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      Views of policy makers and health promotion professionals on factors facilitating implementation and maintenance of interventions and policies promoting physical activity and healthy eating: results of the DEDIPAC project

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          Abstract

          Background

          The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. We aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors facilitating adoption, implementation, and maintenance of multi-level interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland.

          Methods

          Six interventions and six policies were identified based on pre-defined criteria. Forty semi-structured interviews were conducted with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies. All interview transcripts were coded in NVivo, using a common categorization matrix. Coding in the respective countries was done by one researcher and validated by a second researcher.

          Results

          Active involvement of relevant stakeholders and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementation of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured.

          Conclusions

          Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identify similar factors facilitating adoption, implementation, and maintenance of these interventions and policies.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-4929-9) contains supplementary material, which is available to authorized users.

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          Most cited references13

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          Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review.

          The worksite is a promising setting for health promotion. This review summarizes the evidence of effect of intervention studies in European countries promoting a healthy diet solely and in combination with increasing physical activity at the workplace. A systematic review of published literature was carried out. Inclusion criteria were: studies conducted in European countries; papers published from 1 January 1990 to 1 October 2010; worksite-based interventions promoting a healthy diet solely or in combination with physical activity; primary prevention; measurement of anthropometrical or behavioural change and adults (≥18 years old). Levels of evidence for intervention effectiveness on behavioural determinants, nutrition and physical activity behaviours and body composition and the quality of the included interventions were assessed. Seventeen studies solely focusing on promotion of a healthy diet were identified. Eight were educational, one used worksite environmental change strategies, and eight used a combination of both (multi-component). None of the interventions were rated as 'strong'; seven met the criteria for 'moderate' quality. The reviewed studies show moderately evidence for effects on diet. Thirteen studies focusing both on nutrition and physical activity (nine educational and four multi-component studies) were identified. Ten were rated as having 'weak' and three as having 'moderate' methodological quality, providing inconclusive evidence for effects. Limited to moderate evidence was found for positive effects of nutrition interventions implemented at the workplace. Effects of workplace health promotion interventions may be improved if stronger adherence to established quality criteria for such interventions is realized.
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            Dietary patterns and CVD: a systematic review and meta-analysis of observational studies.

            Epidemiological studies show that diet is linked to the risk of developing CVD. The objective of this meta-analysis was to estimate the association between empirically derived dietary patterns and CVD. PubMed was searched for observational studies of data-driven dietary patterns that reported outcomes of cardiovascular events. The association between dietary patterns and CVD was estimated using a random-effects meta-analysis with 95 % CI. Totally, twenty-two observational studies met the inclusion criteria. The pooled relative risk (RR) for CVD, CHD and stroke in a comparison of the highest to the lowest category of prudent/healthy dietary patterns in cohort studies was 0·69 (95% CI 0·60, 0·78; I 2=0%), 0·83 (95% CI 0·75, 0·92; I 2=44·6%) and 0·86 (95% CI 0·74, 1·01; I 2=59·5%), respectively. The pooled RR of CHD in a case-control comparison of the highest to the lowest category of prudent/healthy dietary patterns was 0·71 (95% CI 0·63, 0·80; I 2=0%). The pooled RR for CVD, CHD and stroke in a comparison of the highest to the lowest category of western dietary patterns in cohort studies was 1·14 (95% CI 0·92, 1·42; I 2=56·9%), 1·03 (95% CI 0·90, 1·17; I 2=59·4%) and 1·05 (95% CI 0·91, 1·22; I 2=27·6%), respectively; in case-control studies, there was evidence of increased CHD risk. Our results support the evidence of the prudent/healthy pattern as a protective factor for CVD.
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              Towards the integration and development of a cross-European research network and infrastructure: the DEterminants of DIet and Physical ACtivity (DEDIPAC) Knowledge Hub

              To address major societal challenges and enhance cooperation in research across Europe, the European Commission has initiated and facilitated ‘joint programming’. Joint programming is a process by which Member States engage in defining, developing and implementing a common strategic research agenda, based on a shared vision of how to address major societal challenges that no Member State is capable of resolving independently. Setting up a Joint Programming Initiative (JPI) should also contribute to avoiding unnecessary overlap and repetition of research, and enable and enhance the development and use of standardised research methods, procedures and data management. The Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub (KH) is the first act of the European JPI ‘A Healthy Diet for a Healthy Life’. The objective of DEDIPAC is to contribute to improving understanding of the determinants of dietary, physical activity and sedentary behaviours. DEDIPAC KH is a multi-disciplinary consortium of 46 consortia and organisations supported by joint programming grants from 12 countries across Europe. The work is divided into three thematic areas: (I) assessment and harmonisation of methods for future research, surveillance and monitoring, and for evaluation of interventions and policies; (II) determinants of dietary, physical activity and sedentary behaviours across the life course and in vulnerable groups; and (III) evaluation and benchmarking of public health and policy interventions aimed at improving dietary, physical activity and sedentary behaviours. In the first three years, DEDIPAC KH will organise, develop, share and harmonise expertise, methods, measures, data and other infrastructure. This should further European research and improve the broad multi-disciplinary approach needed to study the interactions between multilevel determinants in influencing dietary, physical activity and sedentary behaviours. Insights will be translated into more effective interventions and policies for the promotion of healthier behaviours and more effective monitoring and evaluation of the impacts of such interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12966-014-0143-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                muellmann@leibniz-bips.de
                steenbock@leibniz-bips.de
                Katrien.DeCocker@UGent.be
                marieke.decraemer@ugent.be
                hayesc9@tcd.ie
                miriam.oshea@gmail.com
                khorodyska@swps.edu.pl
                justyna.bell@yahoo.com
                aluszczy@uccs.edu
                gun.roos@sifo.hioa.no
                langoien@gmail.com
                gro.rugseth@nih.no
                laura.terragni@hioa.no
                ilse.debourdeaudhuij@ugent.be
                J.Brug@uva.nl
                +49-421-21856912 , pischke@leibniz-bips.de
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                6 December 2017
                6 December 2017
                2017
                : 17
                : 932
                Affiliations
                [1 ]ISNI 0000 0000 9750 3253, GRID grid.418465.a, Leibniz Institute for Prevention Research and Epidemiology – BIPS, ; Bremen, Germany
                [2 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Department of Movement and Sports Sciences, , Ghent University, ; Ghent, Belgium
                [3 ]ISNI 0000 0004 1936 9705, GRID grid.8217.c, Department of Public Health and Primary Care, , Institute of Population Health, School of Medicine, Trinity College Dublin, University of Dublin, ; Dublin, Ireland
                [4 ]ISNI 0000 0001 2184 0541, GRID grid.433893.6, Department of Psychology, , SWPS University of Social Sciences and Humanities, ; Wroclaw, Poland
                [5 ]Trauma, Health, & Hazards Center, University College of Applied Sciences Colorado, Colorado Springs, CO USA
                [6 ]Consumption Research Norway – SIFO, Oslo and Akershus, Oslo, Norway
                [7 ]ISNI 0000 0000 8567 2092, GRID grid.412285.8, Department for Physical Education, , Norwegian School of Sports Science, ; Oslo, Norway
                [8 ]ISNI 0000 0000 9151 4445, GRID grid.412414.6, Oslo and Akershus University College of Applied Sciences, ; Oslo, Norway
                [9 ]ISNI 0000000084992262, GRID grid.7177.6, Faculty of Social and Behavioural Sciences, , University of Amsterdam, ; Amsterdam, The Netherlands
                Article
                4929
                10.1186/s12889-017-4929-9
                5718005
                29207993
                a683a98a-0304-4a40-9f91-2e53ba4efcab
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 October 2016
                : 20 November 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;
                Funded by: Belgium, Research Foundation – Flanders
                Funded by: The Netherlands Organisation for Health Research and Development
                Funded by: The Health Research Board – HRB
                Funded by: The Research Council of Norway
                Funded by: The National Centre for Research and Development
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2017

                Public health
                multi-level intervention,policy,physical activity,diet,adoption,implementation,maintenance,dedipac,europe,case studies

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