Assessing effectiveness of Communities on the Move (CoM) Challenges and preliminary results TAFISA World Congress, 26 October 2013, Marion Herens Annemarie Wagemakers, Maria Koelen, Lenneke Vaandrager, Johan van Ophem

Background: Communities on the move programme (CoM)  Persistent health and physical activity inequalities (Van der Lucht et al, 2010; Van Oort et al, 2004)  Groups not meeting PA guidelines in poor socio-economic conditions and migrants (Hildebrandt et al, 2010)  CoM developed by the Netherlands Institute for Sports and Physical Activity (NISB)  Aim: to initiate and enhance physical activity in inactive low SES groups

Goal (cost)-effectiveness research CoM  Assessment effectiveness of CoM at individual and group level  Identifying mechanisms explaining what works for whom and why

Research questions Program Community Group Individual Economic evaluation at program level (cost benefit)? Relationship PA activities and community participation in general? Active participation, pleasure and group learning? Effects found in PA behaviour, health related quality of life, life satisfaction? Overall: Which mechanisms explain what works and for whom?

Design (Herens et al, 2013) Mix quantative and qualitative methods Multiple levels Multiple cases 4-6 locations Effect evaluation cohort design Monitoring groups of participants (n=240) for 18 months (4 measurements: T 0 -T 3 ) Process evaluation Action research at group, program and community level In depth study Effects on community participation and social capital

Measuring health and physical activity * Vraagstelling o.b.v. Lokale en Nationale Monitor volksgezondheid Variableindicator Socio-economic status (SES)Age, sex, income, work situation, ethnic background Quality of lifeEuroQoL (quality of life) Visual analogue scale (0-100) Life satisfactionCantril’s Self-Anchoring Ladder for Life Satisfaction (0-10) Physical Activity BehaviourSQUASH - Short Questionnaire to Assess Health enhancing physical activity Sport historySport membership Care consumptionVisit health care past 4 weeks Personal motivationOpen ended question BMIlength & height

Main findings  8 groups reached through five local organisations  Baseline survey (T 0 ) in 8 groups (N=97)  Follow up measurements (T 1 ) in 3 groups (N=35)

Program characteristics CityProgram Target group Frequency (x week) Exercise duration (hrs) Overall program time Helmond Move Garden Outdoor fitness adults1-21ongoing Tilburg Special Gym Adapted sport yrs11ongoing RotterdamMoving to Music Migrant women 1-21ongoing Muscle strengthening exercise Elderly migrant men 11ongoing AmsterdamWalking groups Migrant women 11,510 weeks EnschedeScoring with health Unempl./ migrant women 12,513 weeks

Participants characteristics (n=97)  Majority women with chronic condition  Mean age: 60 yrs (sd 14,6)  65 % respondents migrant background, 16 different countries of origin (mean number of years in the Netherlands: 28 (sd 11,8)  Living conditions: 34 % single, 54 % with partner, and/or children, 12 % single with children (mean household size: 2,4 (sd 1,5)  Employment status: 7 % part time job, >90 % retired/on social benefit or unable to work, and/or housekeeper  Household income: 60% < €1.350, - /month  Education: 50 % no or only primary school, 49% secondary school, 1% higher education

Health and well being (n=97) Top 3 personal motivations: health and weight loss, sociability/fun, disease management BMI: mean 30,0 (sd 5,2) Life satisfaction (0-10): mean 7,4 (sd 1,7) Quality of Life (vas 0-100): 69,4 (sd 14,2) Top 3 care consumption: >50 % GP, 20 % medical specialist, 20 % physiotherapist

Daily Physical Activity (based on SQUASH; n=97) Activity Days/weekMinutes/day MeanSD MeanSD Household Light 4,9 2, Heavy 1,3 1, Leisure time Walking 2,8 2, ,9 Cycling 1,82,622 43,9 Sports 0,91,4 4685,3

 Large differences within groups (between respondents)  Contribution PA work and commuting: hardly any  Household most important PA environment  Favourite leisure time PA: walking and cycling  Sport membership: 20 % actual member, 45 % member in the past, 35 % never member  Sport activities: swimming/aqua jogging, (Nordic) walking, zumba, variety of fitness exercises Highlights daily physical activity

Group interview Eight statements and group interview to measure impact of CoM principles in the group

Some findings  The exercise trainer as role model: "Yes, I think so, and she is our age. She is very sporty, agile and everything... What we are not."  Pleasure "I come to exercise and it is also nice with other women, and simply social. Time for yourself.“  Learning "Yes, I try to exercise at home, in the car or... withdraw your belly, walking pace, that we all learned.”  Participation "You pass it along to your fellow neighbors."

 Target group reached  Health main reason to participate  Relatively high scores on health complaints and overweight  Risk inactivity target group  Well being: health related Quality of Life, Life satisfaction, reasonable positive  Role exercise trainer important for learning, group support, pleasure and safety  Active participation in mobilizing own social network Conclusions

Thank you for listening ! Marion Herens PhD Candidate M: T: +31(0) E:

References 1. Hildebrandt VH, Chorus AMJ, Stubbe JH (2010). Trend report Physical Activity and Health 2008/ , TNO Innovation for Life, Leiden. 2. Van Oort FVA, van Lenthe FJ, Mackenbach JP (2004). Co-occurrence of lifestyle risk factors and the explanation of education inequalities in mortality: results from the GLOBE study. Preventive Medicine, 39(6), Van der Lucht F, Polder JJ (2010). Towards better health. The Dutch 2010 Public Health Status and Forecasts Report, National Institute for Public Health and Environment (RIVM), Bilthoven. 4. Herens M, Wagemakers A et al. (2013). Evaluation design for community-based physical activity programs for socially disadvantaged groups – the case of Communities on the Move. JMIR Res Protocol