Impact of the COVID-19 pandemic on ongoing health research: an ad hoc survey among investigators in Germany.

OBJECTIVES: To gain insights into the impact of the COVID-19 pandemic on ongoing health research projects, using projects from a selected funding programme in Germany as an example. DESIGN: Online survey and validation workshop. SETTING: Lockdowns and social distancing policies impact on clinical and public health research in various forms, especially if unrelated to COVID-19. Research institutions have reduced onsite activities, data are often collected remotely, and during the height of the crisis, clinical researchers were partially forced to abandon their projects in favour of front-line care. PARTICIPANTS SURVEY: 120 investigators of health research projects across Germany, performed between 15 and 25 May 2020; workshop: 32 investigators, performed on 28 May 2020. RESULTS: The response rate (78%) showed that the survey generated significant interest among investigators. 85 responses were included for analysis, and the majority of investigators (93%) reported that their projects were affected by the pandemic, with many (80%) stating that data collection was not possible as planned, and they could not carry out interventions as intended (67%). Other impacts were caused by staff being unavailable, for example, through child or elder care commitments or because of COVID-19 quarantine or illness. Investigators also reported that publications were delayed or not feasible at all (56%), and some experienced problems with PhD or Masters theses (18%). The majority of investigators had mitigation strategies in place such as adjustment of data collection methods using digital tools (46%) or of project implementation in general (46%), others made changes in research design or research questions (27%). CONCLUSIONS: The COVID-19 pandemic has severely impacted on health research projects. The main challenge is now to mitigate negative effects and to improve long-term resilience in health research. The pandemic has also acted as a driver of innovation and change, for example, by accelerating the use of digital methods.

How Does the Campus Environment Influence Everyday Physical Activity? A Photovoice Study Among Students of Two German Universities.

Background: Sedentary time is high among university students. Prolonged sitting time and reduced physical activity is linked to a number of health risks, therefore interventions to increase options for physical activity on campuses are of high public health relevance. Evidence about the influence of the campus environment on movement and sedentary behavior of students is scarce. This study explores how the structural and social environment of two University campuses are related to students' everyday physical activity. Methods: We used the photovoice method to get a thorough insight into students' daily life on campus. We recruited a total of 46 University students in two German cities (University 1: n = 22, University 2: n = 24). They were asked to take ≥15 photos of places and situations on their respective campus that facilitate or hinder them to be physically active. The pictures were discussed with the participants in 10 focus groups. Focus group discussions were audio-recorded, transcribed and analyzed using content analysis. Results: Both universities do not exploit their potential of fostering daily physical activity on campus, according to the photos and discussions of the participating students. The vast green spaces offer no cues for movement: easily accessible equipment for sports (fixed or mobile) is lacking, walkways are partially hidden, and the facilities discourage from cycling to and on campus. Social norms induce participants to keep sitting during lectures and learning time. It was also pointed out that indoor hallways and foyers could be put to better use with regard to physical activity. The Photovoice project raised the participants' awareness of how the context influences their movement behavior, and helped them come up with solutions to make physical activity easier for students of their respective universities. Conclusion: The studied campuses discouraged students from being physically active by missing out on opportunities-indoors and outdoors-for fostering movement, such as designating the greens for games or walks, or providing sufficient lockers for biking gear. The results can serve as a basis to plan custom-made public health interventions.

How Older Citizens in Germany Perceive and Handle Their Food Environment-A Qualitative Exploratory Study.

Apart from individual factors like knowledge or personal motivation, the environment also influences a person's eating behaviour. Food environments can be described as the collective physical, economic, policy and sociocultural surroundings, opportunities and conditions that influence people's food choices and nutritional status. In order to explore how older citizens in rural Germany perceive and handle their food environment, we conducted semi-structured face-to-face interviews with 35 older adults (71 ± 7 years), asking about micro-, meso- and macro-level influences on eating habits. Participants reported social factors to be crucial in shaping their diets, such as preferences of family members or social expectations connected to roles (guest, host). On a physical level, structural aspects and resources in their nearby surroundings influenced shopping and eating behaviour (for example access to an own vegetable garden, local shopping facilities and restaurants). Macro-level influences such as the food industry were hardly mentioned. Participants noticed that the environment affects their diets but dealt with undesired influences using strategies of adaptation and behaviour change, rather than challenging the environmental influences. Public health projects should raise the awareness of the multiple environmental influences on eating behaviour and also help people to create healthier food environments.

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.

German senior citizens' capabilities for physical activity: a qualitative study.

Sen's capability approach (CA) has found its way into health promotion over the last few years. The approach takes both individual factors as well as social and environmental conditions into account and therefore appears to have great potential to explore opportunities for ('capabilities') and barriers to active lifestyles. Thus, our objective in this study was to investigate which capabilities senior citizens perceive to have available to them in order to be physically active. In Southern Germany, we conducted 26 semi-standardized interviews with senior citizens aged 66-97, as well as 9 interviews with key persons who have close contact to senior citizens in their work life. We identified 11 capabilities which the interviewees considered as important in leading an active lifestyle. They could be grouped into four domains: (1) individual resources, (2) social interactions and norms, (3) living conditions and (4) organizational environment. Results highlight the need for health-promoting interventions that widen the range of capabilities on social and environmental levels in a way that individuals can freely choose to be as physically active as they like. The results make clear that interventions should not only target and involve older adults themselves, but also their families, nursing home staff or community representatives, because these groups are important in shaping older adults' capabilities for an active lifestyle.

Empowering senior citizens for healthy nutrition in Germany: A pilot study.

Main goal of this study was to analyse how empowerment processes and bottom-up activities aimed at healthier food choices and food environment could be initiated among a group of senior citizens (between 60 and 75 years old). The intervention was set up as a pilot study in a rural community (15,000 inhabitants) in the federal state of Bavaria, South Eastern Germany. A process evaluation documented how group formation and empowerment processes developed during the course of the intervention. Extensive field notes were taken in 27 meetings, interviews (n = 13) and focus groups (n = 4) were conducted with participants and key persons at different points of the intervention. Data were analysed using content analysis. The intervention succeeded in motivating senior citizens to participate in regular meetings over 11 months. During the intervention, the group members' awareness of factors influencing their eating behaviour increased. Furthermore, they developed ideas to improve the community's food environment and accomplished duties needed to implement these ideas. However, initiating empowerment processes, especially in terms of fostering leadership and transferring responsibility, took longer than expected and could be realised only partially. The findings support a further use and evaluation of the empowerment approach for addressing nutritional aspects among senior citizens.

Empowerment for healthy nutrition in German communities: a study framework.

Empowerment is seen as a key strategy for sustainable health promotion efforts. However, there is only limited research on how to link the empowerment approach to the promotion of healthy eating, which is a major current public health issue. The article presents the development of a study framework for implementing and evaluating an empowerment intervention for healthy nutrition. This framework was created for a community intervention study meaning to involve elderly citizens in Bavaria, Germany. The study protocol was developed in an iterative process basing on (i) literature reviews on the topics empowerment in relation to healthy nutrition and mixed-methods evaluation, (ii) workshops with empowerment and public health experts and (iii) consultations with local community representatives. Through these measures we identified good practice criteria as well as specific challenges of integrating empowerment and healthy nutrition, e.g. engaging people in healthy nutrition, reconciling participants' nutrition preferences with public health nutrition priorities and evaluating bottom-up activities in the community. Consequences for the study design were deducted from the literature and the consultations, e.g. practical recommendations as to how power could be gradually assigned to group members. A qualitative mixed-method evaluation design was chosen to capture emergent empowerment processes. The study framework presented here is the first on empowerment and nutrition to provide explicit guidance on how empowerment may be applied to healthy nutrition and implemented and evaluated in the community context.