilities to practice and play sports outside of regular training hours, for instance at the sports club or at playgrounds or parks in the neighbourhood

Evaluation of an incentive program to stimulate the shift from car commuting to e-cycling in the Netherlands

This paper reports on the effects of an e-cycling incentive program in the province of North-Brabant, The Netherlands, in which commuters could earn monetary incentives when using their e-bike. The study used a longitudinal design allowing to observe behaviour change and mode shifts. The program appeared to be highly effective in stimulating e-bike use, as one month after the start of the program, the share of commute trips made by e-bike increased from 0% to 68%, with an increase up to 73% after half a year of participating. The environmental, congestion and health benefits of this shift are however mixed. Half of the e-bike trips substitute car trips, with positive effects on environment, congestion and health. The other half substitutes conventional cycling trips, implying fever health benefits. Our analyses further suggest that distance is an important factor for adopting e-cycling, where e-bike has a larger acceptable distance than a conventional bike. Nevertheless, we observed that the likelihood to use the e-bike decreased as commuting distance increased. Multivariate analyses suggest that a shift to e-cycling is affected by age, gender, physical condition, car ownership and household composition. Our study did find support for the hypothesis that having a strong car-commuting habit decreases the probability of mode shift to a new mode alternative. In contrast, multimodality may increase the likelihood of e-bike use as a result of openness to other travel options and a more deliberate mode choice. Lastly, dissatisfaction with the current travel mode positively influences mode shift towards the e-bike. Our results imply that stimulating e-cycling may be a promising way of stimulating physical activity, but that it will be most effective if targeted at specific groups who are not currently engaging in active travel

How can National Government Policies Improve Food Environments in the Netherlands?

Objectives: Government policies are essential to create food environments that support healthy diets. The aims of this study were 1) to benchmark the implementation of Dutch government policies influencing food environments, and 2) to identify and prioritize actions to improve food environments in the Netherlands. Methods: The Healthy Food Environment Policy Index (Food-EPI) was applied. The Food-EPI includes 46 indicators of food environment policy and infrastructure support. Independent experts (n = 28) rated the extent of implementation on these indicators against international best practices, and formulated and prioritized policy and infrastructure support actions to improve food environments. Results: Most policy indicators were rated as having a low (50%) or very low (41%) level of implementation. Most infrastructure support indicators were rated as having a fair (42%) or medium (42%) level of implementation. 18 policy and 11 infrastructure support actions were recommended by experts to improve food environments in the Netherlands. Conclusion: There is large potential for the Dutch national government to strengthen its policy action and infrastructure support in order to improve the healthiness of food environments in the Netherlands

Dynamics of the complex food environment underlying dietary intake in low-income groups: a systems map of associations extracted from a systematic umbrella literature review

Background: Inequalities in obesity pertain in part to differences in dietary intake in different socioeconomic groups. Examining the economic, social, physical and political food environment of low-income groups as a complex adaptive system – i.e. a system of multiple, interconnected factors exerting non-linear influence on an outcome, can enhance the development and assessment of effective policies and interventions by honouring the complexity of lived reality. We aimed to develop and apply novel causal loop diagramming methods in order to construct an evidence-based map of the underlying system of environmental factors that drives dietary intake in low-income groups. Methods: A systematic umbrella review was conducted on literature examining determinants of dietary intake and food environments in low-income youths and adults in high/upper-middle income countries. Information on the determinants and associations between determinants was extracted from reviews of quantitative and qualitative studies. Determinants were organised using the Determinants of Nutrition and Eating (DONE) framework. Associations were synthesised into causal loop diagrams that were subsequently used to interpret the dynamics underlying the food environment and dietary intake. The map was reviewed by an expert panel and systems-based analysis identified the system paradigm, structure, feedback loops and goals. Results: Findings from forty-three reviews and expert consensus were synthesised in an evidence-based map of the complex adaptive system underlying the food environment influencing dietary intake in low-income groups. The system was interpreted as operating within a supply-and-demand, economic paradigm. Five sub-systems (‘geographical accessibility’, ‘household finances’, ‘household resources’, ‘individual influences’, ‘social and cultural influences’) were presented as causal loop diagrams comprising 60 variables, conveying goals which undermine healthy dietary intake. Conclusions: Our findings reveal how poor dietary intake in low-income groups can be presented as an emergent property of a complex adaptive system that sustains a food environment that increases the accessibility, availability, affordability and acceptability of unhealthy foods. In order to reshape system dynamics driving unhealthy food environments, simultaneous, diverse and innovative strategies are needed to facilitate longer-term management of household finances and socially-oriented practices around healthy food production, supply and intake. Ultimately, such strategies must be supported by a system paradigm which prioritises health