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Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study.

ABSTRACT: BACKGROUND:Since 2010, the Zwolle Healthy City approach, an integrated community-based approach, has been implemented in the Dutch municipality of Zwolle. This approach is proven successful in reducing health inequalities. However, the key elements of this approach are not clear. The current study aimed to identify key elements of this successful local community-based approach, according to the perspectives of various stakeholders. METHODS:Semi-structured interviews were carried out with 29 professionals who were involved in the approach in the period 2010-2018 and have occupations at the strategic (n = 4), tactical (n = 17) and operational level (n = 8). Data was analyzed using the thematic analysis approach. RESULTS:We identified nine perceived key elements that contributed to the success of the approach aimed at reducing socioeconomic health inequalities. The respondents indicated the following key elements: (1) collaboration between a variety of local organizations that want to have impact on the health of citizens; (2) support for the approach on the strategic, tactical and operational level of involved organizations; (3) proper communication and coordination, both for the network and within the organizations; (4) embeddedness in organizations' policies and processes and (5) collaboration with private organizations is of added value, although there is no "one size fits all". Other key elements are (6) collaboration with citizens, (7) profiling the approach like a brand and (8) moving along with and taking advantage of opportunities. Finally, (9) continuous monitoring and evaluating goals and processes, and learning from the results, is important. CONCLUSION:Nine key elements were identified that, according to various stakeholders, contributed to the success of the Zwolle Healthy City approach. These insights are important to further strengthen the Zwolle Healthy City approach but may also help and inspire other local integrated community-based approaches aimed at reducing socioeconomic health inequalities, to improve and adapt the approach within their specific local and dynamic context.

SUBMITTER: Wilderink L

PROVIDER: S-EPMC7575081 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study.

Wilderink Lisa L Bakker Ingrid I Schuit Albertine J AJ Seidell Jacob C JC Renders Carry M CM

PloS one 20201020 10

<h4>Background</h4>Since 2010, the Zwolle Healthy City approach, an integrated community-based approach, has been implemented in the Dutch municipality of Zwolle. This approach is proven successful in reducing health inequalities. However, the key elements of this approach are not clear. The current study aimed to identify key elements of this successful local community-based approach, according to the perspectives of various stakeholders.<h4>Methods</h4>Semi-structured interviews were carried o ...[more]

PMID: 33079952

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Project description:BackgroundMen of low socioeconomic position (SEP) are less likely than those of higher SEP to consume fruits and vegetables, and more likely to eat processed discretionary foods. Education level is a widely used marker of SEP. Few studies have explored determinants of socioeconomic inequalities in men's eating behaviours. The present study aimed to explore intrapersonal, social and environmental factors potentially contributing to educational inequalities in men's eating behaviour.MethodsThirty Australian men aged 18-60 years (15 each with tertiary or non-tertiary education) from two large metropolitan sites (Melbourne, Victoria; and Newcastle, New South Wales) participated in qualitative, semi-structured, one-on-one telephone interviews about their perceptions of influences on their and other men's eating behaviours. The social ecological model informed interview question development, and data were examined using abductive thematic analysis.ResultsThemes equally salient across tertiary and non-tertiary educated groups included attitudes about masculinity; nutrition knowledge and awareness; 'moralising' consumption of certain foods; the influence of children on eating; availability of healthy foods; convenience; and the interplay between cost, convenience, taste and healthfulness when choosing foods. More prominent influences among tertiary educated men included using advanced cooking skills but having relatively infrequent involvement in other food-related tasks; the influence of partner/spouse support on eating; access to healthy food; and cost. More predominant influences among non-tertiary educated men included having fewer cooking skills but frequent involvement in food-related tasks; identifying that 'no-one' influenced their diet; having mobile worksites; and adhering to food budgets.ConclusionsThis study identified key similarities and differences in perceived influences on eating behaviours among men with lower and higher education levels. Further research is needed to determine the extent to which such influences explain socioeconomic variations in men's dietary intakes, and to identify feasible strategies that might support healthy eating among men in different socioeconomic groups.

Project description:Higher Education (HE) is seen as a tool to create job opportunities and enhance individuals' quality of life. Research demonstrates that students' expectations of career success in HE are an important predictor of their motivation and academic attainment. However, there is a lack of clarity about how career success is defined and whether individuals perceive that their experiences (e.g., gender) may be associated with these definitions. In online written interviews with 36 university students in the United Kingdom, we examine how students define career success and how they perceive their identity (gender, socioeconomic status) experiences underpinning these definitions. We analysed three main definitional themes: (a) career success as personal development, (b) career success as individual mobility, and (c) lack of clarity about what career success is. Findings suggest that gender and socioeconomic experiences had an important role in students' understanding of career success, especially for students from disadvantaged backgrounds. Indeed, in the intersection of gender and socioeconomic status, inequalities persist: female students anticipated difficulties in terms of work-life balance and gender stereotypes that constrained their career success definitions. Moreover, family experiences were important to understand students' definitions of career success, particularly for disadvantaged socioeconomic groups. The current research sheds light on an important paradox in HE organisations: while students tend to define career success in relatively individualistic ways, such as individual mobility, financial success, or personal development, it was clear that their social identities (e.g., gender, socioeconomic status) and related experiences played an important role in creating definitions of career success. This further implies that when universities encourage a perception of career success as individual mobility, for example, having better job opportunities, or by espousing the belief that higher education and/or professional sectors are truly meritocratic-this will not always align with, and may create tension for, students from disadvantaged groups.

Project description:BackgroundThere is growing evidence of the impact of overweight and obesity on short- and long-term functioning, health and well-being. Internationally, childhood obesity rates continue to rise in some countries (for example, Mexico, India, China and Canada), although there is emerging evidence of a slowing of this increase or a plateauing in some age groups. In most European countries, the United States and Australia, however, socioeconomic inequalities in relation to obesity and risk factors for obesity are widening. Addressing inequalities in obesity, therefore, has a very high profile on the public health and health services agendas. However, there is a lack of accessible policy-ready evidence on what works in terms of interventions to reduce inequalities in obesity.Methods and designThis article describes the protocol for a National Health Service Trust (NHS) National Institute for Health Research-funded systematic review of public health interventions at the individual, community and societal levels which might reduce socioeconomic inequalities in relation to obesity amongst children ages 0 to 18 years. The studies will be selected only if (1) they included a primary outcome that is a proxy for body fatness and (2) examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation and poverty) or the intervention was targeted specifically at disadvantaged groups (for example, children of the unemployed, lone parents, low income and so on) or at people who live in deprived areas. A rigorous and inclusive international literature search will be conducted for randomised and nonrandomised controlled trials, prospective and retrospective cohort studies (with and/or without control groups) and prospective repeat cross-sectional studies (with and/or without control groups). The following electronic databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts and the NHS Economic Evaluation Database. Database searches will be supplemented with website and grey literature searches. No studies will be excluded on the basis of language, country of origin or publication date. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of (1) individual, (2) community and (3) societal level public health interventions on socioeconomic inequalities in childhood obesity. Interventions will be characterised by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organised, implemented and delivered will also be examined.DiscussionIn this review, we consider public health strategies which reduce and prevent inequalities in the prevalence of childhood obesity, highlight any gaps in the evidence base and seek to establish how such public health interventions are organised, implemented and delivered. PROSPERO registration number: CRD42011001740.

Project description:Socioeconomic inequalities in obesity and associated risk factors for obesity are widening throughout developed countries worldwide. Tackling obesity is high on the public health agenda both in the United Kingdom and internationally. However, what works in terms of interventions that are able to reduce inequalities in obesity is lacking.The review will examine public health interventions at the individual, community and societal level that might reduce inequalities in obesity among adults aged 18 years and over, in any setting and in any country. The following electronic databases will be searched: MEDLINE, EMBASE, CINAHL, PsycINFO, Social Science Citation Index, ASSIA, IBSS, Sociological Abstracts, and the NHS Economic Evaluation Database. Database searches will be supplemented with website and gray literature searches. No studies will be excluded based on language, country or publication date. Randomized and non-randomized controlled trials, prospective and retrospective cohort studies (with/without control groups) and prospective repeat cross-sectional studies (with/without control groups) that have a primary outcome that is a proxy for body fatness and have examined differential effects with regard to socioeconomic status (education, income, occupation, social class, deprivation, poverty) or where the intervention has been targeted specifically at disadvantaged groups or deprived areas will be included. Study inclusion, data extraction and quality appraisal will be conducted by two reviewers. Meta-analysis and narrative synthesis will be conducted. The main analysis will examine the effects of 1) individual, 2) community and 3) societal level public health interventions on socioeconomic inequalities in adult obesity. Interventions will be characterized by their level of action and their approach to tackling inequalities. Contextual information on how such public health interventions are organized, implemented and delivered will also be examined.The review will provide evidence, and reveal any gaps in the evidence base, of public health strategies which reduce and prevent inequalities in the prevalence of obesity in adults and provide information on the organization, implementation and delivery of such interventions.PROSPERO registration number: CRD42013003612.

Project description:BackgroundAddressing socioeconomic inequalities in health and healthcare, and reducing avoidable hospital admissions requires integrated strategy and complex intervention across health systems. However, the understanding of how to create effective systems to reduce socio-economic inequalities in health and healthcare is limited. The aim was to explore and develop a system's level understanding of how local areas address health inequalities with a focus on avoidable emergency admissions.MethodsIn-depth case study using qualitative investigation (documentary analysis and key informant interviews) in an urban UK local authority. Interviewees were identified using snowball sampling. Documents were retrieved via key informants and web searches of relevant organisations. Interviews and documents were analysed independently based on a thematic analysis approach.ResultsInterviews (n = 14) with wide representation from local authority (n = 8), NHS (n = 5) and voluntary, community and social enterprise (VCSE) sector (n = 1) with 75 documents (including from NHS, local authority, VCSE) were included. Cross-referenced themes were understanding the local context, facilitators of how to tackle health inequalities: the assets, and emerging risks and concerns. Addressing health inequalities in avoidable admissions per se was not often explicitly linked by either the interviews or documents and is not yet embedded into practice. However, a strong coherent strategic integrated population health management plan with a system's approach to reducing health inequalities was evident as was collective action and involving people, with links to a "strong third sector". Challenges reported include structural barriers and threats, the analysis and accessibility of data as well as ongoing pressures on the health and care system.ConclusionWe provide an in-depth exploration of how a local area is working to address health and care inequalities. Key elements of this system's working include fostering strategic coherence, cross-agency working, and community-asset based approaches. Areas requiring action included data sharing challenges across organisations and analytical capacity to assist endeavours to reduce health and care inequalities. Other areas were around the resilience of the system including the recruitment and retention of the workforce. More action is required to embed reducing health inequalities in avoidable admissions explicitly in local areas with inaction risking widening the health gap.

Project description:ObjectiveThe contribution of smoking to socioeconomic inequalities in health is increasing worldwide, including in Brazil. Youth smoking may play an important role in the increasing social inequalities related to smoking. This study investigates social determinants of smoking among 15-year-old to 19-year-old individuals.DesignCross-sectional study.SettingThe study uses data of 3536 participants aged 15-19 years of age of the Global Adult Tobacco Survey (GATS) and the National Household Sample Survey (Pesquisa Nacional por Amostragem de Domicilio, PNAD) obtained from household interviews. Smoking was defined as currently smoking tobacco products, regardless of frequency. Household socioeconomic indicators included per capita income, the educational level and sex of the head of the household, the presence of smoking restrictions and the number of smokers (excluding adolescents). Adolescent social factors included years of delaying school and social status (full-time student, working, and neither working nor studying). The hierarchical logistic regression analysis considered the effect of the complex sampling design.ResultsFrom 3536 participants, 6.2% were smokers (95% CI 5.4 to 7.1). More men than women had the habit of smoking (7.2%; 5.9 to 8.6 vs 3.6%; 2.7 to 4.6). The likelihood of smoking was significantly greater for men and older teens. There was an upward trend in the OR of smoking according to the number of smokers in the house. Adolescents living in households with no smoking restrictions had a greater likelihood of being smokers. OR of smoking rose as the number of years of delaying school increased, being about three times greater among adolescents who were working and five times greater among those who were neither studying nor working.ConclusionsResults demonstrate that socioeconomic inequality in smoking is established at younger ages and that school delay as well as school abandonment may contribute to increased smoking-related inequalities. Smoking restrictions at home were protective against adolescents becoming smokers. Living with other smokers was a strong predictor of adolescents becoming smokers.

Project description:BackgroundTackling childhood obesity is one of the major contemporary public health policy challenges and vital in terms of addressing socioeconomic health inequalities.We aimed to systematically review studies of the effectiveness of interventions (individual, community and societal) operating via different approaches (targeted or universal) in reducing socio-economic inequalities in obesity-related outcomes amongst children.MethodsNine electronic databases were searched from start date to October 2012 along with website and grey literature searches. The review examined the best available international evidence from interventions that aimed to prevent obesity, treat obesity, or improve obesity-related behaviours (diet and/or physical activity) amongst children (aged 0-18 years) in any setting and country, so long as they provided relevant information and analysis on both socioeconomic status and obesity-related outcomes. Data extraction and quality appraisal were conducted using established mechanisms and narrative synthesis was conducted.ResultsWe located 23 studies that provided the 'best available' (strongest methodologically) international evidence. At the individual level (n = 4), there was indicative evidence that screen time reduction and mentoring health promotion interventions could be effective in reducing inequalities in obesity. For the community level interventions (n = 17), evidence was inconclusive - with some studies suggesting that school-based health promotion activities and community-based group-based programmes were effective in reducing obesity - others not. Societal level evaluations were few (n = 1). However, there was no evidence to suggest that any of these intervention types increase inequalities and several studies found that interventions could at least prevent the widening of inequalities in obesity. The majority of studies were from America and were of 6-12 year old children.ConclusionsThe review has found only limited evidence although some individual and community based interventions may be effective in reducing socio-economic inequalities in obesity-related outcomes amongst children but further research is required, particularly of more complex, societal level interventions and amongst adolescents.

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Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study.

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Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study.

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