Settings-based Health Promotion Research Articles

Older adults' and service providers' experiences of a settings-based health promotion initiative in English football.

The study was undertaken to explore the experiences of older adults and service providers in a settings-based health promotion initiative in a football club. We conducted semi-structured interviews with 10 older adults attending an 'Extra Time Hub' (ETH) and two staff delivering the initiative. Our reflexive thematic analysis generated six themes. Findings revealed the brand of the sports club attracted some to join the ETH, but through partnerships with local agencies, the initiative was also successful in widening participation beyond older adults with an interest in football. Participants perceived that the ETH was beneficial for their mental health, helped them develop social connections, and promoted positive physical activity experiences. Moreover, the variety of pleasures derived from participation were also discussed. Our findings also illustrate the central role of staff in older adults' experiences of this form of health promotion. Overall, this study contributes to understandings of settings-based health promotion activities in sports clubs, and also demonstrates the potential for sports clubs to widen engagement with the local community through health promotion for older adults.

Developing Public Health Promotion Strategies for Social Networking Sites: Perspectives of Young Immigrant Women in Norway.

Social networking sites (SNS) have emerged as digital settings for youth participation and health promotion. Understanding the complex dynamic of analog/digital participation has become crucial for settings-based health promotion strategies that aim to enable people to increase control over their health and environments. Previous research demonstrates that SNS influence young people's health in complex ways, but less is known about how processes related to intersectionality are reflected in digital settings. This study asked the following question: how do young women with immigrant backgrounds experience and navigate SNS and how can this inform settings-based health promotion strategies? The study included three focus groups with 15 women aged 16-26 years and used thematic content analysis. Young women with immigrant backgrounds reported that transnational networks provided a sense of belonging. However, their presence on SNS strengthened negative social control and had consequences for endeavors to connect with local peers in both digital and analog settings. Both challenges and resources were amplified. The participants reported that sharing strategies to navigate complex networks was useful; they emphasized the importance of anonymous chats, they shared health-related information with extended networks with lower e-literacy, and they saw opportunities for the cocreation of health promotion strategies.

Zukunftstrends und Einsatzmöglichkeiten digitaler Technologien in der settingbezogenen Prävention und Gesundheitsförderung – eine Delphi-Befragung

ZusammenfassungHintergrundDigitale Technologien zeigen ein hohes Nutzenpotenzial für die Gesundheitsförderung und Prävention, eine Analyse entlang der Planungs‑, Umsetzungs- und Evaluationsphasen von settingbasierter Gesundheitsförderung erfolgte bisher nicht. Auch ist noch unklar, inwiefern digitale Technologien Partizipation, Partnerschaften, Empowerment und Gerechtigkeit in Settings fördern.ZielDie vorliegende Studie zielt auf die Erschließung künftiger Trends und Einsatzmöglichkeiten von Technologien entlang der Phasen settingbasierter Gesundheitsförderung in den nächsten 5 Jahren. Weiter wird der Technologieeinsatz zur Schaffung von Partizipation, Partnerschaften, Empowerment und Gerechtigkeit in Settings diskutiert und Unterschiede in Prognosen zwischen Expert*innen aus Wissenschaft und Praxis werden aufgezeigt.MethodeEs erfolgte eine 2‑stufige webbasierte Delphi-Befragung von Expert*innen der settingbezogenen Gesundheitsförderung/Prävention. Offene Fragen wurden inhaltsanalytisch ausgewertet, geschlossene Fragen quantitativ.ErgebnisseDie digitale Transformation wird laut Expert*innen (N = 42, vollständige Teilnahme erste Befragungsrunde) in den nächsten 5 Jahren zunehmend Einzug in die verschiedenen Prozessphasen halten. Insbesondere Technologien zur Verhaltensänderung in Hybridformaten werden erwartet. Der Technologieeinsatz kann künftig einerseits zu mehr Partizipation, Partnerschaften, Empowerment und Gerechtigkeit in Settings führen, andererseits aber auch Exklusion und Ungerechtigkeit verstärken, wenn keine geeigneten Rahmenbedingungen vorliegen.DiskussionEs bedarf der Forschung zu verhältnispräventiven Technologien. Der Ausbau digitaler Kompetenzen und Infrastrukturen in Settings ist nötig, damit die Entwicklung gesundheitsfördernder Settings digital unterstützt werden kann.

O3-1 Key factors for sustainable implementation of community-based physical activity promotion with a focus on individuals with social disadvantages: a systematic review with narrative synthesis

Abstract Background According to the German prevention law (§ 20a SGB V) of 2016, statutory health insurances are legally bound to integrate sustainable setting-based health promotion in their activities. This includes the development of sustainable concepts for community-based physical activity promotion (cbPAP) with a focus on socially disadvantaged individuals (SDI) (e.g. individuals with low income, low social status) to improve health equity. The aim of the systematic review with a narrative synthesis is to identify context-specific factors for the sustainable implementation of cbPAP and further, to inform the project KOMBINE (German acronym for ‘Community-Based PA Promotion to Implement National Recommendations’) for a scientific and practice-based implementation of the National Recommendations for Physical Activity and Physical Activity Promotion in communities. Methods A systematic review with narrative synthesis was conducted. The search was carried out in the databases PubMed, Scopus, CINAHL, PsycINFO/SportDiscus, and WebofScience. Searches were limited to only include studies published up until 04/2020, in English and German. Altogether, qualitative, quantitative, “mixed-method” studies, reports and reviews were considered. Articles referring to factors of sustainable implementation of community-based physical activity promotion with a whole-system approach were included. Although this was not an inclusion criterion, articles addressing accessibility for SDI were specifically taken into account. The framework by Schell et al. (2013) was used for data extraction and analysis, while the four main elements from Popay et al. (2006) were applied in the narrative synthesis process. Results 29 studies (13 qualitative, 1 quantitative, 9 “mixed-method” studies, 3 reviews, 3 reports) were included in the review. 137 references to sustainability factors were identified. According to the framework by Schell et al. (2013), factors were most frequently reported in domains of organizational levels (21), partnerships (18) and financial stability (16). Additional factors in the domains of accessibilities for SDI (11), infrastructure (7), participation (9), and cultural context (10) were identified by the authors. The relationship between the factors and the context of the programs are considered as well. Conclusions The identified factors for sustainability should be systematically addressed at an early stage in the conception of cbPAP measures for SDI to ensure sustainability after implementation.

Co-producing an action-oriented framework for community-based Physical Activity Promotion in Germany.

SummaryGerman National Recommendations for Physical Activity (PA) and PA Promotion recommend community-based approaches to promote PA at the local level with a focus on health equity. In addition, the German Federal Prevention Act addresses health equity and strengthens setting-based health promotion in communities. However, the implementation of both in the local context remains a challenge. This article describes Phase 1 of the KOMBINE project that aims to co-produce an action-oriented framework for community-based PA promotion focusing on structural change and health equity. (i) In a series of workshops, key stakeholders and researchers discussed facilitators, barriers and needs of community-based PA promotion focusing on health equity. (ii) The research team used an inductive approach to cluster all findings and to identify key components and then (iii) compared the key components with updated literature. (iv) Key components were discussed and incorporated into a gradually co-produced framework by the participants. The first result of the co-production process was a catalog of nine key components regarding PA-related health promotion in German communities. The comparison of key components with scientific evidence showed a high overlap. Finally, a six-phase action-oriented framework including key components for community-based PA promotion was co-produced. The six-phase action-oriented framework integrates practice-based and scientific evidence on PA-related health promotion and health equity. It represents a shared vision for the implementation of National Recommendations for PA and PA Promotion in Germany. The extent to which structural changes and health equity can be achieved is currently being investigated in pilot-studies.

Health Promotion Interventions in Sports Clubs: Can We Talk About a Setting-Based Approach? A Systematic Mapping Review.

Many researchers and authorities have recognized the important role that sports clubs can play in public health. In spite of attempts to create a theoretical framework in the early 2000s, a thorough understanding of sports clubs as a setting for health promotion (HP) is lacking. Despite calls for more effective, sustainable, and theoretically grounded interventions, previous literature reviews have identified no controlled studies assessing HP interventions in sports clubs. This systematic mapping review details how the settings-based approach is applied through HP interventions in sports clubs and highlights facilitators and barriers for sports clubs to become health-promoting settings. In addition, the mapped facilitators and barriers have been used to reformulate previous guidelines of HP in sports clubs. Seven databases were searched for empirical research published between 1986 and 2017. Fifty-eight studies were included, principally coming from Australia and Europe, describing 33 unique interventions, which targeted mostly male participants in team sports. The settings-based approach was not yet applied in sports clubs, as more than half of the interventions implemented in sports club targeted only one level of the socio-ecological model, as well as focused only on study participants rather than the club overall. Based on empirical data, the analysis of facilitators and barriers helped develop revised guidelines for sports clubs to implement settings-based HP. This will be particularly useful when implementing HP initiatives to aid in the development of sports clubs working with a whole setting approach.

Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia.

Despite the growing health and economic burden associated with overweight and obesity, preventive policy progress has been deficient globally. This study investigated the policy process involved in the adoption of the Achievement Program, a settings-based health promotion intervention that was a key pillar of the Healthy Together Victoria obesity prevention initiative. The qualitative study utilised multiple theories of the policy process, as well as Causal Loop Diagramming (CLD) methods, to understand the policy systems underlying the decision to adopt the Achievement Program. Factors that impacted this obesity prevention policy adoption included problem prioritisation at Federal and state government levels; political risks regarding policy action and inaction, and framing used by policy advocates to reduce risks and highlight the opportunities related to the Achievement Program policy implementation. The use of CLD methods was advantageous to further conceptualise potential leverage points and effective ways to influence obesity prevention policy in future. As such, the findings contribute to the obesity prevention policy evidence base and toward developing a number of recommended actions for policy actors seeking to increase future policy action.

Obesity Prevention: A Systematic Review of Setting-Based Interventions from Nordic Countries and the Netherlands.

Aim Effective evidence-based interventions have an important role in obesity prevention. Our aim was to present a qualitative synthesis of setting-based health promotion interventions on obesity, from Nordic countries and the Netherlands. Methods A systematic review of the literature was completed for studies in the community, schools, and worksite, with BMI as an outcome. A descriptive analysis was completed for all full-text articles meeting the inclusion criteria. Results Thirty-three articles were identified: 7 whole of community, 3 worksite, and 23 school-based interventions. The studies were largely quasiexperimental in design (21/33), with follow-up from 4 months to 8 years. The explicit use of theory was not featured in many of the studies (20/33). No consistent direction for BMI change could be identified in the whole of community interventions (2/7 positive, 2/7 negative, and 3/7 no effect) and no effect for worksite (3/3 no effect) or many of the school-based interventions (1/23 negative, 4/23 positive, 15/23 no effect, 1/23 BMI significant increase only for control group and 3/23 no data available). Conclusions There is a need to prioritise interventions with study designs of high quality, theory, and a participatory approach, for optimal implementation and evaluation of obesity prevention interventions.

Education setting-based health promotion in New Zealand: evaluating the wellbeing and vitality in education (WAVE) programme.

Wellbeing and vitality in education (WAVE) is an education setting based health promotion initiative in South Canterbury, New Zealand. A mixed method approach was used for assessing change over time. Over ninety percent of education settings (94%) were participating in WAVE (n = 95). A total of 73 education settings completed the questionnaire at both baseline and follow-up. Evaluation of the WAVE programme shows that a robust partnership between health and education sectors can provide the basis for high levels of participation and significant changes in practice across all levels of education and a whole province. Evaluation results included that professional development for staff in some health related topics had improved. There was evidence of increasing partnerships between schools and community. Teachers had become role models for health messages and students had taken on leadership roles. Although the approach was based on health promoting schools literature, early engagement with education settings allowed the development of a local programme and branding. The overall outcome of WAVE has been a culture change in South Canterbury, where promoting the health of students, staff and families is becoming part of normal business for education settings. The results provide reason for optimism regarding the careful use of a health promoting schools framework, working in partnership with a range of stakeholders towards improving the health and subsequent life chances of young people.

Food marketing to children in Canada: a settings-based scoping review on exposure, power and impact.

Food marketing impacts children's food knowledge, behaviours and health. Current regulations in Canada focus on restricting promotional aspects of food marketing with little-to-no consideration of the places where children experience food. Understanding food marketing in children's everyday settings is necessary to protect children. This scoping review describes the current literature on food marketing to children in Canada by setting. The author searched databases for Canadian research on children's exposure to food marketing, and the power and impact of food marketing to children (2-17 years) across settings, and on how current regulations may mediate the effect of food marketing on children. Peer-reviewed studies in English, published between 2000 and 2016, were included. Twenty-five studies documented children's exposure to food marketing and its power and/or impact on them in homes (via television, or online) (n = 12), public schools (n = 1), grocery stores (n = 8), fast food restaurants (n = 2), and in general (n = 2). Research trends suggest that unhealthy foods are targeted at children using multiple promotional techniques that overlap across settings. Several research gaps exist in this area, leading to an incomplete, and potentially underestimated, picture of food marketing to children in Canada. Available evidence suggests that current Canadian approaches have not reduced children's exposure to or the power of food marketing in these settings, with the exception of some positive influences from Quebec's statutory regulations. The settings where children eat, buy or learn about food expose them to powerful, often unhealthy food marketing. The current evidence suggests that "place" may be an important marketing component to be included in public policy in order to broadly protect children from unhealthy food marketing. Organizations and communities can engage in settings-based health promotion interventions by developing their own marketing policies that address the promotion and place of unhealthy food and beverages.

Considerations on establishing prevention reporting at the national level in Germany.

The adoption of the Preventive Health Care Act in July 2015 was a key step in strengthening settings-based health promotion and disease prevention. This increases the importance of developing prevention reporting at the national level. In light of international experiences, we therefore propose a multi-step process, which formulates specific goals based on epidemiologically grounded public health needs, which should then be addressed through appropriate intervention strategies. The implementation status of activities needs to be continuously documented and their effectiveness evaluated.

Dilly Wanderer initiatives – Wollondilly Health Alliance

Introduction : The Wollondilly Shire Local Government Area is a peri-urban area located on the south west fringe of the Sydney Metropolitan area facing increasing challenges associated with population growth, health concerns and service provision. Residents have access to local primary care but must travel outside the region for higher level health services. Compared to NSW, there are higher rates of obesity, alcohol consumption, smoking and lung cancer. Short description of practice change implemented : The Dilly Wanderer is Wollondilly Shire Council’s mobile mini bus community engagement and information service. It visits towns and villages in Wollondilly Shire providing information to community members and activities for children and families to participate in. Aim and theory of change : The vision for Wollondilly is that the community is healthier, finds it easier and quicker to access services, enjoys quality services and has a say in the development and provision of health services that affect them. Consistent with the WHO Draft Framework for Country Action across Sectors for Health and Health Equity (2015) the Dilly Wanderer is an exemplar of “action initiated at the local government level…various sectors working together to address public health and health equity issues…through community-based or setting-based health promotion activities.” Targeted population and stakeholders : Potentially isolated individuals and families at risk of poor health due to deficits in social connectedness, health literacy, nutritional choices and physical activity. Timeline : The Dilly Wanderer enhancement commenced in May 2014 and is currently funded to 2017. Highlights : Since May 2015, the following enhanced activities have been delivered via the Dilly Wanderer, all evaluated through satisfaction survey or client experience interview: - Kiosks In addition to the regular Dilly Wanderer timetable, a specific schedule has been established which ensures the Dilly attends a predetermined location each week with the aim of promoting healthy messages and activities. - Special events Due to the increase in the hours of operation, the Dilly Wanderer has been able to attend community gatherings and events not previously attended, boosting overall community awareness and creating a positive brand association. - Workshops/education sessions Information sessions have been delivered to several Wollondilly villages on the topics of child development, parenting skills, healthy eating for families, how to access and identify the need for Allied Health services and basic first aid. The program has been enthusiastically received with all agreeing they would recommend the program to family and friends, 43% confident in making changes to their lifestyle, 63% enhancing their parenting skills and knowledge and 50% feeling a lot more connected to other people in their community. - Walking and exercise groups Walking and exercise sessions have been provided in several Wollondilly villages. The sessions have been well received with over 60 participants to date. Conclusions : Over a short period the Dilly Wanderer has generated positive community engagement, raised awareness, attained solid attendance, expanded its reach and tailored services to health need. Discussions : Community engagement, health literacy and social connectedness can be rapidly improved through mobile mini bus health promotion messaging.

Promoting health in schools: Theoretical reflections on the settings approach versus nudge tactics

This paper compares and contrasts two different concepts of health promotion in schools from a theoretical perspective: on the one hand, nudge tactics seeking to change both students’ eating behaviour and their exercise routine and, on the other hand, the settings approach which focuses on the social determinants of health. After assessing both concepts critically, it is argued that nudge has three drawbacks in comparison to setting-based health promotion: Firstly, in primarily focussing on individual choices, nudge exclusively promotes students’ behavioural prevention while disregarding measures of structural prevention. Secondly, choice architects (nudgers) are likely to enforce cultural homogeneity when defining the meaning of school health, i.e. the right food or dose of exercise, while deviating lifestyles are implicitly judged to be irrational and unhealthy. Thirdly, within a nudge-based approach students are predominantly addressed as consumers (nudgees), while less attention is paid to other social identities such as citizens or co-producers. By investigating the examples of smart lunchrooms and an environment encouraging activity, it is demonstrated that nudge is not perceived as a deliberative and context-bound process but instead displays a selective focus on health issues. Due to these significant concerns, it is concluded that – despite its practical shortcomings – setting-based health promotion is superior to nudge – especially in schools.

Political Challenges in Complex Place-Based Health Promotion Partnerships: Lessons From an Exploratory Case Study in a Disadvantaged Area of Queensland, Australia.

Settings-based health promotion involving multiple strategies and partners is complex, especially in disadvantaged areas. Partnership development and organizational integration are examined in the literature; however, there is more to learn from the examination of practice stakeholders' experience of intersectoral partnership processes. This case study examines stakeholder experiences of challenges in new partnership work in the context of a culturally diverse and socioeconomically disadvantaged region in Queensland, Australia. Health promotion staff and community representatives participated in interviews and focus groups, and the thematic analysis included observations and documentary analyses. Our findings highlight the retrogressive influence of broader system dynamics, including policy reform and funding changes, upon partnership working. Partnership enablers are disrupted by external political influences and the internal politics (individual and organizational) of health promotion practice. We point to the need for organization level commitment to a consistent agreed vision specifically accounting for place, as a cornerstone of intersectoral health promotion partnership resilience. If organizations from diverse sectors can embed a vision for health that accounts for place, complex health promotion initiatives may be less vulnerable to broader system reforms, and health in all policy approaches more readily sustained.

Leisure-time as a health-promoting setting –experiences from youth-centers in Sweden

Background: Leisure-time is an important part of young people’s lives. Despite this, leisure-time settings have hitherto had a minor role in setting-based health-promotion initiatives. Improving adolescents’ quality of leisure-time activities can reduce social differences in health. Youth centers can therefore be good settings for promoting health. However, young people with immigrant backgrounds participate less in organized leisure-time activities. The aim of the study is to increase awareness of the importance of young people's leisure-time activities in a health promotion perspective. Further questions like who participate and why, what they gain, and what particular strategies the different youth-centers use in their everyday work will be presented. Methods: In this practice-based longitudinal study data were collected 2012-2014 at two youth-centers in multicultural, socially deprived suburbs using surveys with 12-16 year old adolescents (n=207). Individual interviews with staff (n=7) and focus-groups interviews with adolescents (6 groups, 50 % girls). Moreover individual interviews (n=3) were made with cooperation partners in the neighborhoods. Quantitative, qualitative and mixed methods were used for analysis. Results: Most of the participants are second generation immigrants. They feel healthy, enjoy school, and feel quite safe in their neighborhoods. They participate in youth-centers to do fun and interesting activities, to see friends as well as to have leaders that care about them. If factors like support from youth-center leaders, influence, gender equality or alcohol and drug rules are important for making adolescents use less alcohol or feel better will also be revealed. Strategies for recruiting youth to youth-centers are central to succeeding. Conclusions: Youth centers can be health-promoting settings when their strategies include some important factors, both in theory and in daily practice. Main messages: Leisure-time activities are underestimated health promoting settings. Youth-centers can be a health-promoting setting.

Moving university campuses tobacco‐free: collective responsibility and collaboration the key to a healthier Victoria

Full article Smoking is Victoria's leading preventable cause of death and continues to kill 4,000 Victorians every year.1 In a demonstration of public health leadership, all Victorian universities have recently joined forces in the implementation of the Victorian Universities Tobacco-Free Initiative to contribute to reducing the burden from tobacco-related disease in Victoria. The reach of Victorian universities to implement public health initiatives is significant and growing, with nearly 300,000 students and more than 40,000 academic and professional staff, as is the potential for universities to influence the heath behaviours of young people in a period where life-long behaviours are formed. This is particularly important, given that Victorians of university age (aged 18–29 years) are more likely to smoke than people aged 30–49 years and 50+ years.2 The Initiative educates and engages students and staff on the benefits of reducing smoking, supports smokers to quit and creates smoke-free campuses. This approach is more than just asking students and staff to leave the campus to have a cigarette; it provides a comprehensive suite of supports to help smokers quit that is likely to have a real impact on reducing harm from tobacco. The Tobacco-Free Initiative approach is collaborative across all universities and has been designed and implemented in association with university communities. An advantage of adopting a settings-based health promotion approach is that real changes can be implemented at local level without the need for government intervention or new legislation. Health promotion approaches driven by the community are efficient, timely and allow flexibility. Like the approach used in the Initiative, they create an environment that encourages healthy choices, and supports changes in communities that will have a positive impact on individuals, and also households, families, friends and broader networks. Therefore, this approach is not about helping one individual – it is about supporting a community to be healthier. The prevalence of chronic disease is increasing in Victoria.3 Cardiovascular disease, diabetes and chronic kidney disease share many common lifestyle-related risk factors and contribute a large proportion of the disease burden.4 Lifestyle factors such as tobacco smoking, excessive alcohol use, unhealthy diet and lack of physical activity contribute to the chronic disease burden.5 The direct health costs and lost productivity from smoking add up to $2.4 billion annually in Victoria alone.1 These costs are incurred across businesses, governments and by individuals. Given the recent concern about the sustainability of the health system in Australia, the costs attributable to smoking need to be addressed immediately. Victorian universities are doing their bit to help. The Victorian Universities Tobacco-Free Initiative provides an effective framework for universities to continue to work together and demonstrate public health leadership in developing settings-based health promotion approaches to address the increasing incidence of chronic disease and lifestyle-related risk factors. The unprecedented degree of collaboration between Australian universities over this initiative also allows them to share resources and wisdom and to jointly evaluate the programs in place. This not only expedites the development and roll out of tobacco-free programs, but builds a very sound evidence-base for the most effective strategies in these settings. The framework provides guidance for other industries in Victoria to work together to support the implementation of collaborative health promotion initiatives. The gravity of the future health, social and economic burden of chronic disease requires a timely and continued investment by government, but also by the private sector. The universities of Victoria encourage other major employers to join them and take an active role in developing environments that promote health for all Victorians. References 1 Collins DJ, Lapsley HM. The Social Costs of Smoking in Victoria in 2008/09 and the Social Benefits of Public Policy Measures to Reduce Smoking Prevalence. Melbourne (AUST): Quit Victoria and the VicHealth Centre for Tobacco Control; 2011. 2 Emily Bain SD, Wakefield M. Smoking Prevalence and Consumption in Victoria: Key Findings from the 1998–2012 Population Surveys. Melbourne (AUST): Victorian Department of Health; 2013. 3 Department of Health. Victorian Population Health Survey 2010. Melbourne (AUST): State Government of Victoria; 2012. 4 Australian Institute of Health and Welfare. Chronic Diseases and Associated Risk Factors in Australia, 2001. Canberra (AUST): AIHW; 2012. 5 Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, The Burden of Disease and Injury in Australia 2003. Canberra (AUST): Australian Institute of Health and Welfare; 2007.

Sports clubs as settings for health promotion: fundamentals and an overview to research.

This paper explores the efficacy and value of sports clubs as a setting for health promotion. Sports clubs for children and adolescents are the primary focus of the paper, and the aims are two-fold. Firstly, the paper aims to review the basis for and elements of the health promoting sports club (HPSC) concept. Secondly, the aim is to overview the international evolution of the HPSC concept and its usefulness in the research. The settings-based health promotion approach forms the basis for the HPSC concept and it is introduced first. Thereafter, both obligating and prospecting factors, to justify the importance for sports clubs to address health promotion, are expressed. Major prospecting factors relate to the facts that sports club activities reach a lot of children and adolescents, and that its educational nature is informal due to voluntary participation. The paper also presents multilevel structure of sports clubs, as well as the determinants affecting the settings-based work. The research concerning health promotion in sports-related settings is evolving worldwide, and Nordic countries are in the front line of this new-wave of settings-based health promotion. Indeed, it has been claimed that, for the settings approach to assimilate to current societal challenges, there is a need to widen the reach of the approach to non-traditional, non-institutional settings, like sports clubs.

Unintended effects in settings-based health promotion.

The settings-based approach to health promotion (HP) employs a social ecological (SE) framework to integrate HP into the usual activities of the setting and to increase the setting's support for healthy choices. The SE approach calls for systems thinking to account for the inextricable relationship between people, their behaviour and their environment. Knowledge about a setting can be used to mobilise people to participate in HP, to optimise success by taking into account the local context, and to anticipate and avoid barriers to success. In other words, the SE approach aims to help HP reach its goals for better health, established in concert with community needs and wishes. Yet, the focus on HP goals may detract attention from how intervention may have unanticipated, and even untoward effects on the setting. There is much evidence from classical ecological research that well-meaning interventions have unintended effects. Biology is so tuned to the possibility that the study of unintended effects is integral to the field. There is some evidence--but much less--that HP also has unexpected, deleterious effects. The evidence is limited because of neglect; the subject of unintended effects is only of peripheral interest in HP. This is a call for a more robust SE approach, in which frameworks used to guide settings-based HP are augmented so as to be concerned with planned effects, and also unplanned effects. What can be done to more responsibly monitor, document and report the full panoply of our effects, including detecting and preventing untoward effects?

Youth sports clubs’ potential as health-promoting setting: Profiles, motives and barriers

Setting and Objective: For decades, the World Health Organisation has promoted settings-based health promotion, but its application to leisure settings is minimal. Focusing on organised sports as an important leisure activity, the present study had three goals: exploring the health promotion profile of youth sports clubs, identifying objective club characteristics (e.g. size, type of sport), predicting the presence/absence of health promotion in youth sports clubs and identifying perceived motives and barriers to health promotion in youth sports clubs, thereby improving the basis for policy guidelines. Method: Respondents were representatives from the board of 154 youth sports clubs. Data were collected through an online survey, including the health-promoting sports club index (HPSC-I). Linear regression and analysis of variance were used to identify predictors and differences. Results: Even though the motives were strongly supported, a majority of youth sports clubs were rated as low health promoting on the HPSC-I (59%). Overall, linear regression indicated that clubs founded more recently, offering multiple types of sports and offering both recreation and competition scored higher on the health promotion indices. Health promotion not being a priority of the board and lack of expertise were identified as the most important barriers. Conclusion: Progress is needed before youth sports clubs can truly be considered health-promoting settings. Policy suggestions are made to address the barriers, for example, financial incentives to maximise efforts and establishing collaborations between sports clubs and health promotion experts.

Knowledge and Synthesis Gaps in Men’s Health: Type 2 Diabetes and Depression in Northern British Columbia, Canada

The workplace is notable as an optimal setting for health promotion programs. The workplace offers a natural convenient environment to support the promotion of health and wellness of workers in organizations. Adult men (18 years of age or over) in natural resource industries who work full-time spend more of their waking hours at work, away from their families due to shift work, hectic hours, and busy lifestyles. The workplace setting can therefore be harnessed to offer workers frequent and sustained exposure to effective interventions during prime hours. The purpose of this Scopus review paper is to assess the magnitude of type 2 diabetes (T2D) and depression among working men in resource-based occupations (trucking; logging; mining; oil and gas; and forestry). The paper proposes a settings-based workplace health promotion (WHP) framework to be adapted from a community-based perspective. We argue the proposed framework can be applied to effect individual worker's lifestyle behaviours, and from a socio-ecological perspective to influence organizational change and health policy. We propose WHP programs for men recognizing that gender has an important role in influencing one's lifestyle and overall health. From a socio-ecological perspective, the environment also plays a pivotal role in affecting lifestyle choices by supporting or hindering behaviours that occur in 'settings' such as family, school, workplace, or community environments. While arguing for WHP interventions, the paper recognizes the importance of upstream policy initiatives that should enhance and cultivate such interventions at organizational and community levels.