Socio-ecological Model Research Articles

Advancing research on femicide prevention: A mixed methods approach.

Femicide, the killing of women, girls, and infants, is a pervasive problem affecting all global societies. Policy and research are impeded by inaccurate and missing prevalence data, gaps in understanding of femicide, especially for hard-to-reach marginalized populations, and conflicting perceptions between jurisdictions. Leveraging on a combined socio-ecologic model and Public Health approach, the paper spans the methods of a computed tomography-based injury study, an in-depth media-analysis, a legislation evaluation study, and a data barriers' study. Injury patterns, media depiction, and end-user consultations will close the loop on residual problems such as implementation, data gaps, and cultural perceptions. By mixed methods research representing multiple regions, and stakeholders, this project will enhance knowledge on interpersonal, institutional, and societal factors of femicide, advancing the humanitarian forensic discipline. The research method will identify emerging trends and facilitate improvements in tertiary prevention of femicide, specific to resource settings.

“As a patient I do not belong to the clinic, I belong to the community”: co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa

BackgroundAnticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.MethodsUsing a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework.ResultsIntervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.ConclusionsDecreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Sugar-Sweetened Beverages and Diet Related Chronic Non-Communicable Diseases in Sub-Saharan Africa

abstract In Sub-Saharan Africa (SSA), diet-related chronic non-communicable diseases (DR-CNCDs) pose a growing public health threat, jeopardising progress towards achieving Sustainable Development Goal 3.4. One contributing factor to this rising threat is the recent surge in consumption of sugar-sweetened beverages (SSBs), across SSA in recent years. Using the socio-ecological model, this commentary explores the nexus between DR-NCDs and SSBs and offers interventions to address this public health challenge at the individual, interpersonal, community, organisational and policy levels. At the individual level, health education campaigns should target individuals and ensure an increase in awareness creation. The life-course approach underscores the importance of promoting healthier dietary choices from childhood to prevent diet-related non-communicable diseases in later life. Schools and workplaces enforcing local policies that discourage SSB consumption patterns will make a huge difference at the community and organisational levels. At the societal/policy level, comprehensive strategies such as sugar taxes, front-of-pack labelling, advertising restrictions and health education programmes are crucial.

Multilevel determinants of antiretroviral therapy initiation and retention in the test-and-treat era of Nepal: a qualitative study

BackgroundThe transition to the “test-and-treat” policy in Nepal in 2017, coupled with the rapid initiation of antiretroviral therapy (ART) in 2020, necessitates an in-depth understanding of factors influencing ART initiation and retention. This study investigates these factors from the perspectives of healthcare providers, families/communities, and people living with HIV (PLHIV).MethodsEmploying a qualitative design, in-depth interviews were conducted with 24 ART clients and 26 healthcare providers across different provinces of Nepal. A comprehensive interview guide facilitated the exploration of experiences and perceptions. Interviews were transcribed verbatim, and thematic analysis was applied to distill key insights. Guided by a socio-ecological model, interviews were analyzed to identify the barriers and facilitators to ART initiation and continuation at the individual, family/community, and health system levels.ResultsFacilitators and barriers were identified at three levels. Individual-level facilitators included fear of death, perceived health benefits, knowledge about HIV/ART, confidentiality, and financial support. Barriers encompassed concerns about lifelong medication, side effects, denial of HIV status, fear of disclosure, and financial constraints. At the family/community level, support from family and community health workers facilitated ART adherence, while social stigma and discrimination posed barriers. The health system’s role was dual; the provision of free treatment, a client tracking system and a robust drug supply chain were facilitators, whereas logistical challenges and service accessibility during the COVID-19 pandemic were notable barriers.ConclusionsThis study highlights the various factors that influence ART initiation and retention in Nepal during the test-and-treat era. Tailored interventions should focus on increasing awareness about HIV and ART, strengthening healthcare systems, ensuring availability of medications, and providing accessible treatment during service disruptions. Furthermore, these interventions should encourage supportive environments at the individual, community, and healthcare system levels. Taking this holistic approach is essential for effectively implementing ART and achieving long-term health outcomes in light of changing public health policies.

‘Not taking medications and taking medication, it was the same thing:’ perspectives of antiretroviral therapy among people hospitalised with advanced HIV disease

BackgroundDespite HIV's evolution to a chronic disease, the burden of advanced HIV disease (AHD, defined as a CD4 count of < 200 cells/uL or WHO clinical Stage 3 or 4 disease), remains high among People Living with HIV (PLHIV) who have previously been prescribed antiretroviral therapy (ART). As little is known about the experiences of patients hospitalised with AHD, this study sought to discern social forces driving hospitalisation with AHD. Understanding such forces could inform strategies to reduce HIV-related morbidity and mortality.MethodsWe conducted a qualitative study with patients hospitalised with AHD who had a history of poor adherence. Semi-structured interviews were conducted between October 1 and November 30, 2023. The Patient Health Engagement and socio-ecological theoretical models were used to guide a thematic analysis of interview transcripts.ResultsTwenty individuals participated in the research. Most reported repeated periods of disengagement with HIV services. The major themes identified as driving disengagement included: 1) feeling physically well; 2) life circumstances and relationships; and 3) health system factors, such as clinic staff attitudes and a perceived lack of flexible care. Re-engagement with care was often driven by new physical symptoms but was mediated through life circumstances/relationships and aspects of the health care system.ConclusionsCurrent practices fail to address the challenges to lifelong engagement in HIV care. A bold strategy for holistic care which involves people living with advanced HIV as active members of the health care team (i.e. ‘PLHIV as Partners’), could contribute to ensuring health care services are compatible with their lives, reducing periods of disengagement from care.

Detection and management of localized prostate cancer in Nigeria: barriers and facilitators according to patients, caregivers and healthcare providers

BackgroundProstate cancer mortality rates are high in Nigeria. While prostate cancer is highly curable with early detection and effective multidisciplinary management, the quality of care is suboptimal in this setting. Sustainable delivery of high-quality care for patients with localized prostate cancer is needed to save more lives. To inform future interventions to improve care, this study aimed to identify barriers and facilitators that influence prostate cancer detection and management in Nigeria.MethodsSix focus group discussions (FGDs), stratified by stakeholders were conducted with a purposive sample of prostate cancer patients (n = 19), caregivers (n = 15), and healthcare providers (n = 18), in two academic tertiary hospitals in northern and southern Nigeria. A discussion guide organized based on the socio-ecological model was used. FGDs were recorded, transcribed, and analysed using the framework technique.ResultsBarriers and facilitators were identified at the individual, interpersonal, and organizational levels. Barriers to detection included limited knowledge and misperceptions among patients, caregivers, and community-based non-specialist healthcare providers, and limitations of centralized opportunistic screening; while facilitators included the potential for religious institutions to encourage positive health-seeking behaviour. Barriers to management included non-uniformity in clinical guideline usage, treatment abandonment amidst concerns about treatment and survival, absence of patient interaction platforms and follow-up support systems, difficulty in navigating service areas, low health insurance coverage and limited financial resource of patients. Facilitators of management included the availability of resource stratified guidelines for prostate cancer management and the availability of patient peers, caregivers, nurses, and medical social workers to provide correct medical information and support patient-centred services. Participants also provided suggestions that could help improve prostate cancer detection and management in Nigeria.ConclusionThis study identified multiple determinants affecting the detection and management of localized prostate cancer. These findings will inform the refinement of implementation strategies to improve the quality of prostate cancer care in Nigeria.

A socio-ecological approach to understanding the experiences of women and girls playing male-dominated sports

This study aimed to understand the experiences of women and girls playing male-dominated sports through a gendered lens on the socio-ecological model. Data collected from fifteen semi-structured interviews with Australian women and girls was thematically analysed at the societal, the organisational/community, the interpersonal and the intrapersonal levels. The study highlights that gendered factors shaped women’s and girls’ experiences at all levels. Club leadership valued women and girls’ inclusion, but resources were sometimes unevenly committed, and men’s participation and leadership were privileged. This inequity fuelled women and girls’ desire to advocate change for future generations. A socio-ecological system approach is critical to continue gender equity developments in sport.

Acceptance level of advance care planning and its associated factors among the public: A nationwide survey

BackgroundAdvance care planning (ACP) can contribute to individuals making decisions about their healthcare preferences in advance of serious illness. Up to now, the acceptance level and associated factors of ACP among the public in China remain unclear. This study aims to investigate the acceptance level of ACP in China and identify factors associated with it based on the socioecological model.MethodsA total of 19,738 participants were included in this survey. We employed a random forest regression analysis to select factors derived from the socioecological model. Multivariate generalized linear model analysis was then conducted to explore the factors that were associated with the acceptance level of ACP.ResultsOn a scale ranging from 0 to 100, the median score for acceptance level of ACP was 64.00 (IQR: 48.00–83.00) points. The results of the multivariate generalized linear model analysis revealed that participants who scored higher on measures of openness and neuroticism personality traits, as well as those who had greater perceptions of social support, higher levels of health literacy, better neighborly relationships, family health, and family social status, were more likely to accept ACP. Conversely, participants who reported higher levels of subjective well-being and greater family communication levels demonstrated a lower likelihood of accepting ACP.ConclusionsThis study identified multiple factors associated with the acceptance level of ACP. The findings offer valuable insights that can inform the design and implementation of targeted interventions aimed at facilitating a good death and may have significant implications for the formulation of end-of-life care policies and practices in other countries facing similar challenges.

Navigating Gender Disparities on the Management of Chronic Disease: a Narrative Review

Chronic diseases globally expose significant gender disparities in management and outcomes. Women often experience delays and inadequate treatment due to biological, psychosocial, and systemic biases, compounded by societal norms hindering self-care and health-seeking behaviours. Similarly, the LGBTQIA+ community faces discrimination and lacks culturally competent healthcare. This review addresses these issues collectively, aiming to uncover root causes and propose strategies for equitable healthcare outcomes. A literature review (2016-2024) using PubMed, Google Scholar, and Wiley Online identified peer-reviewed studies on gender, health determinants, and chronic diseases, focusing on socioeconomic, biological, and psychological factors. Socio-ecological models and culturally sensitive healthcare strategies are crucial for enhancing treatment adherence and reducing gender bias. Community-level interventions and policy changes are essential for equitable healthcare access. Integrating gender-inclusive practices into medical education is pivotal to achieving global health goals by 2030.

Behavioral change interventions, theories, and techniques to reduce physical inactivity and sedentary behavior in the general population: a scoping review

BackgroundWorldwide, physical inactivity (PIA) and sedentary behavior (SB) are recognized as significant challenges hindering the achievement of the United Nations (UN) sustainable development goals (SDGs). PIA and SB are responsible for 1.6 million deaths attributed to non-communicable diseases (NCDs). The World Health Organization (WHO) has urged governments to implement interventions informed by behavioral theories aimed at reducing PIA and SB. However, limited attention has been given to the range of theories, techniques, and contextual conditions underlying the design of behavioral theories. To this end, we set out to map these interventions, their levels of action, their mode of delivery, and how extensively they apply behavioral theories, constructs, and techniques.MethodsFollowing the scoping review methodology of Arksey and O’Malley (2005), we included peer-reviewed articles on behavioral theories interventions centered on PIA and SB, published between 2010 and 2023 in Arabic, French, and English in four databases (Scopus, Web of Science [WoS], PubMed, and Google Scholar). We adopted a framework thematic analysis based on the upper-level ontology of behavior theories interventions, Behavioral theories taxonomies, and the first version (V1) taxonomy of behavior change techniques(BCTs).ResultsWe included 29 studies out of 1,173 that were initially screened/searched. The majority of interventions were individually focused (n = 15). Few studies have addressed interpersonal levels (n = 6) or organizational levels (n = 6). Only two interventions can be described as systemic (i.e., addressing the individual, interpersonal, organizational, and institutional factors)(n = 2). Most behavior change interventions use four theories: The Social cognitive theory (SCT), the socioecological model (SEM), SDT, and the transtheoretical model (TTM). Most behavior change interventions (BCIS) involve goal setting, social support, and action planning with various degrees of theoretical use (intensive [n = 15], moderate [n = 11], or low [n = 3]).Discussion and conclusionOur review suggests the need to develop systemic and complementary interventions that entail the micro-, meso- and macro-level barriers to behavioral changes. Theory informed BCI need to integrate synergistic BCTs into models that use micro-, meso- and macro-level theories to determine behavioral change. Future interventions need to appropriately use a mix of behavioral theories and BCTs to address the systemic nature of behavioral change as well as the heterogeneity of contexts and targeted populations.

How immigration detention harms children: A conceptual framework to inform policy and practice.

This paper identifies the multiple adversities and trauma experienced by children who are detained after seeking asylum. A conceptual framework identifies the specific impact of immigration detention on the psychosocial development and mental health of refugee children that can inform policy and prevent additional migration-related trauma. The paper draws on international evidence about the impact of childhood adversity, challenges faced by all displaced children, and the additional negative consequences of immigration detention. It integrates socioecological, temporal, and relational approaches to identify the pathways through which detention of forcibly displaced children causes preventable harm. The public health and human rights implications are identified. The framework draws on Bronfenbrenner's socioecological model and has the child, their development, and experience at the center. Refugee children are exposed to cumulative adversity during displacement, flight, and resettlement. Immigration detention is associated with multiple additional adversities and human rights violations. International and national contexts and the detention environment impact on family functioning and directly on the child's well-being. Immigration detention is a preventable and profoundly negative reception experience for already vulnerable children. It is unavoidably associated with multiple additional adverse exposures with significant health and public health consequences. The proposed framework demonstrates adversity in each socioecological sphere of the detained child's life and across time. The framework can inform migration, child protection, and public health policy. Advocacy and political action to end this practice are urgently required to prevent further harm. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the social and cultural aspects of Chinese family caregivers’ experience as they support loved ones with dementia transitioning into nursing homes: a qualitative study protocol

IntroductionAsian American caregivers supporting loved ones with dementia experience greater burden and more stress than other racial/ethnic groups, warranting the need for more culturally and linguistically appropriate formal support, such...

Communication Public Health: An Integration of Audiology, Speech-Language Pathology, and Public Health.

Health care is advancing toward a collaborative and integrative approach that promotes general health and wellness while addressing health inequities through the consideration of broader social and economic factors that influence the well-being of the entire population. Recently, there has been growing evidence of public health concept applications in fields related to speech, language, and hearing. However, there is an outstanding need to explicitly define the intersection of public health, including prevention and health promotion, and the discipline of communication sciences and disorders (CSD) across the areas of education, clinical practice, research, and policy. The authors propose a definition for this intersection using the new term communication public health. This tutorial provides guidance on how to conceptualize communication public health and invites refinement and expansion of the intersection between public health and CSD. Because readers are experts in CSD, this tutorial aims to supplement existing knowledge with information on public health to achieve three main objectives: (a) increase knowledge of the application of public health concepts among speech, language, hearing, and related professionals (SLHP+); (b) introduce the concept of communication public health; and (c) discuss the relevance of communication public health across domains within CSD. The authors utilize the socioecological model to provide examples of applications. The concept of communication public health is proposed as the collaborative area of CSD and public health, which encompasses prevention and promotion of equity in communication health through individual-, community-, and population-level efforts. The goals of communication public health are achieved through applications of public health principles in CSD education, clinical practice, research, and policy. Communication public health defines an area of collaboration between public health and CSD in which SLHP+ can apply public health concepts to both advance communication health and address health disparities.

Prevalence and determinants of risky behaviors: a comprehensive review of substance use and sexual risk behaviors among adolescents in the United States

Adolescents are often the most vulnerable to risky behaviors due to their quest for independence, experimentation, and identity development, resulting in deep-rooted patterns that affect health across the life course. This review examines the prevalence and determinants of substance use and sexual risk behaviors among adolescents in the United States. A systematic search of peer-reviewed literature published between 1980-2023 was conducted using multiple databases. Studies focusing on U.S. adolescents aged 12-19 and reporting on prevalence or associated factors of substance use (alcohol, tobacco, marijuana, or any illicit drugs) or sexual risk behaviors (early sexual initiation, multiple partners, or inconsistent condom use) were included. The review synthesized data from 40 studies meeting inclusion criteria. Results indicate concerning rates of substance use and sexual risk-taking, with variations by demographic factors. Alcohol and marijuana use were most prevalent, reported by 30-40% of adolescents. Nearly half of high school students reported having sexual intercourse, with 40% not using condoms consistently. Prevalence was generally higher among older adolescents, sexual minorities, and some racial minority groups. Key determinants of risk behaviors were reviewed based on socioecological models including individual, interpersonal, community and societal factors. The review highlights the multilevel nature of influences on adolescent risk behaviors. Findings underscore the need for tailored interventions addressing multiple determinants. Particular attention to vulnerable groups such as African American Adolescents and social determinants of health inequities is warranted. More research on risk and protective factors and effective interventions is needed. This synthesis can inform the development of evidence-based policies and programs to reduce substance use and sexual risk behaviors among U.S. adolescents.

Meditation modalities for ADHD in minority pediatric populations in the USA: a scoping review.

Roughly 10% of children aged 3 -17 in the USA are diagnosed with attention-deficit hyperactivity disorder (ADHD), and minorities are less likely to initiate common pharmacologic treatment. We conducted a review of the literature to examine meditation as a safe, effective, and low-cost alternative. We searched PubMed and other journals using "meditation," "mindfulness," "minority," related keywords, and relevant MeSH terms. Eligible studies involved racial/ethnic minorities in the USA, reported quantitative psychosocial outcomes, and were published in a peer-reviewed, English-language journal. Out of 119 "hits," 111 were eliminated as duplicates or were not relevant. A full-text review of the remaining eight revealed that none fully met our eligibility criteria. Besides the obvious lack of studies, those reviewed reported incomplete demographic and clinical data. They also employed different and inconsistent research methodologies, interventions and modalities, and statistical analyses. This hindered understanding exactly which populations may benefit from meditation, and for which specific symptoms. We recommend a socio-ecological model in examining intervention modalities, especially in the context of intrapersonal, interpersonal, organizational, environmental, and policy domains. We also suggest the possible inclusion of research older than 10 years, conducted outside of the USA, on minority and non-minority populations, for supplementary and confirmatory data. We advocate for consistency in study design and data collection, which would help align research conducted in different countries. Searches should also include variations of meditation such as "mindfulness" and "guided imagery," and associated symptoms and comorbidities of ADHD, including "learning disorder" and "behavioral problems."

Applying a Socio-Ecological Model to Understanding the Needs of Children and Young People Bereaved by Intimate Partner Homicide across their Life Course

Applying a Socio-Ecological Model to Understanding the Needs of Children and Young People Bereaved by Intimate Partner Homicide across their Life Course

Understanding geomorphodynamics in the Pergamon micro-region from a socio-ecological perspective

A systematic interdisciplinary approach based on the socio-ecological model of the Vienna school has been adopted to achieve a more nuanced and multifaceted understanding of the ancient metropolis of Pergamon (western Anatolia) and its micro-region. The city of Pergamon ranks among the ‘guiding fossils’ of urban culture in antiquity. We describe how the socio-ecological model is subject to adaptation and discussion to fit the needs and circumstances of archaeology. In focussing on geomorphodynamics, we use several approaches to conceptualise and model selected aspects of human-environment interactions, integrating data from physical geography, archaeology, building archaeology (Bauforschung) and ancient history. The model includes several dimensions of the social metabolism of Pergamon, first and foremost the carrying capacity of the environment and demographics, comprising population increase and labour as an active investment in nature. Geomorphodynamics are regarded as major ‘events’ in the model, related to the social metabolism (e.g. increased erosion/deposition in the micro-region in relation to urban sprawl). With the social-ecological model, it is possible – and becomes imperative – to include the perception and representation of human-environment interactions manifested in, for example, administrative patterns and religious practices or architecture and built infrastructure (such as terraces, riverbank stabilisation, substraction terraces and substraction bridges). Geomorphodynamics also involve various aspects of the perception of the environment, though these are not recorded in ancient texts on Pergamon known to date. Concurrently, the importance of the model in organising, structuring, and communicating interdisciplinary collaboration and discourse is highlighted.

Reflecting on the Impact of Hybrid Work on an Academic Library Using the Socio-Ecological Model

Covid-19 led to a dramatic change in the academic library work environment, with many workers shifting to a hybrid work schedule once they returned to in person work. The authors describe the impact of this schedule shift through the novel use of the socio-ecological model. The socio-ecological model looks at the impact of choices through varying circles or levels. The authors discuss the individual, interpersonal, community, and societal levels of impact that the switch to hybrid work had within their context and discuss their role as unit leaders and the decisions made to address these varying impacts.

Psychosocial and mental health challenges facing perinatally HIV-infected adolescents along the Kenyan coast: a qualitative inquiry using the socioecological model.

The advent of antiretroviral therapy has led perinatally HIV-infected (PHI) adolescents to live long, fulfilling lives through lifelong treatment. However, there is limited knowledge about the lived experiences and psychosocial and mental health challenges faced by PHI adolescents in sub-Saharan Africa, where 80% of PHI adolescents reside. To address this gap, we adapted the socioecological model to investigate the challenges and lived experiences of PHI adolescents in rural coastal Kenya. Between October and November 2018, a sample of 40 participants (20 PHI adolescents and their 20 primary caregivers) participated in a qualitative study using an H-assessment data collection approach for adolescents and focus group discussions with caregivers. Data analysis was conducted using a framework approach on NVIVO 11 software. PHI adolescents from this setting experience many challenges across various levels of the ecosystem. At the individual level, challenges include living in denial, HIV status disclosure, antiretroviral adherence, internalized stigma, and mental health issues. Within the family, challenges such as parental loss, insufficient care from parents, and unacceptance lead to threats of harm. In the broader community, key challenges such as gossip, unsupportive community members, long waiting times at the health facility, isolation, rejection, and an unresponsive school system fail to address the needs of PHI adolescents. Finally, HIV-related stigma and discrimination manifested across different levels of the socioecological framework. To cope with these challenges, PHI adolescents often rely on privacy and social support from their families. The findings underscore the need to develop and implement multi-level adolescent-friendly interventions to address PHI adolescent challenges and guide future investment in adolescent's health. Furthermore, there is a need to address internalized and interpersonal stigmas through individual-level interventions that promote resilience and the active involvement of adolescents, their caregivers, peers, and teachers who are their social support system.

Contextual drivers on local sport promotion policy: a Dutch case study on the relevance of the COVID-19 pandemic

ABSTRACT The aim of this study was to explore why and how the COVID-19 pandemic influenced local sport promotion policy in the Netherlands. We used a case study approach examining the Dutch context. We studied the perspectives of Local Sport Managers (LSMs) and (coordinators of) neighbourhood sport coaches (NSCs). We applied the principles of the Multiple Streams Framework (MSF) within a socioecological model of local sport promotion policy to examine whether the COVID-19 pandemic created a ‘policy window’ for policy change and if so why. Online questionnaires were sent to LSMs (n = 352, response 26%) and online group interviews (n = 11) were conducted with LSMs and (coordinators of) NSCs. Our study revealed the COVID-19 pandemic indeed opened a ‘policy window’ and resulted in local policy changes related to the facilities and public space (hardware), organisational actors (orgware) and organised activities (software). In most cases, this did not lead to totally new policy, but more a shift in focus. National politics as a response on the COVID-19 pandemic increased the generic awareness of the importance of sport for health. This helped in legitimising the existence of sport promotion policy for a broader purpose. It is important for LSMs and NSCs to take advantage of this ‘policy window’ and use it to create advocacy and support for sport promotion policy over a longer period. As policy change and implementation normally take a period of multiple years, the current Dutch policy framework provides (financial) opportunities for LSMs and NSCs to follow this through.