Purpose: This meta-review aims at examining if context-related determinants of implementation of policies promoting physically active lifestyle, i.e., promoting physical activity (PA) and reducing sedentary behavior (SB), receive strong and preliminary support in reviews and stakeholder documents. To identify the context-related determinants that facilitate or hinder implementation of policies, we applied the context and implementation of complex interventions framework (CICI) which comprises 7 domains: geographical, epidemiological, socio-cultural, economic, ethics-related, political, and legal. In addition, it was checked whether the context factors operate at the macro-level (nation-wide) or meso/micro-levels (organizational/individual).

Methods: Systematic search of 9 electronic databases and 9 document databases of major international stakeholders was conducted resulting in inclusion of k = 25 reviews and k = 17 stakeholder documents in further analyses. Context determinants that were corroborated in ≥ 50% of analyzed documents were considered as preliminary supported by data, whereas determinants corroborated in ≥ 60% of analyzed documents were considered as strongly supported by data.

Results: Across reviews/stakeholder documents addressing implementation PA/SB policies (k = 9) 3 context-related determinants from 2 CICI domains received strong support (≥ 60%): setting’s infrastructure (66.7%; the geographical domain) and knowledge/beliefs/abilities of the target population (88.9%) and the implementers (77.8%; both in the socio-cultural domain). Furthermore, 3 context-related determinants from another 2 CICI domains received preliminary support: individual/organizational economic resources (55.6%; the economic domain), policies in organizations involved/partner organizations (55.6%;), and interrelated policies and political pressure (55.6%; both in the political domain).

Conclusions: These findings suggest that geographical, socio-cultural, economic, and political context-related implementation determinants need to be accounted for when making plans for translating PA/SB policies into action. Clarifying the effects of the implementation context may improve the understanding of factors enabling a broad reach, implementation, and sustainability of successful policies.

Purpose: Sugar-sweetened beverages (SSB) are a major health risk. SSB taxation is seen as one possibility to curb the obesity trend, to affect consumer behaviour and to reduce costs within the modern food supply chain. 45 countries have currently implemented SSB taxes. However, the term SSB taxation differs in terms of objectives, type, rate, scale and revenue use. This study investigates the SSB tax implementation process that is what happens between adoption of the tax as law and its application.

Methods: Database searches were combined with grey literature up to February 2020 and hand searches for studies that report on implementation processes for SSB taxes. All studies were screened by two reviewers independently following pre-defined criteria. Data were extracted following a pre-developed and tested extraction sheet.

Results: Across 2,649 screened publications n = 3 papers met inclusion criteria. They contained the description of implementation process of six SSB taxation cases, covering Portugal, the Pacific Region (Fiji, Samoa, Nauru, French Polynesia), and the city of Berkeley (CA, USA) . In three cases the tax was introduced to foster healthy diet, in two cases to raise revenues, and in one case to achieve both. The SSB tax was part of a complex bundle of initiatives in most cases. In two cases, it was combined with a specific awareness campaign. In two cases the Health Ministry took a leading role, and in two cases the Finance Ministry or the revenue and consumer authority, and in Berkeley it was the City Government. In four cases the tax collection was linked to existing mechanisms; a tax administration company was hired in one instance. Classification of products (syrup) and terms (natural sweetener) were mentioned as reasons for uncertainty related to tax implementation. Indirect effects of tax application mentioned were cost reduction for bottled water and switch to cheaper products.

Conclusion: The findings show that there is very limited data describing the SSB tax implementation processes. SSB tax implementation process varied in terms of objectives, type, scale, and leading organization. Based on the results, it is currently difficult to benchmark policy implementation process for the SSB taxation.

Purpose: Understanding young people’s own perspectives is essential to developing successful interventions. This review aims to systematically identify and synthesise qualitative data on adolescents’ experiences of the barriers and facilitators of physical activity (PA) to understand whether these experiences differ by socioeconomic position (SEP).

Methods:  A systematic search of peer-reviewed literature was conducted across multiple databases (MEDLINE, Web of Science Core Collection, PsycINFO and ERIC) in August 2020. Two reviewers screened the title and abstract and full text of all studies in duplicate using Covidence. Studies were included if they reported qualitative data collected from adolescents (aged 11-18), a measure of SEP and focused on PA. Studies not published in English or before 2000 were excluded. Two authors appraised the literature using the Critical Appraisal Skills Programme qualitative checklist and extracted relevant data. Data were analysed following Thomas and Harden’s (2008) methods for the thematic synthesis of qualitative studies. 

Results/findings: After screening, 25 articles met the inclusion criteria. Four analytical themes emerged from the analysis: (1) Social Support (2) Gendered Experiences (3) Accessibility and the Environment (4) Other Behaviours and Health. These themes appeared across socioeconomic groups, however their narratives varied significantly. For example, adolescents of low SEP discussed the distance of PA facilities from their homes as a barrier, whereas those of high SEP highlighted proximity to PA facilities as a facilitator. Across the data, low SEP adolescents focused more on barriers to PA and adolescents from middle and high SEP reported more facilitators. The importance of school-based opportunities were emphasised by low SEP adolescents, due to limited opportunities they perceived outside the school environment. This was not the case for middle and high SEP adolescents who reported ample opportunities outside of school, including sports club membership and countryside access. 

Conclusions: Narratives of common barriers and facilitators to PA varied by SEP. These findings can be used to inform how different socioeconomic groups may benefit, or be disadvantaged by current interventions and how strategies can be tailored to meet the needs of different groups. 

Purpose: Due to regulations regarding the COVID-19 pandemic in 2020 and 2021, two interventions with self-reliant, peer-moderated working groups for participants aged 60 and older were put on hold although the two annual interventions had just started before the lockdown. Aims of both interventions were to improve health and food literacy as well as self-management by regular in-person meetings. To counteract intervention drop-out, a bridging program was developed.

Methods: Telephone interviews with 23 peer-moderators on technical equipment for digital communication, media literacy and health promotion topics were conducted. The peer-moderators were trained in performing independently video conferences and telephone conferences as well as telephone chains.

Results/findings: A total number of 23 moderators leading 15 groups with 170 participants were involved in the interventions before the lockdown. Interviews with the moderators yielded only minor literacy of the participants to perform video and telephone conferences. Based on these findings, an adjusted bridging program was developed including health information and exercises which were sent by post, a telephone conference under instruction, six telephone chains and a training course for video conferences. The health information was distributed every four weeks and additionally the telephone chains were implemented. Both were well-accepted by all but two groups. Telephone conferences with the moderators were conducted only twice due to low acceptance. Despite training for video conferences, none of the groups managed to utilize digital media solely for communication. Nevertheless, only four groups, nine moderators and 94 participants quit the program during the lockdown.

Conclusions: The acceptance of the moderators is the key factor in opening up the participants to new communication channels. However, the participants were found to be a heterogeneous group. Due to insufficient digitalized homes, lack of digital devices or technical affinity, the distribution predominantly took place via postal dispatch. Even though the bridging program was well accepted, participants still rather waited until in-person meetings were allowed again instead of opened up to digital communication. To engage a vulnerable group like older adults in times of crisis, a regular, participatory developed, multichannel intervention can help to maintain the whole study.

Purpose: Since the outbreak of COVID-19, many employees work from home, resulting in more sedentary behaviour, less physical activity, and poorer mental and physical health. Out of a concern for the health of their employees and the positive association between employees’ health and performance, many organisations invest in worksite health promotion (WHP) initiatives, such as onsite fitness facilities. As most of these initiatives are linked to the workplace, employees working from home cannot use them. This study examines how organisations can help employees maintain a healthy lifestyle when they work from home. To our knowledge, research on WHP initiatives for employees working from home is scarce, as many organisations are currently implementing these. We study three types of WHP (walking during the working day, taking short breaks and online physical activity classes) and examine under which conditions employees use these. We expect that this is the case when employees are enabled to combine WHP with their work and home situation, and their colleagues and partner join them.

Methods: Data are currently being collected among employees in many organisations using a factorial survey design. Participants rate 6 hypothetical situations (vignettes) describing WHP at home on how likely they are to use WHP (1 ‘definitely not’ to 11 ‘definitely’). The type of WHP, duration, number of days working at home, if WHP use counts as working hours, colleague and partner joined use vary between vignettes. Demographics and current physical activity behaviour, among others, are measured in a survey. We will employ multilevel models where intention to use WHP is predicted by the vignette factors while controlling for employee demographics and current behaviour. This design is appropriate as it measures employees’ intention to use WHP when these are not yet offered, informing employers in implementing WHP for employees working from home.

Conclusions: Our study shows which WHP initiatives employees are willing to use at home and how to promote use of these. As working from home is expected to remain common, this informs employers how to successfully promote the health of employees who work at home or away from the worksite.

Purpose: Healthy food-store interventions (HFIs) are promising tools for the reduction of non-communicable diseases through promoting healthier diets. The fit between the intervention components and the context (food-stores) is vital for their sustainability and scalability. Co-creation of HFIs by interventionists and contextual actors may improve this fit, and thus their sustainability and potential impact. However, little is known on the application of co-creative methods in the context of HFIs. Our aim is to share a case study regarding the integration of knowledge from contextual actors into HFI designs, through co-creative methods, to explore the challenges, advantages, and outcomes of such methods.

Method: This study was part of the Supreme Nudge project in which we co-created an HFI in the context of a Dutch supermarket chain. The process involved three increasingly specific phases of intervention design. Each phase was a cycle of specification (design ideas proposed by interventionists, based on literature, previous feedback, and pilot studies), evaluation (discussion with supermarket actors on factors relevant to implementation) and adaptation (adjusting intervention designs based on the discussion output), which fed back into the specification step of the subsequent phase. The evaluation discussions were transcribed and analysed through a combined deductive/inductive thematic analysis.

Results: The co-creative process helped us to develop four types of interventions: 1) price strategies, 2) product presentation and positioning 3) signage, and 4) interactive messaging. Through the co-creative process, interventions were aligned with some characteristics of the supermarket context, while simultaneously challenging others, which were detrimental to their health-promotion goals. Which context characteristics were aligned with, or challenged, varied between intervention types, and specific interventions. Some characteristics, such as financial interests were found to be both barriers and facilitators to implementation, depending on the intervention. Through the three phases of the design process a selection was made of intervention designs which were generally considered sustainable and feasible to scale up.

Conclusions: Our results illustrate the potential benefits of co-creative methods in guiding intervention design. We also reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes.