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      Wat werkt in een integrale aanpak van overgewicht voor mensen met een lage sociaaleconomische status en/of een niet westerse migratieachtergrond?

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          Samenvatting

          Het percentage mensen met ernstig overgewicht neemt de komende jaren toe, vooral onder mensen met een kwetsbare positie, zoals groeperingen met een lage sociaaleconomische status (SES) en/of een niet-westerse migratieachtergrond. Overgewicht is een complex probleem dat vraagt om een integrale aanpak. Het doel van dit onderzoek is het voor deze doelgroepen identificeren van potentieel werkzame elementen van een integrale aanpak gericht op overgewicht. In dit exploratief kwalitatieve onderzoek zijn twaalf groepsinterviews met 25 professionals en vier focusgroepgesprekken met 24 mensen uit de doelgroep gehouden. In totaal zijn 41 potentieel werkzame elementen geïdentificeerd voor een succesvolle integrale aanpak. Deze zijn ingedeeld op het individuele, programma, gemeentelijk en landelijk niveau, en op de sociale en fysieke omgeving. Hiervan hebben achttien potentieel werkzame elementen specifiek betrekking op mensen met een lage SES en/of niet-westerse migratieachtergrond. Daarnaast zijn vier competenties van professionals geïdentificeerd die in potentie kunnen bijdrage aan een werkzame integrale aanpak: verbinden, durven, integraal werken, volhouden. De twee randvoorwaarden tijd en financiële middelen lijken relevant op alle niveaus. Dit exploratieve onderzoek laat zien dat een integrale aanpak van professionals niet alleen vraagt dat zij verschillende potentieel werkzame elementen (tegelijkertijd) inzetten, maar ook dat ze zich continu en proactief inspannen om dit te realiseren.

          Abstract

          In coming years, the percentage of people who are overweight will increase most among vulnerable people, such as people with a low socio-economic status (SES) and/or a non-Western migration background. Overweight is a complex problem that requires an integrated approach. The aim of this research is to determine potentially effective elements of an integrated approach aimed at overweight for these specific target groups. In this explorative qualitative research twelve group interviews with professionals ( n = 25) and four group interviews ( n = 24) with people from the target group were conducted. In total 41 potentially effective elements have been identified for a successful integrated approach. These elements can be classified at the individual, program, municipal and national level, and the social and physical environment. Of these, 18 potentially effective elements relate specifically to people with a low SES and/or non-Western migration background. In addition, there are four competencies regarding the professional that can potentially contribute to an integrated approach: connect, dare, work in an integrated manner, persevere. The two preconditions of time and financial resources seem relevant. This study shows that an integrated approach not only requires professionals to deploy various effective elements (simultaneously), but also a continuous and proactive effort to achieve this.

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          Most cited references20

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          Qualitative Research : A Guide to Design and Implementation

          <b>The bestselling guide to qualitative research, updated and expanded</b> <p><i>Qualitative Research</i> is the essential guide to understanding, designing, conducting, and presenting a qualitative research study. This fourth edition features new material covering mixed methods, action research, arts-based research, online data sources, and the latest in data analysis, including data analysis software packages as well as narrative and poetic analysis strategies. A new section offers multiple ways of presenting qualitative research findings. The reader-friendly, jargon-free style makes this book accessible to both novice and experienced researchers, emphasizing the role of a theoretical framework in designing a study while providing practical guidance. <p>Qualitative research reaches beyond the <i>what, where,</i> and <i>when</i> of quantitative analysis to investigate the <i>why</i> and <i>how</i> behind human behavior and the reasons that govern such behavior, but this presents a number of significant challenges. This guide is an invaluable reference for students and practitioners alike, providing the deep understanding that this sometimes difficult area of research requires to produce accurate results. The book contains a step-by-step guide to analyzing qualitative data and an addendum for graduate students with a template for a thesis, dissertation, or grant application. <ul> <li>Build a strong foundation in qualitative research theory and application</li> <li>Design and implement effective qualitative research studies</li> <li>Communicate findings more successfully with clear presentation</li> <li>Explore data sources, data analysis tools, and the different types of research</li> </ul>
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            Whole systems approaches to obesity and other complex public health challenges: a systematic review

            Background Increasing awareness of the complexity of public health problems, including obesity, has led to growing interest in whole systems approaches (WSAs), defined as those that consider the multifactorial drivers of overweight and obesity, involve transformative co-ordinated action across a broad range of disciplines and stakeholders, operate across all levels of governance and throughout the life course. This paper reports a systematic review of WSAs targeting obesity and other complex public health and societal issues, such as healthy lifestyles for prevention of non-communicable disease. Methods Seven electronic databases were searched from 1995 to 2018. Studies were included if there had been an effort to implement a WSA. Study selection was conducted by one reviewer with a random 20% double checked. Data extraction and validity assessment were undertaken by one reviewer and checked by a second reviewer. Narrative synthesis was undertaken. Results Sixty-five articles were included; 33 about obesity. Most examined multicomponent community approaches, and there was substantial clinical and methodological heterogeneity. Nevertheless, a range of positive health outcomes were reported, with some evidence of whole systems thinking. Positive effects were seen on health behaviours, body mass index (BMI), parental and community awareness, community capacity building, nutrition and physical activity environments, underage drinking behaviour and health, safety and wellbeing of community members, self-efficacy, smoking and tobacco-related disease outcomes. Features of successful approaches reported in process evaluations included: full engagement of relevant partners and community; time to build relationships, trust and capacity; good governance; embedding within a broader policy context; local evaluation; finance. Conclusions Systems approaches to tackle obesity can have some benefit, but evidence of how to operationalise a WSA to address public health problems is still in its infancy. Future research should: (a) develop an agreed definition of a WSA in relation to obesity, (b) look across multiple sectors to ensure consistency of language and definition, (c) include detailed descriptions of the approaches, and (d) include process and economic evaluations. Electronic supplementary material The online version of this article (10.1186/s12889-018-6274-z) contains supplementary material, which is available to authorized users.
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              Upending the social ecological model to guide health promotion efforts toward policy and environmental change.

              Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.

                Author and article information

                Journal
                TSG - Tijdschrift voor gezondheidswetenschappen
                TSG Tijdschr Gezondheidswet
                Springer Science and Business Media LLC
                1388-7491
                1876-8776
                November 2021
                October 14 2021
                November 2021
                : 99
                : 4
                : 137-145
                Article
                10.1007/s12508-021-00315-w
                34cb1711-c2f3-4170-b5d3-8f6463dd17d6
                © 2021

                https://creativecommons.org/licenses/by/4.0

                https://creativecommons.org/licenses/by/4.0

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