Social Factors of Dietary Risk Behavior in Older German Adults: Results of a Multivariable Analysis

With this analysis, we aimed to examine the associations between social factors and dietary risk behavior in older adults. Data were collected through a full-population postal survey of German adults aged 65 years or older (n = 1687, 33% response proportion, 52% female, mean age = 76 years). Using principal component analysis (PCA), a data-driven Dietary Risk Behavior Index (DRB) was computed. Dietary risk behavior was defined as consumption frequencies of vegetables/fruit, whole grains, and dairy products below national dietary recommendations. By performing a multiple linear regression, we analyzed associations between sociodemographic, socioeconomic, psychosocial, and behavioral factors and dietary risk behavior. Physical activity, female gender, socioeconomic status, social support, and age (in the male sample) were negatively associated with dietary risk behavior. Alcohol consumption and smoking were positively associated with dietary risk behavior. A group-specific analysis revealed a higher goodness-of-fit for the low socioeconomic status group, older adults aged 65–79 years, and women. A comprehensive understanding of the relationships between social factors and dietary risk behavior in older adults assists the group-specific targeting of dietary-related interventions. Demand-oriented dietary interventions should account for underlying social conditions to reduce inequity in dietary risk behavior among older adults. The results of this work may be transferable to municipalities in high-income European countries.Peer Reviewe

How German health insurance providers use social online networks to promote healthy lifestyles: a content analysis of Facebook® accounts

Background Social networking sites such as Facebook® can contribute to health promotion and behaviour change activities, but are currently underused for this purpose. In Germany, health insurance companies are relevant public health agencies that are responsible for health promotion, primary prevention, and health education. We intended to analyse the Facebook® accounts of health insurance providers to explore the range of prevention topics addressed, identify the communication formats used, and analyse user activity stimulated by prevention-related posts. Methods We performed a quantitative content analysis of text and picture data on Facebook® accounts (9 months in retrospect) in a cross-sectional study design. 64/159 German health insurance providers hosted a Facebook® page, 25/64 posted ≥ 10 posts/months. Among those 25, we selected 17 health insurance companies (12 public, 5 private) for analysis. All posts were categorized according to domains in the classification system that was developed for this study, and the number of likes and comments was counted. The data were analysed using descriptive statistics. Results We collected 3,763 Facebook® posts, 32% of which had a focus on prevention. The frequency of prevention-related posts varied among health insurance providers (1–25 per month). The behaviours addressed most frequently were healthy nutrition, physical activity, and stress/anxiety relief, often in combination with each other. All these topics yielded a moderate user engagement (30–120 likes, 2–10 comments per post). User engagement was highest when a competition or quiz were posted (11% of posts). The predominant communication pattern was health education, often supplemented by photos or links, or information about offline events (e.g. a public run). Some providers regularly engaged in two-side communication with users, inviting tips, stories or recipes, or responding to individual comments. Still, the interactive potential offered by Facebook® was only partly exploited. Conclusions Those few health insurace companies that regularly post content about prevention or healthy lifestyles on their Facebook® accounts comply with suggestions given for social media communication. Still, many health insurance providers fail to actively interact with wider audiences. Whether health communication on Facebook® can actually increase health literacy and lead to behaviour changes still needs to be evaluated.Peer Reviewe

How Health Promoters Can Assess Capacity Building Processes in Setting-Based Approaches—Development and Testing of a Monitoring Instrument

Background: Health promoters often use stakeholder groups to jointly plan and implement local interventions. Stakeholder groups should take over responsibility to later run the health promotion program independently. Monitoring this process of capacity building can help health promoters improve the quality of the process. Instruments for the systematic assessment of capacity building among stakeholder groups are scarce. The goal of this study was to develop, and pilot test a generic assessment instrument for setting-based capacity building. Methods: We drafted a semi-standardized monitoring instrument to be used in stakeholder groups in various settings. This "EVA-protocol" (short for evaluation protocol) was based on capacity building domains e.g., leadership, resource mobilization. It was pilot implemented in a research network on increasing an active lifestyle in various settings. The respective health promoters documented 78 meetings of 15 different stakeholder groups. We performed feedback interviews and member checking among the facilitating health promoters, asking for comprehensibility, length, usability and perceived benefits of the instrument. Findings: Data collected in the "EVA-protocol" helped the facilitating health promoters understand the development of competences and capacities in the stakeholder groups and identify factors that favor or hinder the capacity building process. The instrument was rated as user friendly, but it was remarked that it is best filled out by two persons and reflected upon by those to offer the greatest benefit. Not all projects could afford this procedure due to lack of time/staff resources. Conclusions: The drafted instrument can serve as quality management tool for health promoters who facilitate participatory stakeholder groups in different settings and intend to build capacities for sustainable health promotion structures

Möglichkeiten und Grenzen einer Zusammenarbeit mit Heilpraktikern aus ärztlicher Sicht

Hintergrund: Deutschland weist gegenüber zahlreichen anderen Staaten die Besonderheit auf, dass neben Ärzten auch Heilpraktiker eine staatliche Zulassung zur Ausübung der Heilkunde erlangen können. Das Verhältnis der beiden Berufsgruppen zueinander gilt als schwierig - unabhängig von berufsrechtlichen Hindernissen. Ziel der Untersuchung war es zu klären, inwieweit bei niedergelassenen Ärzten eine Bereitschaft zur Zusammenarbeit mit Heilpraktikern besteht. Gleichzeitig sollten Bedingungen, Chancen sowie Hindernisse einer Kooperation aufgezeigt werden. Methoden: Um die ärztliche Bereitschaft zur Zusammen arbeit mit Heilpraktikern zu evaluieren, wurden mit 15 niedergelassenen Ärzten und Zahnärzten semi-strukturierte Interviews geführt. Die Fragen thematisierten Bedingungen, Chancen sowie Barrieren einer Kooperation. Im Anschluss wurden die Interviews wörtlich transkribiert und mithilfe der thematischen Inhaltsanalyse ausgewertet. Ergebnisse: Einer Zusammenarbeit gegenüber aufgeschlossene Ärzte sehen Heilpraktiker als ergänzende Therapeuten bei leichteren oder psychisch beeinflussten Erkrankungen. Dafür bestehen allerdings klare Bedingungen: Heilpraktiker müssten die Grenzen ihrer Behandlungsfähigkeit erkennen. Voraussetzungen seien auch transparente Regelungen der Kostenerstattung durch Krankenkassen, insbesondere dürften ärztliche Leistungen im Bereich der Komplementär- und Alternativmedizin nicht diskriminiert werden. Neben dem mangelnden Vertrauen der befragten Ärzte in die Heilpraktikerausbildung erweist es sich als hinderlich, wenn Heilpraktiker störend auf die bestehende Arzt-Patienten-Beziehung einwirken bzw. den Abbruch einer schulmedizinischen Therapie veranlassen. Gleichzeitig wird die bestehende Patientenversorgung bereits als zu komplex für eine Kooperation eingeschätzt. Schlussfolgerungen: Um zu reproduzierbaren Ergebnissen zu gelangen, sind Untersuchungen mit quantitativem Forschungsdesign nötig. Auch sollte geklärt werden, inwieweit aus Sicht der Heilpraktiker eine Zusammenarbeit mit Ärzten wünschenswert ist. Der Abbau von Kommunikationsbarrieren ist nötig, damit Patienten offen mit ihrem Arzt über Heilpraktiker besuche sprechen kön-nen. Das Wissen über Unterschiede in Ausbildung und Zulassung zum Arzt oder Heilpraktiker ist Grundvoraussetzung für eine informierte Entscheidung der Patienten

„Der Mensch, der Handball spielt, braucht den Ball, den Kontakt und die Gemeinschaft“ – Veränderungen im Sportangebot durch die COVID-19 Pandemie und deren Bedeutung für Sportvereine

Ziel der Studie Sportvereine spielen eine wichtige Rolle für die Bewegungs- und damit auch die Gesundheitsförderung in Deutschland. Die vorliegende Studie befasst sich vor dem Hintergrund der Corona-bedingten Einschränkungen mit den Veränderungen in der Angebotsstruktur und deren Bedeutung für die Sportvereine. Methode Es wurden 15 Experteninterviews mit Vertretern und Vertreterinnen bayerischer Sportvereine geführt. Die Daten wurden transkribiert und mittels thematischer Analyse induktiv ausgewertet. Ergebnisse Von den Vereinen wurden umfangreiche Aktivitäten entwickelt, um den Mitgliedern auch unter den Rahmenbedingungen der COVID-19-Pandemie Möglichkeiten für sportliche Aktivitäten zu bieten. Die Vereinsmitglieder hätten dabei mit viel Verständnis auf die Veränderungen und Einschränkungen im Angebot reagiert. Die Nutzung der neu geschaffenen digitalen Angebote durch die Mitglieder scheint sich von der Nutzung der realen Kurse zu unterscheiden. Das längerfristige Potenzial der digitalen Angebote wird jedoch weitgehend skeptisch betrachtet. Insbesondere der im Sport normalerweise immanente Gemeinschaftsaspekt würde den Teilnehmenden an digitalen Formaten fehlen. Schlussfolgerungen Die Anstrengungen der Sportvereine, ein geregeltes Bewegungsprogramm auch unter den Rahmenbedingungen einer Pandemie bereit zu stellen, betont deren Bedeutung für Prävention und Gesundheitsförderung. Aus Public-Health-Sicht bieten die Veränderungen in der Angebotsstruktur darüber hinaus das Potenzial, auch unter normalisierten Rahmenbedingungen beibehalten zu werden. Hierzu sind aber weiterführende Forschungsarbeiten notwendig.Aim Sports clubs play an important role in the promotion of physical activity and health in Germany. Against the background of restrictions due to the COVID-19 pandemic, the present study explores the changes in sport activities and their significance for sports clubs. Methods We conducted 15 expert interviews with representatives of Bavarian sports clubs. The data were transcribed and evaluated inductively by means of thematic analysis. Results The clubs developed extensive activities to provide members with opportunities for sport and exercise even under the conditions of the COVID-19 pandemic. In general, the club members were understanding and positive towards the changes in the clubs. The participation in the newly created digital offers by the members seemed to differ from those in real courses. Nevertheless, the interviewees were skeptical about the long-term potential of digital sports offerings. Participants could miss the personal contact, the collective experience and team spirit when meeting only virtually. Conclusions The efforts of the sports clubs to provide regular opportunities for sport and exercise during the COVID-19-pandemic underlines their importance for prevention and health promotion. From a public health perspective, changes in the offered activities may outlast the pandemic. However, further research is necessary.Peer Reviewe

Capacity Building in Community Stakeholder Groups for Increasing Physical Activity: Results of a Qualitative Study in Two German Communities

Community capacity building is an essential approach for health promotion, combining a participatory approach with the view to community ownership. Little research focuses on practical capacity building strategies and monitoring. Our paper looks into involving stakeholders in facilitated group discussions as a specific strategy for fostering capacity building processes. These processes focused on physical activity (PA) promotion in two German communities (ACTION4men). Along the dimensions of capacity building suggested in literature (e.g., problem solving, resource mobilization, leadership), we implemented two participatory stakeholder groups (1/community). These groups were motivated to develop and implement PA interventions for men >50 years. For measuring capacity building processes, a semi-standardized monitoring instrument was used to document all group meetings. Additionally, we conducted semi-standardized interviews with group participants and drop-outs to capture their perspectives on capacity building. All documents were analyzed using thematic analysis. We successfully established stakeholder groups that planned and implemented a range of local measures meant to increase PA among older men. In one community, the process was sustainable, whereby the group continued to meet regularly over years. Capacity building was successful to a certain degree (e.g., regarding participation, problem assessment, and resource mobilization), but stalled after first meetings. Capacity building processes differed between the two communities in terms of leadership and sustainability. The developed interventions mainly addressed the access to organized sport courses, rather than tackling walkability or active transport. The theoretical capacity building approach was successful to develop and implement programs aimed at promoting PA. The actual capacity building processes depend upon the composition of stakeholder groups and inherent power relations

How the COVID-19 pandemic and related school closures reduce physical activity among children and adolescents in the WHO European Region: a systematic review and meta-analysis

Background: Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups. Methods: We searched seven databases and included studies for children and adolescents (≤ 19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index and School Closure Index as indicators of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using the ‘Risk of Bias in Non-randomized Studies - of Exposure’ [ROBINS-E]) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Unpublished data was requested from study authors. Data were pooled in random effects models. An a priori protocol was published, reporting is carried out in accordance with the ‘Preferred Reporting Items for Systematic Review and Meta-Analyses’ (PRISMA) statement. Results: Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8–12) and adolescents were particularly affected by the decline. School closures were associated with a reduction in physical activity. The certainty of evidence for all outcomes was low. Conclusions: A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend

A systematic review on empowerment for healthy nutrition in health promotion

Objective The present review aimed to identify and synthesize studies that used an empowerment approach within the field of healthy nutrition. Design A systematic review was conducted. Studies were identified by database searching (PubMed, PsycINFO, Web of Science and Psyndex). Searching, selecting and reporting were done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) Statement. Setting Health promotion including the subject of healthy nutrition. Subjects Individuals from non-clinical populations. Results A total of 1226 studies were screened for eligibility, eight studies were finally included. Three studies used the empowerment approach within a qualitative research paradigm and five studies within (quasi-) experimental intervention studies. Heterogeneity in settings, samples and evaluation methods was high. Most studies referred to the key message of empowerment, i.e. taking control over one’s own life. However, the ways in which this key message was implemented in the interventions differed considerably. Conclusions The number of studies included was very low. Furthermore, most studies had some limitations in terms of reporting how the empowerment approach was actually applied. The empowerment approach still seems to be unfamiliar within the field of healthy nutrition

Factors influencing the nutritional behavior of Syrian migrants in Germany — results of a qualitative study

Background Syrian migrants represent the third-largest group of foreigners in Germany and are therefore potential users of health promotion initiatives, including nutrition programs. It is little known how (healthy) nutrition is understood and implemented by this group and which factors influence their experiences related to food and eating in the host country. Thus, this study aimed to explore the importance of (healthy) nutrition, facilitators, and barriers of a preferred diet; nutritional changes in relation to the country of origin; and how nutrition may change with increasing length of stay. Methods Thirty semi-structured qualitative interviews with Syrian migrants (male = 16, female = 14, 18–35 years, length of stay 10–68 months) were conducted in 2018. Seventeen migrants could be followed-up after 12 months and were interviewed in 2019 again and were asked for changes in their nutritional behavior. Interviews were conducted in German, English, or Arabic, transcribed and translated into English if necessary. For analysis, an abbreviated version of the Grounded Theory was used. Results We identified six overarching themes that described influencing factors on a favored diet in Germany over the course of stay: (1) managing everyday life; (2) intercultural contact with local residents; (3) social context of cooking and eating; (4) ambiguity toward Arabic food; (5) mistrust toward certain types of food; and (6) influence of postmigration stressors. In general, the importance of nutrition is high among Syrian migrants. However, daily stressors, the lack of practical knowledge of how to cook favored dishes, and food insecurity in the new food environment make it difficult to obtain a preferred diet. With increasing stay, many developed a higher awareness of healthy eating, mainly due to a new independence or influences from the social environment in Germany. Conclusion Results highlight the need for health promotion interventions to be more responsive to the specific needs of Syrian migrants, including nutrition. Syrian migrants differ in their capabilities, needs, and aims, and they should be addressed differently by health professionals, social services or migrant specific services. Future research should continue to focus on the living conditions of Syrian migrants and its influence on nutrition