Do participants in a physical activity program from a Care Sport Connector become healthier? An explorative study from the Netherlands.

INTRODUCTION: Care Sport Connectors (CSCs) have been appointed to create a connection between the primary care and physical activity (PA) sectors to stimulate residents who are inactive to become more physically active to gain health benefits. The objective of this explorative study was to find out whether CSCs achieve these goals by testing the hypothesis that more residents become physically active, and score higher for health-related fitness and health-related quality of life. METHOD: We conducted a longitudinal study design whereby participants (n = 402) were measured at three time points: at the start of their PA program (T0); after 6 months (T1); and after 1 year (T2). Participants conducted a fitness test to measure their health-related physical fitness and filled in questionnaires to assess PA level (PA-, Fit-, Combi-, and sport norm), health-related quality of life, motivation for PA, and personal information. We used a multi-level analysis to test whether outcomes of participants differ over time. Participants who dropped out and maintainers were compared with a chi-square test and a one-way ANOVA. RESULTS: This study showed that one-third of the participants dropped out (n = 139). Participants who dropped out were, compared with maintainers, less physically active (P = 0.004) and were more often reached in bigger municipalities, by an integral approach. More participants meet the PA norm (P = 0.007) and sport norm (P<0.001) at T2 then at T0. Scores in health-related physical fitness and quality of life were significant but not a meaningful gain in health-related fitness. CONCLUSION: More residents become physically active and participate in sport because they took part in a PA programs or activity organized by a CSC. Lifestyle interventions should be offered with a higher frequency, intensity, and focus on behavior change. It is necessary to invest in combined lifestyle interventions offered by a collaboration of primary care, welfare, and PA professionals.

Strengthening sense of coherence: opportunities for theory building in health promotion.

Sense of coherence (SOC) reflects a coping capacity of people to deal with everyday life stressors and consists of three elements: comprehensibility, manageability and meaningfulness. SOC is often considered to be a stable entity that is developed in young adulthood and stabilizes around the age of 30. Recent studies have questioned this stability of SOC and some studies report on interventions that have been successful in strengthening SOC in adult populations. Currently, however, there is no clear understanding of the mechanisms underlying SOC. As a consequence, it is a challenge to determine what is needed in health promotion activities to strengthen SOC. This article aims to explore the mechanisms underlying SOC as these insights may underpin future health promotion efforts. An exploration of the salutogenic model suggests two important mechanisms: the behavioural and the perceptual. The behavioural mechanism highlights the possibility to empower people to use their resources in stressful situations. The perceptual mechanism suggests that, in order for people to deal with life stressors, it is essential that they are able to reflect on their understanding of the stressful situation and the resources that are available. Based on these mechanisms, we suggest that both empowerment and reflection processes, which are interdependent, may be relevant for health promotion activities that aim to strengthen SOC. The successful application of resources to deal with stressors is not only likely to have a positive influence on health, but also creates consistent and meaningful life experiences that can positively reinforce SOC levels.

Evaluation of the role of Care Sport Connectors in connecting primary care, sport, and physical activity, and residents' participation in the Netherlands: study protocol for a longitudinal multiple case study design.

BACKGROUND: The number of people with one or more chronic diseases is increasing, but this trend could be reduced by promoting physical activity. Therefore, in 2012, the Dutch Ministry of Health, Welfare, and Sport introduced Care Sport Connectors (CSCs), to whom a broker role has been ascribed. The defined outcome of CSCs role is an increased number of residents participating in local sports facilities and being physically active in their own neighbourhood. To realize this, primary care and sports professionals need to collaborate, and local sports facilities and neighbourhoods need to offer accessible physical activities for people in the locality, including people with one or more chronic diseases or at increased risk of chronic disease(s). Adequate scientific research is needed to assess CSCs' impact on: 1) connecting primary care, sport, and physical activity and 2) increasing the number of residents who engage in physical activity to promote their health. METHODS AND DESIGN: To study the role and the impact of CSCs, a longitudinal multiple case study will be conducted, in nine municipalities spread over the Netherlands, from 2014 until 2017. A mixed methodology will be used to perform action research and process evaluation. Study I focuses on the expected alliances of CSCs and the preconditions that facilitate or hinder CSCs in the formation of these alliances. The study population will consist of intermediary target groups. A literature review, interviews, focus groups, and document analysis will be undertaken. Study II will concentrate on lifestyle program participants to identify health and physical activity behavior changes. For this purpose, interviews, literature studies, a Delphi study, fitness tests, and questionnaires will be used. DISCUSSION: Linking and integrating results gained by multiple methods, at different levels, will provide a validated assessment of CSCs' impact on connecting the primary care and sports sectors. This will reveal changes in residents' physical activity behavior, and also the circumstances under which this will happen. The assessment in combination with general lessons learned from the different case studies will make it possible to determine whether CSCs are able to fulfill the policy aspiration and whether it would be beneficial to extend this function. TRIAL REGISTRATION: Nederlands Trialregister NTR4986 . Registered 14 December 2014.