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This chapter presents a case study exploring how people from a rehabilitation centre experienced a water sports holiday. The location was a water sports island in the Loosdrechtse Plassen, a lake district in the Netherlands. The chapter contributes to the existing literature on the benefits of going on nature-based holidays while having a disability. It identifies the salutogenic mechanisms that shaped participants' experiences of the water sports holiday as part of a rehabilitation trajectory and how these experiences influenced their daily life.

Students with disabilities face several barriers during their academic lives. However, as many of them manage to access a variety of resources, their experiences can be examined through the lens of salutogenesis, which is employed to analyze the mechanisms whereby people succeed in preserving their wellbeing while dealing with stress and difficulties. This study seeks to explain how students with disabilities identify and use resources to reach their academic goals, and to understand how their sense of coherence (namely, a global orientation that expresses the extent to which a person feels that the world is comprehensible, manageable, and meaningful) developed over time. This exploratory study has a dual focus: to test the applicability of salutogenesis to students with disabilities and to investigate their life experiences. A life course perspective has been adopted to allow for an in-depth exploration of the life histories of 11 students with disabilities at Wageningen University. After the participants designed a timeline of their life, semi-structured interviews were conducted. The identified general resistance resources included social support and supportive environments, as well as flexibility, persistence, and awareness of their own skills and limits. Specific resistance resources ranged from aids and treatments to institutional services and disease information. Such resources were identified through reflexive processes that led the students to understand first the stressors that they were facing and then the resources that they needed to deal with these stressors. Finally, some recommendations for disability services providers are reported.

Sport is widely recognised as having the potential to enhance the personal development of socially vulnerable youth, yet there is very limited knowledge on how community sports coaches can create optimal social conditions for life skill development and transferability. We adopt a salutogenic approach in order to study whether and how community sports coaches create these optimal social conditions. Based on the salutogenic framework, a thematic analysis was conducted of 15 in-depth interviews with community sports coaches providing sports lessons to socially vulnerable youth. As part of the interviews, the sports coaches were presented with several training scenarios and asked how they would respond in specific training situations. The results showed that the sports coaches aimed to create meaningful sporting experiences for youths. These meaningful sporting experiences were considered a precondition for keeping youths engaged in the sporting activities, as well as a precondition for life skill development. The sports coaches specifically focused on creating little moments of success and on making sure that the youths felt they belonged to a group. In order to ensure that the youths could experience moments of success, specific coaching strategies were implemented to increase the youths’ comprehensibility and manageability in specific sport situations. According to the sports coaches, experiencing little moments of success could contribute to an increase in socially vulnerable youths’ understanding of the everyday challenges that they face, as well as contribute to their ability to deal with these challenges. Creating meaningful sporting experiences may help youths ‘to learn to cope' – a skill that could be beneficial over their lifespan and in different societal domains.

Public health is about policy, power, and the public and as such might be thought necessarily political. That does not mean, however, that the place of political analysis and engagement in public health is uncontroversial, and there have been longstanding arguments that to discuss politics sullies the scientific nature of public health. This article, introducing a special issue on political science in public health, argues that rigorous use of middle-range theory can inform our analysis of public health problems and avoid the risks of politicization, excessive abstraction or excessive concreteness. It summarizes key political science concepts discussed in the papers: epistemic communities, interest groups, advocacy coalitions, political parties, institutions, legalism, discourse and the political economy of labour. We hope that the series will provide the public health community with some tools and methods for how to integrate public health knowledge into the sphere of decision making in an appropriate way.

Antonovsky’s salutogenesis is a theoretical perspective on health development that explores physical, mental, and social factors that contribute to a ‘healthy life orientation’ and also a theoretical approach to behavior change. Previous studies applying salutogenesis show that a high sense of coherence (SOC), a composite measure from salutogenesis indicating one’s capacity to cope with stress, is associated with a healthy life orientation and lifestyle behaviors, including healthy eating patterns. However, limited evidence exists on the factors that underlie SOC, which could be used to strengthen this capacity as a means to enable healthier eating. Dutch adults ( N = 781) participated in a cross-sectional study examining the relationship between SOC and a set of individual, social-environmental, and physical-environmental factors. The main findings indicate that high SOC was associated with a diverse set of factors including lower doctor-oriented health locus of control; higher satisfaction with weight; higher perceived levels of neighborhood collective efficacy; higher situational self-efficacy for healthy eating; lower social discouragement for healthy eating; and higher neighborhood affordability, accessibility and availability of healthy foods. These findings can inform the design of nutrition interventions that target these factors that strengthen SOC and provide the building blocks for a healthier life orientation.

Purpose: For many people living in low-income countries, poverty implies an increased exposure to conditions that threaten health and wellbeing as well as reduced capacity to maintain health. Despite the challenging conditions caused by poverty, people may consider themselves healthy because they have learned to cope with their situation probably as a result of life experiences which expose people to both challenges and potential solutions. In this paper we present results from studying health and wellbeing challenges and mechanisms to cope with challenges among two different groups of people who are living under conditions of poverty: workers of the Cameroon Development Corporation (CDC) and students of the university of Buea and the university of Yaoundé. Methods: We performed a cross-sectional study, interviewing 21 CDC workers and 21 students. Results Our study reveals context-specific stressors emerging from poor work conditions and study pressure as well as non-context-specific stressors perceived by respondents as living conditions, poor healthcare and financial uncertainty. Respondents devised coping mechanisms to overcome exactly those stressors such as searching for additional money sources, preventive action towards hazardous living conditions and alternative medical support. Conclusion: We conclude that supporting and promoting such avenues is essential for enhanced and continuous coping with stressors.

Background In the Netherlands, people with a low socioeconomic status (SES) live approximately 6 years less and are less engaged in physical activity (PA) than high SES citizens. This contributes to the persistent health inequalities between low and high SES citizens. Care–PA initiatives are deemed effective for stimulating PA and improving health and participation among peoples with a low SES. In those initiatives, multiple sectors (e.g. sports, health insurers, municipalities) collaborate to connect primary care and PA at neighbourhood level. This study focuses on two Dutch municipalities that aim to invest in Health in All Policies (HiAP) and care–PA initiatives to improve the health of people with low SES. The aim is to gain insight into (1) the short-term (3 months) and long-term (1 year) outcomes of participating in care–PA initiatives for low SES citizens in terms of health, quality of life, and societal participation, (2) the effective elements that contribute to these outcomes, (3) the direct and perceived societal costs and benefits of care–PA initiatives, and (4) alternative ways to fund integrated care, prevention, and care–PA initiatives at neighbourhood level. Methods The study will be built on a mixed-methods design guided by action research to continuously facilitate participatory processes and practical solutions. To assess outcomes, body measurements and questionnaires will be used as part of a pre-test/post-test design. Focus groups and interviews will be conducted to gain an in-depth understanding of outcomes and action elements. Action elements will be explored by using multiple tools: concept mapping, the logic model, and capacity mapping. Direct and perceived societal costs will be measured by administrative data from healthcare insurers (before-after design) and the effectiveness arena. An alternative funding model will be identified based on literature study, expert meetings, and municipal workshops. Discussion Initiatives addressing multiple factors at different levels in an integral way are a challenge for evaluation. Multi-methods and tools are required, and data need to be interpreted comprehensively in order to contribute to a contextual insight into what works and why in relation to HiAP and care–PA initiatives.

A moderately high-fat Mediterranean diet does not promote weight gain. This study aimed to investigate the association between dietary intake of specific types of fat and obesity and body weight. A prospective cohort study was performed using data of 6942 participants in the PREDIMED trial, with yearly repeated validated food-frequency questionnaires, and anthropometric outcomes (median follow-up: 4.8 years). The effects of replacing dietary fat subtypes for one another, proteins or carbohydrates were estimated using generalized estimating equations substitution models. Replacement of 5% energy from saturated fatty acids (SFA) with monounsaturated fatty acids (MUFA) or polyunsaturated fatty acids (PUFA) resulted in weight changes of &minus, 0.38 kg (95% Confidece Iinterval (CI): &minus, 0.69, &minus, 0.07), and &minus, 0.51 kg (95% CI: &minus, 0.81, &minus, 0.20), respectively. Replacing proteins with MUFA or PUFA decreased the odds of becoming obese. Estimates for the daily substitution of one portion of red meat with white meat, oily fish or white fish showed weight changes up to &minus, 0.87 kg. Increasing the intake of unsaturated fatty acids at the expense of SFA, proteins, and carbohydrates showed beneficial effects on body weight and obesity. It may therefore be desirable to encourage high-quality fat diets like the Mediterranean diet instead of restricting total fat intake.

The biomedical model of health (BMH) studies the causes and origins of disease. When applied to nutrition research, eating is studied as a behavior that supports physical health. However, the lack of attention the BMH pays to social and historical circumstances in which health behaviors are constructed has been widely addressed in literature. When people are studied without considering contextual influences, the relevance to everyday life is limited. As a result, how individuals actively deal with their context to manage healthful eating is poorly understood. This research applies a complementary model, salutogenic model of health (SMH), and uses life course research methodology to study a group of healthy eaters. The purpose of this research is to unravel how healthful eating develops in everyday life. Healthy eaters (n = 17) were identified and recruited from the NQplus research panel at Wageningen University, the Netherlands. Life course experiences were examined through narrative inquiry. Participants recalled and visually explored life experiences with food and health using timelines. Results indicate that healthful eating results from exposure to individual- and context-bounded factors during childhood and adulthood and involves specific mental and social capacities relevant to coping including amongst others, critical self-awareness; flexibility, craftiness, and fortitude. Through life-course learning moments, participants were able to develop proactive coping strategies which strengthened their sense of agency and helped them in overcoming stressors and challenges. Findings show that nutrition strategies should not only focus on strengthening food-specific factors like cooking skills and nutrition knowledge, but other factors like stress management, empowerment, and participation. Such factors support the development of adaptive skills and behaviors, enable individuals to deal with the demands of everyday life, and are building blocks for health promotion.

Contains fulltext : 196716.pdf (Publisher’s version ) (Closed access) To stimulate physical activity (PA) and guide primary care patients towards local sport facilities, Care Sport Connectors (CSCs), to whom a broker role has been ascribed, were introduced in 2012 in the Netherlands. The aim of this study is to describe CSCs' operational context. A theoretical framework was developed and used as the starting point for this study. Group interviews were held with policymakers in nine participating municipalities, and, when applicable, the CSC's manager was also present. Prior to the interviews, a first outline of the operational context was mapped, based on the analysis of policy documents and a questionnaire completed by the policymakers. A deductive content analysis, based on the theoretical framework, was used to analyse the interviews. Differences were found in CSCs' operational context in the different municipalities, especially the extent to which municipalities adopted an integral approach. An integral approach consists of an integral policy in combination with an imbedding of this policy in partnerships at management level. This integral approach is reflected in the activities of other municipal operations, for example the implementation of health and PA programs by different organisations. Given the CSC mandate, we think that this integral approach may be supportive of the CSCs' work, because it is reflected in other operations of the municipalities and thus creates conditions for the CSCs' work. Further study is required to ascertain whether this integral approach is actually supporting CSCs in their work to connect the primary care and the PA sector.

Sinds januari 2019 worden de zorggerelateerde onderdelen van een Gecombineerde Leefstijlinterventie (GLI), zoals de leefstijlcoach of de diëtist, vergoed vanuit de basisverzekering. Voorwaarde is dat mensen een gewichtsgerelateerd gezondheidsrisico hebben, dat ze zijn doorverwezen door een huisarts, dat het om een door het RIVM erkende GLI gaat en dat de zorggroep een contract heeft met de zorgverzekeraar (zie het Spectrum-artikel van Aldien Poll, verderop in dit nummer). De huidige erkende GLI’s (CooL, Slimmer en BeweegKuur) zijn echter niet specifiek ontwikkeld voor mensen met een lage sociaaleconomische status (SES). Doordat zorg- en beweegaanbieders vanwege de vergoeding alleen erkende GLI’s aanbieden, krijgen andere GLI’s weinig of geen kans zich (verder) te ontwikkelen. De vraag is hoe we tot een systeem komen waarin dit wel mogelijk blijft.

Creating better access to good quality healthcare for the poor is a major challenge to development. In this study, we examined inter-linkages between poverty and disease, referred to as poverty-related diseases (PRDs), by investigating how Cameroon Development Corporation (CDC) camp dwellers respond to diseases that adversely affect their health and wellbeing. Living in plantation camps is associated with poverty, overcrowding, poor sanitation and the rapid spread of diseases. In a survey of 237 CDC camp dwellers in Cameroon, we used the health belief model to understand the drivers (perceived threats, benefits and cues for treatment seeking) of reported responses. Using logistic regression analysis, we looked for trends in people’s response to malaria. We calculated the odds ratio of factors shown to have an influence on people’s health, such as food, water, sanitation challenges and seeking formal healthcare for malaria. Malaria (40.3%), cholera (20.8%) and diarrhoea (17.7%) were the major PRDs perceived by camp dwellers. We found a strong link between what respondents perceived as PRDS and hygiene conditions. Poverty for our respondents was more about living in poor hygiene conditions than lack of money. Respondents perceived health challenges as stemming from their immediate living environment. Moreover, people employed self-medication and other informal health practices to seek healthcare. Interestingly, even though respondents reported using formal healthcare services as a general response to illness (84%), almost 90% stated that, in the case of malaria, they would use informal healthcare services. Our study recommends that efforts to curb the devastating effects of PRDs should have a strong focus on perceptions (i.e. include diseases that people living in conditions of poverty perceive as PRDs) and on hygiene practices, emphasising how they can be improved. By providing insights into the inter-linkages between poverty and disease, our study offers relevant guidance for potentially successful health promotion interventions., Author summary Poverty is a condition that increases disease risks and presents severe health challenges. The negative impact of poverty on health is well understood, but much less is known about how people living in poor conditions themselves perceive health challenges and how they try to overcome these challenges. We studied a group of Cameroon Development Corporation (CDC) plantation workers, living in housing provided by the company, known as camps. Living conditions in plantation camps are characterised by small and very basic housing, shared toilet facilities and overall poor sanitation. In the camps, water sources were public taps found in strategic areas. During water cuts, camp dwellers used streams as their water sources. Water was treated at CDC management level. We questioned 237 labourers (or dependants) on matters related to their health. Malaria, cholera and diarrhoea were reported as the main diseases that they associated with poverty. Our results also show that the labourers associated poverty primarily with the poor state of their living conditions rather than with not having money. Even though CDC offered free healthcare, camp dwellers relied on self-treatment and unofficial medication, especially for malaria for which almost 90% of the workers did not use the free services. Therefore, for interventions to be successful, they should include people’s perceptions and focus on improving hygiene conditions.

To support decision making regarding modifications to the current housing stock, this article explores older people's everyday lived experience of the house in the Netherlands. Twelve in-depth interviews were carried out, using diaries and a topic list. The study found physical, personal and social dimensions of experience that turn a house into a meaningful place in which to live. Although the study focused on the experience of the house as a home, all participants spoke about the importance of the neighbourhood. We therefore suggest that a personalised approach should be adopted in any modification of the current housing stock. © 2015, Copyright © Taylor & Francis Group, LLC.

Research shows that participation in sport is positively related to self-esteem, self-regulation skills, and social inclusion. As socially vulnerable youngsters participate less frequently in sports activities than their average peers, youth work organisations try to guide their clients (i.e., socially vulnerable youngsters) to local sports clubs and inclusive sports activities. Inclusive sports activities, however, cannot be provided by youth work organisations alone. Therefore, in the Netherlands, intersectoral action involving both youth work organisations and local sports clubs has emerged. Because youth workers and stakeholders in local sports clubs are not used to collaborating with each other, we explored the factors that contribute to the quality and performance of such intersectoral actions. On the basis of five open interviews with youth workers and three focus groups with stakeholders in local sports clubs, we described factors relating to the organisation of intersectoral action among youth workers and local sports clubs that are preconditions for the success of this specific type of intersectoral action.

Buurtgerichte beweegprogramma’s richten zich vaak op vrouwen van niet-westerse herkomst, omdat zij relatief minder bewegen. Factoren van invloed op gedragsinitiatie zijn breed onderzocht. Minder is bekend over factoren die van invloed zijn op duurzaam beweeggedrag. Meer kennis van deze factoren kan de effectiviteit van programma’s verhogen. Doel van dit onderzoek was om inzicht te krijgen in factoren die duurzaam beweeggedrag beïnvloeden bij vrouwen van niet-westerse herkomst. Op basis van literatuur zijn factoren in kaart gebracht op niveau van individu, groep, beweegprogramma en sociale en fysieke omgeving. Vier semigestructureerde interviews zijn gehouden met groeps- en beweegbegeleiders (n=6) en drie focusgroepgesprekken met vrouwen (n=25) van beweeggroepen, die tenminste een jaar actief zijn en minimaal eens per week bewegen. Factoren die duurzaam beweeggedrag op individueel niveau beïnvloeden zijn: ervaren (gezondheids-) voordelen, zelfregulatie en leeropbrengsten wat betreft bewegen en maatschappelijke participatie. Op groepsniveau zijn onderlinge steun, veiligheid, gedeelde verhalen en vertrouwen van belang. Op programmaniveau zijn kwaliteit van het beweegprogramma, responsieve begeleiding, continuïteit en laagdrempeligheid van belang. Conclusie: individueel ervaren voordelen en factoren op groeps- en programmaniveau, gericht op het in stand houden van een passende mix van beweeg- en sociale activiteiten, dragen in belangrijke mate bij aan duurzaam beweeggedrag van vrouwen van niet-westerse herkomst.

De Bakermat, verloskundige praktijk in Wageningen, wil haar taken op het gebied van gezondheidsbevordering uitbreiden. Om jongeren te bereiken en omdat het aantal tienerzwangerschappen onder laagopgeleide jongeren in Wageningen is toegenomen, hebben verloskundigen op een vmbo-school lessen over de gezonde zwangerschap verzorgd. De Bakermat vroeg de Wetenschapswinkel van de Wageningen University om een proces- en effectevaluatie van de lessen uit te voeren. In dit artikel beschrijven wij de opzet van de lessen en de resultaten van de evaluatie. De lessen resulteren in kennistoename van leerlingen over de ontwikkeling van de foetus, het risico van medicijngebruik en rauw vlees, het belang van het slikken van foliumzuur en de diensten van de verloskundige. Leerlingen hebben behoefte aan informatie over voor hen nieuwe onderwerpen, zoals gezond zwanger worden, de bevalling en het werk van de verloskundige.

In het project Gezond Ouder Worden in Apeldoorn hebben twee werkgroepen gewerkt met de ActiviteitenDialoog. Dit is een instrument om met elkaar in gesprek te gaan over activiteiten die lokaal kunnen worden uitgevoerd. De inzet van de ActiviteitenDialoog draagt niet alleen bij aan het ontwikkelen en uitvoeren van plannen en activiteiten maar ook aan het verduidelijken van taken en rollen in de samenwerking en daarmee aan de betrokkenheid van organisaties. In dit artikel worden de verschillende stappen van de ActiviteitenDialoog besproken en wordt een beschrijving gegeven van de resultaten en ervaringen van het werken met de ActiviteitenDialoog.

This research follows up on a study by Schultz et al. (2007), in which the effect of a social norm intervention on energy consumption was examined. The present studies included control groups to examine whether social norm effects would persist beyond regression to the mean. Both studies had a 2 (baseline consumption: below mean versus above mean)¿×¿2 (message condition: no-message control versus norm message) design. Based on baseline fruit (Study 1) or unhealthy snack (Study 2) consumption, students were classified as above mean or below mean for consumption. One week later, half of the students in the above-mean and below-mean groups received normative feedback; control groups did not. Neither study showed an effect of norm messages on behavior relative to control, providing evidence for regression to the mean as an alternative explanation. Findings highlight the importance of control groups to distinguish social norm intervention effects from mere regression to the mean.

Research has identified multiple factors that predict unhealthy eating practices. However what remains poorly understood are factors that promote healthy eating practices. This study aimed to determine a set of factors that represent a profile of healthy eaters. This research applied Antonovsky's salutogenic framework for health development to examine a set of factors that predict healthy eating in a cross-sectional study of Dutch adults. Data were analyzed from participants (n = 703) who completed the study's survey in January 2013. Logistic regression analysis was performed to test the association of survey factors on the outcome variable high dietary score. In the multivariate logistic regression model, five factors contributed significantly (p

Background: Treatment programs for overweight and obese young children are of variable effectiveness, and the characteristics of effective programs are unknown. In this systematic review with meta-analysis, the effectiveness of treatment programs for these children is summarized. Methods: PubMed, Embase, Web of Science, and PsycINFO databases were searched up to April 2012. Articles reporting the effect of treatment on the body weight of overweight or obese children with a mean age in the range of 3–

Background Regular physical activity (PA) is deemed to contribute to the primary and secondary prevention of several chronic diseases, like diabetes mellitus, cancer, cardiovascular diseases, and osteoporosis. In 2012, Care Sport Connectors (CSC), to whom a broker has been ascribed, were introduced in the Netherlands to stimulate PA and guide primary care patients towards local sport facilities. The aim of this study was to explore which structural embedding is the most promising for CSCs’ work. Methods In three rounds of interviews, 13 CSCs were followed for 2 years in their work. In these interviews, a network survey was used to identify organisations in the CSCs’ network, whether they collaborated with these organisations, and the role of the organisations in the connection. Data from the network survey were analysed using the RE-AIM framework and disaggregated into how CSCs were structurally embedded (Type A: only PA sector; Type B: different sectors; Type C: partnership). A related samples Wilcoxon signed rank test was performed to study how the CSCs’ network developed between 2014 and 2016. Results All CSCs established a connection between the primary care and the PA sector in which the average number of organisations with which CSCs collaborated increased significantly between 2014 (8.3) and 2016 (19.8) (p = 0.002). However, differences were identified in the way CSCs were structurally embedded and in the way they established the connection. Type A CSCs established the connection mostly around their own activities, supported PA organisations with their activities, and collaborated with primary care and welfare professionals around their own activities. Type B and Type C CSCs established the connection by organising, supporting, and implementing different kinds of activities targeting different kinds of audiences, and collaborated mostly with primary care professionals around the referral of professionals’ patients. Conclusions The results of this study suggest that adopting an integral approach (Type B and C) for the structural embedding of the CSC is more promising for reaching the desired outcomes. Whether CSCs really improve the target groups’ PA level and health needs to be further studied. Trial registration Dutch Trial Register NTR4986. Registered 14 December 2014. Electronic supplementary material The online version of this article (10.1186/s12889-017-4830-6) contains supplementary material, which is available to authorized users.

Background Sport is often recognised as an avenue for the positive development of young people. In line with this, policymakers and health professionals in the Netherlands, and elsewhere in the world, encourage socially vulnerable youth to participate in sport. Socially vulnerable youth are characterised as having an accumulated amount of negative experiences with the societal institutions in their lives, leading to distorted relationships with those institutions and, eventually, to feelings of isolation and low self-esteem. As socially vulnerable youth participate less in sport than their non-vulnerable peers, encouraging them to participate may support these youths in leading a healthy and productive life. However, to date, our understanding of the role of sport in positive youth development has been primarily based on research conducted in non-vulnerable populations and very little research has been conducted among socially vulnerable youth. The research that has been conducted for this thesis has been inspired by the salutogenic model of health, allowing us to examine the underlying mechanisms and processes of sports participation in alleviating social vulnerability. Aim The overall aim of this thesis is to unravel the value of sports participation for socially vulnerable youth. Four research objectives were formulated: To provide insights into the mechanisms underlying people’s capacity to cope with stressors (sense of coherence) to underpin health promotion activities that aim to strengthen this coping capacity. To provide insights into the relation between sports participation and youth development for socially vulnerable youth; To examine if and how community sports coaches can create optimal conditions for the personal development of socially vulnerable youth; To explore how socially vulnerable youth experience their participation in sport and the value they derive from sports participation in a socially vulnerable childhood. Methods This study has adopted a mixed-methods research design. More specifically, this study has used literature review (objective 1 and 2), questionnaire research (objective 2), semi-structured interviews (objective 3), and narrative interviews and life-course interviews (objective 4). Results The findings provide insights into the mechanisms underlying sense of coherence which reflects people’s capacity to deal with stressors in a health promoting way ( i.e., research objective 1). Sense of coherence consists of three components: the extent to which people experience the world as consistent and structured (comprehensibility); the extent to which people feel that there are resources available to meet the demands of everyday life (manageability); and the extent to which people feel that dealing with the stressors of everyday life is worthy of investment and engagement (meaningfulness). Based on a literature review of the salutogenic model of health, two opportunities for strengthening this sense of coherence in health promotion activities were identified: the behavioural mechanism and the perceptual mechanism. Both empowerment and reflection processes are important for the development of sense of coherence and can strengthen the healthy development of individuals. The findings provide insights into the relation between sports participation and youth development for socially vulnerable youth (i.e., research objective 2). In the systematic review, it was demonstrated that relatively few studies have been conducted regarding the life skill development of socially vulnerable youth in sports programs and that the evidence that is available is inconclusive regarding the benefits of sports. In the quantitative study, a positive relation was found between sports participation and several youth developmental outcomes (i.e., pro-social behaviour, subjective health, well-being, school performance and sense of coherence) but not with problem behaviour and the self-regulation skills. However, no conclusions can be drawn about a causal relationship between sports participation and youth development based on these data. The findings also demonstrated the crucial role of the sports coach in reaching optimal social conditions for life skill development and transferability (i.e., research objective 3). The community sports coaches mainly adopted an implicit approach to life skill transferability, meaning that they did not employ explicit strategies to stimulate the transfer of life skills from the sports setting to other societal domains. Nonetheless, the sports coaches believed that socially vulnerable youth could develop life skills in the sports setting that could also be used in school, the family or in the community. Coaching actions were directed at creating meaningful, comprehensible, and manageable sports experiences for socially vulnerable youth. Finally, the findings shed a light on how socially vulnerable youth experience their participation in sport and the role that sports participation could play in a socially vulnerable childhood (i.e., research objective 4). The youths’ positive and negative sports experiences rested on an intricate balance of the extent to which they experienced visibility of their skills, the extent to which they felt confident while playing their sport, and the extent to which they felt sport was a nice challenge that they liked to take on. The roles that sports participation could play in a socially vulnerable childhood are diverse: sport as a safe place, sport as a learning experience, sport as an instrument to reach goals, and sport as a purpose in life. As the challenges that socially vulnerable youth face in the sports setting can resemble some of the struggles they find in everyday life, their negative sports experiences could also potentially increase feelings of vulnerability. Conclusion Sports participation can support socially vulnerable youth in their personal development, but we also have to remain critical towards to use of sport as a means to reach positive youth development. The results from this thesis provide a deeper understanding of the conditions under which sport can contribute to positive youth development and offers recommendations for professionals in the field.

Background Asset-based approaches have become popular in public health. As yet it is not known to what extent health and welfare professionals are able to identify and mobilise individual and community health assets. Therefore, the aim of this study was to understand professional’s perceptions of health and health assets. Methods In a low-SES neighbourhood, 21 health and welfare professionals were interviewed about their definition of health and their perceptions of the residents’ health status, assets available in the neighbourhood’s environment, and the way residents use these assets. A Nominal Group Technique (NGT) session was conducted for member check. Verbatim transcripts of the semi-structured interviews were coded and analysed using Atlas.ti. Results The professionals used a broad health concept, emphasizing the social dimension of health as most important. They discussed the poor health of residents, mentioning multiple health problems and unmet health needs. They provided many examples of behaviour that they considered unhealthy, in particular unhealthy diet and lack of exercise. Professionals considered the green physical environment, as well as health and social services, including their own services, as important health enhancing factors, whereas social and economic factors were considered as major barriers for good health. Poor housing and litter in public space were considered as barriers as well. According to the professionals, residents underutilized neighbourhood health assets. They emphasised the impact of poverty on the residents and their health. Moreover, they felt that residents were lacking individual capabilities to lead a healthy life. Although committed to the wellbeing of the residents, some professionals seemed almost discouraged by the (perceived) situation. They looked for practical solutions by developing group-based approaches and supporting residents’ self-organisation. Conclusions Our study shows, firstly, that professionals in the priority district Slotermeer rated the health of the residents as poor and their health behaviour as inadequate. They considered poverty and lack of education as important causes of this situation. Secondly, the professionals tended to talk about barriers in the neighbourhood rather than about neighbourhood health assets. As such, it seems challenging to implement asset-based approaches. However, the professionals, based on their own experiences, did perceive the development of collective approaches as a promising direction for future community health development. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4555-6) contains supplementary material, which is available to authorized users.

Poverty-related diseases (PRDs) assume poverty as a determinant in catching disease and an obstacle for cure and recovery. In Cameroon, over 48 % of the population lives below the poverty line. This dissertation starts from the premise that the relation between poverty and disease is mediated by a person’s capacity to cope with the challenges posed by the natural and social environment. The central problem addressed is that in (inter)national health promotion, disease eradication is overemphasized whereas strengthening the capacity of people to cope with harsh conditions is disregarded. Research efforts show a similar division in emphasis, resulting in a limited understanding of the way people deal with health challenges in conditions of poverty. This dissertation is based on the salutogenic model of health that emphasizes the combined effects of (natural) disease conditions, mental conditions and social factors as determinants of health. This implies an emphasis on health as a positive strategy to deal with stressors and also an emphasis on the agency of people to respond to challenges that hamper their health and wellbeing. The study is carried out among two different groups of people in Cameroon. These are workers including dependants of workers of the Cameroon Development Corporation (CDC) and students from the universities of Buea and Yaoundé. The overall aim of this dissertation is to understand how conditions of poverty impact the health of people and how they manage these challenges. Specifically, the study aims to unravel the interlinkages between poverty and health by creating a deeper understanding of the social and material dynamics which enable people’s capacity to preserve health, anticipate health risks, and mitigate or recover from stressors such as PRDs. The main research question addressed is: What factors underlie the maintenance of good health and overcoming stressors in the face of PRDs in Cameroon? Different research methods were used to collect data. Interviews were carried out with respondents from both groups addressing PRDs, other stressors and coping strategies. General surveys were carried out to identify perceptions as well as health behaviour patterns across the two groups. Standardised surveys were carried out to measure individual factors such as sense of coherence, resilience, self-efficacy, subjective well-being and self-rated health. Results presented in different empirical chapters of the thesis each respond to a specific research question. In Chapters 2 and 3 are presented surveys with 272 students and 237 camp-dwellers respectively. Perceptions, attributed causes of, and responses towards PRDs are explored as well as motivations for given responses to health challenges. In chapter 4, a qualitative study with 21 camp-dwellers and 21 students is presented in which the dynamics of health-seeking behaviour is highlighted. In this chapter also, factors which are influential in seeking formal healthcare are indicated. Chapter 5 elaborates on what people experience as stressors and the mechanisms they put in place to cope with the stressors. In this chapter, not only is the diversity of stressors outlined for both groups, but also presented are the different identified coping mechanisms put in place by respondents. Chapter 6 which is the last empirical chapter presents coping with PRDs through an analysis of individual, demographic and environmental factors. Based on the studies carried out, this thesis concludes that the two groups investigated are very aware of what PRDs are and can differentiate them from common diseases. Major PRDs listed by the two groups of respondents were malaria, cholera and diarrhoea. This classification is different from what is considered major PRDs by (inter)national health bodies such as the World Health Organisation and the Ministry of Public Health in Cameroon. Also, organisations such as CDC and Universities, offer limited contributions towards better health for camp-dwellers and students respectively. This is experienced relative to the living conditions, quality of the healthcare system and poor work or study conditions. That notwithstanding, people play an active role in maintaining their health through diverse coping mechanisms. Coping was most strongly related to enabling individual factors such as sense of coherence and subjective health, perceptions of effective strategies to respond to diseases as well as social factors such as the meaningful activities in the social groups to which they belong. The results presented in this thesis are intended to contribute to sustainable and effective response strategies towards PRDs.

Background: In Cameroon, poverty-related diseases (PRDs) are a major public health concern. Research and policies addressing PRDs are based on a particular understanding of the interaction between poverty and disease, usually an association between poverty indicators and health indicators for a specific country or region. Such indicators are useful but fail to explain the nature of the linkages between poverty and disease or poverty and health. This paper presents results of a study among university students, unravelling how they perceive diseases, the linkages with poverty, their responses to diseases and the motivations behind reported responses. Based on the health belief model, this cross-sectional study was carried out among 272 students at the universities of Buea and Yaoundé in Cameroon. Data were collected using questionnaires containing items matching the research objectives. The questionnaires were self-completed. Results: Malaria was considered as the most common disease perceived and also a major PRD. Contrary to official rankings of HIV/AIDS and TB, cholera and diarrhoea were considered as other major PRDs. Also, typhoid fever was perceived to be more common and a PRD than HIV/AIDS and TB combined. The most prominently attributed cause for disease was (lack of) hygiene. In response, students deployed formal and/or informal healthcare strategies, depending on factors like available money, perceived severity of the disease and disease type. Discrepancies were observed in respondents' response to diseases generally and to malaria in particular. Even though, overall, respondents pre-dominantly reported a formal healthcare response toward diseases in general, for malaria, informal responses dominated. There was an overall strong awareness and (pro)activity among students for dealing with diseases. Conclusions: Although the high use of informal facilities and medication for malaria may well be a reason why eradication is problematic, this seems to be a deliberate strategy linked to an awareness of the limitations of the formal health system. In any intervention intended to foster health, it is therefore vital to consider people's perceptions toward diseases and their response strategies. Our results give important leads to health promotion interventions to develop group-specific programs.

Lezingenreeks 2017: Kracht van Sport in de WijkBiedt sport kwetsbare jongeren meer structuur in hun dagelijkse leven? Voelt een vluchteling zich eerder welkom door sportdeelname? Leert sport mensen met psychiatrische problemen beter om te gaan met tegenslag? In de vijfdelige lezingreeks ‘Kracht van Sport’ stond in 2017 de problematiek en inzet van sport bij diverse doelgroepen in de wijk centraal.In de lezingenreeks Kracht van Sport in de Wijk gingen experts op zoek naar manieren waarop welzijnswerkers, zorgverleners en professionals sport gezamenlijk als middel kunnen inzetten om de leefkwaliteit van wijkbewoners te verhogen.

Sports participation is considered beneficial for the development of socially vulnerable youth, not only in terms of physical health but also in terms of cognitive, social and emotional health. Despite the strong belief that sports clubs offer a setting for positive youth development, there is limited knowledge about how socially vulnerable youths experience their participation in these clubs. Interviews were conducted with 22 socially vulnerable youths that play a sport at a local sports club. An inductive content analysis was conducted and three themes were discovered that are included in the positive and negative sports experiences: the extent to which the youths experienced visibility of their skills, the extent to which the youths felt confident while playing their sport, and the extent to which the youths felt that sport was a challenge they liked to take on. More importantly, there was a fragile balance within each of the themes and the sports coaches played an important role in installing and maintaining a supportive environment in which the youths could have meaningful, consistent and balanced sports experiences. It is not self-evident that for socially vulnerable youth sports experiences are positive and supporting.

Gemeenten zijn per 1 januari 2015 verantwoordelijk voor uitvoering van de Jeugdwet, Wmo en de Participatiewet. De invoering van de Participatiewet leidt tot de toestroom van een nieuwe doelgroep waaronder veel mensen met psychische problemen die behoefte hebben aan langdurige ondersteuning.De decentralisaties vormen een grote uitdaging voor gemeenten. Niet alleen komen er nieuwe taken op gemeenten af, maar er wordt ook flink bezuinigd. Gemeenten moeten dus meer doen met minder geld. Maar er zijn ook kansen.Voor het eerst krijgt één partij, de gemeente, zeggenschap over praktisch het hele sociale domein. De decentralisaties maken dwarsverbanden tussen de Wmo/Awbz, de jeugdzorg en het domein van werk en inkomen mogelijk. Werkplekken waar mensen vanuit de participatiewet, WMO en jeugdzorg terecht kunnen hebben daarom de aandacht van gemeenten.Deze factsheet gaat over de mogelijkheden die het groen biedt voor re-integratie van mensen met psychische problemen. Interessante voorbeelden van re-integratie initiatieven zijn stadslandbouwbedrijven, landschapsonderhoud,zorgboerderijen, groenonderhoud en groene wijkinitiatieven.De factsheet is gebaseerd op literatuuronderzoek, interviews en groepsgesprekken met initiatiefnemers, mensen met psychische problemen die werken in het groen (deelnemers) en betrokken beleidsmedewerkers van verschillende groene re-integratie initiatieven. In deze factsheet komen de volgende thema’s aan bod:• Welke vormen van groene re-integratie bestaan er in Nederland?• Wat is de mogelijke theoretische onderbouwing en wat zijn de werkzame elementen van groene re-integratie?• Wat zijn de randvoorwaarden van groene re-integratie? En wat is er nodig om deze vorm van re-integratie verder inte bedden en op te schalen?

Ongeveer een op de tien mensen krijgt tijdens hun jeugd een vorm van jeugdhulp. Deze jongeren hebben te maken met een of meerdere uitdagingen die een gezonde toekomst in de weg staan. Denk bijvoorbeeld aan leer- of gedragsproblemen, een instabiele gezinssituatie of sociale druk van vrienden om het verkeerde pad op te gaan. Beleidsmakers en jeugdhulporganisaties proberen op verschillende manieren de ongelijkheid in toekomstperspectieven tussen jongeren te verkleinen. Steeds vaker denken zij daarbij aan de sportvereniging als een plek waar de genoemde sociaal kwetsbare jongeren zich positief kunnen ontwikkelen. Hoewel bekend is dat voor jeugd sportdeelname samenhangt met verschillende positieve uitkomsten (zie kader 1), is het onduidelijk of dit ook geldt voor kwetsbare jongeren. Wat betekent sportdeelname voor het toekomstperspectief van kwetsbare jongeren? Hoe geef je vorm aan een sportomgeving die kan bijdragen aan positieve sportervaringen? En wat is nodig voor een succesvolle samenwerking tussen jeugdhulporganisaties en sportverenigingen? Die vragen beantwoorden we in deze samenvatting van de bevindingen van vier jaar onderzoek naar jeugdhulp en sport.

De duurzame inzetbaarheid van medewerkers op de Nederlandse universiteiten staat onder druk. Voor SoFoKleS was dit aanleiding om duurzame inzetbaarheid hoog op de agenda te zetten.Uit een eerdere verkenning van SoFoKleS bleek dat er nog veel ruimte was om employability, vitaliteit en SPP te verbeteren. Wat bleek is dat universiteiten weliswaar al veel employabilitymaatregelen hebben genomen (brons), maar dat deze maatregelen vaak nog onvoldoende bekend zijn bij medewerkers (zilver) en onvoldoende worden gebruikt en geborgd binnen de instelling (goud). Aanvullend beleid is nodig om daarvoor te zorgen. Ten aanzien van SPP bleek dat slechts een beperkt aantal universiteiten destijds bezig was met de implementatie ervan. Veel universiteiten wilden er wel mee starten, maar ervoeren obstakels om tot een succesvolle implementatie over te gaan. Vitaliteitsprogramma’s bleken nog in de kinderschoenen te staan en er lagen kansen voor een verdere inbedding in het organisatiebeleid, meer oog voor de rol van de organisatie (in plaats van alleen de rol van het individu), beter maatwerk en samenwerking tussen HRM en wetenschappelijke staf, zodat de vitaliteitsprogramma’s (beter) onderbouwd en geëvalueerd worden.De leernetwerken hadden tot doel deelnemende universiteiten te ondersteunen bij de implementatie van interventies voor de verbetering van employability, SPP en vitaliteit. Per leernetwerk hebben de universiteiten interventies geïmplementeerd of geïntensiveerd. Uitgangspunt hierbij was dat universiteiten dit met een pionierende aanpak doen zonder centraal opgelegde aanpak, in een leernetwerk waarin ruimte was om met andere universiteiten ervaringen met het implementatieproces te delen en hierop te reflecteren.

Population ageing is a global trend. For example, in the EU-27 population the share of the older population (65 and above) increased from 13.9 % in 1991 to 17.5 % in 2011. It is expected that by 2060 the share of those 65 years and overwill account for 29.5 % of the EU-27 population (Eurostat, 2013). The ageing of the population results from decreasing fertility rates, but also from increasing life-expectancy rates and the progressive ageing of the ageing population itself.These latter trends are partially attributable to improved quality of nutrition, and advances in medicine, especially knowledge about diseases and their control, and to developments such as early detection of colorectal and breast cancer in screening programmes which increase the chances of survival. Improvements in housing, nutrition, and sanitation standards have also contributed to improved life expectancy (Staehelin, 2005).In developed countries, years added to life are generally lived in good health. However, because more people live into old age and because chronic diseases more frequently occur in the older population, the burden of disease will alsoincrease. The ageing of the population will have an impact on healthcare, housing and community facilities, consumption patterns, and also on social security costs. In response, health professionals, researchers, and policymakers are increasingly concerned with healthy ageing, where ageingin-place is used as a key concept. In this chapter, we first discuss the meaning of the concept of healthy ageing, and how Sense of Coherence contributes to this process. Next, we discuss the characteristics of the community in whicholder people live their lives and how the community can provide resources (GRR and SRR) to strengthen Sense of Coherence and hence perceived well-being and quality of life.

Gemeenten zijn per 1 januari 2015 verantwoordelijk voor uitvoering van de Jeugdwet, Wmo en de Participatiewet. De invoering van de Participatiewet leidt tot de toestroom van een nieuwe doelgroep waaronder veel mensen met psychische problemen die behoefte hebben aan langdurige ondersteuning.De decentralisaties vormen een grote uitdaging voor gemeenten. Niet alleen komen er nieuwe taken op gemeenten af, maar er wordt ook flink bezuinigd. Gemeenten moeten dus meer doen met minder geld. Maar er zijn ook kansen.Voor het eerst krijgt één partij, de gemeente, zeggenschap over praktisch het hele sociale domein. De decentralisaties maken dwarsverbanden tussen de Wmo/Awbz, de jeugdzorg en het domein van werk en inkomen mogelijk. Werkplekken waar mensen vanuit de participatiewet, WMO en jeugdzorg terecht kunnen hebben daarom de aandacht van gemeenten.Deze factsheet gaat over de mogelijkheden die het groen biedt voor re-integratie van mensen met psychische problemen. Interessante voorbeelden van re-integratie initiatieven zijn stadslandbouwbedrijven, landschapsonderhoud,zorgboerderijen, groenonderhoud en groene wijkinitiatieven.De factsheet is gebaseerd op literatuuronderzoek, interviews en groepsgesprekken met initiatiefnemers, mensen met psychische problemen die werken in het groen (deelnemers) en betrokken beleidsmedewerkers van verschillende groene re-integratie initiatieven. In deze factsheet komen de volgende thema’s aan bod:• Welke vormen van groene re-integratie bestaan er in Nederland?• Wat is de mogelijke theoretische onderbouwing en wat zijn de werkzame elementen van groene re-integratie?• Wat zijn de randvoorwaarden van groene re-integratie? En wat is er nodig om deze vorm van re-integratie verder inte bedden en op te schalen?

Currently, the engagement of local communities in Health Impact Assessment is becoming more and more important. A scoping review was performed to take stock of visions, methods and experiences in this field.A combined Scopus and Medline search yielded 100 articles in scientific journals. The final selection consisted of 43 papers, including case studies, evaluation studies, reviews, and opinion papers. After analysis, consultation of four experts was performed to check preliminary study outcomes. A grey literature web search was performed to check and complement the results.Results show that community participation is generally considered a core element in HIA. Views as expressed in the papers concern, firstly, the need for and value of local knowledge, secondly, the adherence to or application of democratic values and, thirdly, empowerment of communities. Three categories of methods are used in relation to community participation, often in combination: methods to facilitate knowledge elicitation, to ensure the inclusion of communities in the HIA process, and to build community capacity to participate in policy development. However, the theoretical or practical underpinning of the choice for specific methods is mostly not presented. The experiences described in the papers mainly focus on the access to local knowledge and its usability as a source of evidence in the HIA process. Described effects of community participation are (improved) relations between communities and local agencies, policy makers and professionals and the empowerment of community members. Although these effects are ascribed to community participation, many papers do not provide support for this conclusion beyond the retrospective perception of participants. Expert consultation and additional analysis of the grey literature supported the results derived from the scientific literature and provided more in-depth knowledge. In the grey literature theoretical frameworks, methods and tools for community participation in HIA were more extensively reported as compared to the scientific literature.We conclude that the visions, methods and experiences concerning community participation show that a participative approach may contribute to better, context specific knowledge. It appears that participative HIA has health promotion potential as it helps develop responsive policies.To accomplish this, HIA should, firstly, be better embedded in broader health promotion programmes. Secondly, the methods and approaches for community participation applied in HIA should be theory-informed and well described. The grey literature offers entry points. Finally, more robust and systematic evaluation and research is needed to assess the impact of HIAs on communities and policies.

In Italy, social farming (SF) did not develop homogeneously across the national territory. In this context, actors with SF aspirations may benefit from knowledge of the factors that fostered the development of SF in the areas in which it showed more remarkable progress. This study adopted a multi-level perspective in order to understand how SF developed in Italy, and to examine its evolution across regions at different stages of development. In order to achieve such aim, a literature study about the development of SF in Italy was carried out, and was followed by in-depth semi-structured interviews conducted with 29 stakeholders coming from four Italian regions (Tuscany, Latium, Abruzzo and Molise). The findings indicate SF practices at the niches level managed to establish connections with the regime as positive results emerged, networks and support organizations were set up, universities became interested in SF, and policymakers started recognizing and funding SF. The different degrees of support coming from the public sector, SF and agricultural organizations, universities, and policymakers, contributed to the differences between the SF practices in the four regions under study. In particular, in the southernmost regions, several SF's stakeholders showed less entrepreneurial skills, while the public authorities tended to have less knowledge about SF, and sometimes diffidence towards it. In conclusion, some recommendations to foster the development of SF are to make SF practices’ success visible, to cultivate entrepreneurial skills, and to build and support networks between actors with different backgrounds, thus facilitating knowledge exchange.

Citizen science – the active participation of lay people in research – may yield crucial local knowledge and increase research capacity. Recently, there is growing interest to understand benefits for citizen scientists themselves. We studied the perceived impacts of participation in a public health citizen science project on citizen scientists in a disadvantaged neighbourhood in the Netherlands. Local citizen scientists, characterised by low income and low educational level – many of whom were of migrant origin – were trained to interview fellow residents about health-enhancing and health-damaging neighbourhood features. Experiences of these citizen scientists were collected through focus groups and interviews and analysed using a theoretical model of potential citizen science benefits. The results show that the citizen scientists perceived participation in the project as a positive experience. They acquired a broader understanding of health and its determinants and knowledge about healthy lifestyles, and took action to change their own health behaviour. They reported improved self confidence and social skills, and expanded their network across cultural boundaries. Health was perceived as a topic that helped people with different backgrounds to relate to one another. The project also induced joint action to improve the neighbourhood’s health. We conclude that citizen science benefits participants with low educational or literacy level. Moreover, it seems to be a promising approach that can help promote health in underprivileged communities by strengthening personal skills and social capital. However, embedding projects in broader health promotion strategies and long-term engagement of citizen scientists should be pursued to accomplish this.

Lezingenreeks 2017: Kracht van Sport in de WijkBiedt sport kwetsbare jongeren meer structuur in hun dagelijkse leven? Voelt een vluchteling zich eerder welkom door sportdeelname? Leert sport mensen met psychiatrische problemen beter om te gaan met tegenslag? In de vijfdelige lezingreeks ‘Kracht van Sport’ stond in 2017 de problematiek en inzet van sport bij diverse doelgroepen in de wijk centraal.In de lezingenreeks Kracht van Sport in de Wijk gingen experts op zoek naar manieren waarop welzijnswerkers, zorgverleners en professionals sport gezamenlijk als middel kunnen inzetten om de leefkwaliteit van wijkbewoners te verhogen.

De duurzame inzetbaarheid van medewerkers op de Nederlandse universiteiten staat onder druk. Voor SoFoKleS was dit aanleiding om duurzame inzetbaarheid hoog op de agenda te zetten.Uit een eerdere verkenning van SoFoKleS bleek dat er nog veel ruimte was om employability, vitaliteit en SPP te verbeteren. Wat bleek is dat universiteiten weliswaar al veel employabilitymaatregelen hebben genomen (brons), maar dat deze maatregelen vaak nog onvoldoende bekend zijn bij medewerkers (zilver) en onvoldoende worden gebruikt en geborgd binnen de instelling (goud). Aanvullend beleid is nodig om daarvoor te zorgen. Ten aanzien van SPP bleek dat slechts een beperkt aantal universiteiten destijds bezig was met de implementatie ervan. Veel universiteiten wilden er wel mee starten, maar ervoeren obstakels om tot een succesvolle implementatie over te gaan. Vitaliteitsprogramma’s bleken nog in de kinderschoenen te staan en er lagen kansen voor een verdere inbedding in het organisatiebeleid, meer oog voor de rol van de organisatie (in plaats van alleen de rol van het individu), beter maatwerk en samenwerking tussen HRM en wetenschappelijke staf, zodat de vitaliteitsprogramma’s (beter) onderbouwd en geëvalueerd worden.De leernetwerken hadden tot doel deelnemende universiteiten te ondersteunen bij de implementatie van interventies voor de verbetering van employability, SPP en vitaliteit. Per leernetwerk hebben de universiteiten interventies geïmplementeerd of geïntensiveerd. Uitgangspunt hierbij was dat universiteiten dit met een pionierende aanpak doen zonder centraal opgelegde aanpak, in een leernetwerk waarin ruimte was om met andere universiteiten ervaringen met het implementatieproces te delen en hierop te reflecteren.

The objective of this article is to provide insight in the five-step development process of the best evidence, best practice intervention for obese young children 'AanTafel!'. A set of requirements for intervention development was developed to guide the data inquiry: the use of theory, influencing factors, tailoring, multi-disciplinarity, duration/frequency and evaluation and monitoring. Step I retrieved evidence from clinical guidelines, followed by a systematic review with meta-analysis (Step II) and an extended literature review (Step III). Evidence was consistent with regard to parent-focus, targeting family level, including diet, physical activity and behaviour change techniques and tailoring to age. However, no evidence or inconsistent evidence emerged from the theory-basis, group-versus-individual sessions, face-to-face contact versus Internet-mediated contact, which disciplines to involve and how to involve them, as well as intervention duration and intensity. Hence, practice-based insights from parental interviews (Step IV) and involved therapists were added and subsequently integrated to the intervention 'AanTafel!' (Step V). 'AanTafel!' is a multi-component, multi-disciplinary, family-based, parent-focused, age-specific intervention, which is tailored to individual children and families with a duration of 1 year, and using a combination of individual and group sessions as well as a Web-based learning module. Changes in scientific working principles with regard to data collection, reporting and translation to guidelines are required. Practice and science may benefit from close collaboration in designing, implementing and evaluating interventions.

Introduction To stimulate physical activity (PA) and guide primary care patients towards local PA facilities, Care Sport Connectors (CSC) (in Dutch Buurtsportcoach), to whom a broker role has been ascribed, were introduced in 2012. This function is new, and to our knowledge no study has yet explored a broker role and its impact on improving intersectoral collaboration between both sectors. The aim of this thesis was to explore CSCs’ role and impact in connecting the primary care and the PA sector. Method This thesis employed a multiple case study design in which 15 CSCs from nine municipalities spread over the Netherlands were followed in their work from 2014 to the end of 2016. Different data collection methods were used (literature review, interviews, focus groups, document analysis, and questionnaires), and perspectives of different stakeholders (policymakers, professionals, CSCs) on different levels (policy and community) were taken into account (Chapter 2). Results The connection between the primary care and the PA sector: a chain approach The connection between both sectors can be characterised as a chain in which CSCs guide the target group towards PA facilities after referral by primary care professionals or their own recruitment. In this connection CSCs fulfilled three roles - broker, referral, and organiser – which did not change over time (Chapter 4 and 5). Barriers at system and sector level hinder the established connection Barriers related to the primary care (lack of time, money and knowledge) and the PA sector (lack of suitable PA activities and adequate instructors) are currently hindering the connection between both sectors (Chapter 4 and 6). Barriers related to the collaboration between both sectors, like cultural differences and different interests as identified in our literature review (Chapter 3) were not identified. The importance of an integral approach for CSCs and the connection between both sectors An integral approach to structural embed CSCs (Chapter 7) seemed to influence CSCs’ work and subsequently their impact. CSCs working in municipalities who structurally embedded CSCs only at the PA sector, connected both sectors mostly by jointly organising activities. CSCs working in municipalities who adopted an integral approach connected both sectors by a variety of activities targeting different audiences, and primary care professionals fulfilled mostly a role in the referral of their patients. The structural imbedding of the CSC according an integral approach seems the most promising in reaching the desired outcomes (Chapter 8). Conclusion CSC’ role is promising for establishing a connection between the primary care and the PA sector. However, to make a success of the connection changes are needed at system and sector level. Further research should focus on CSCs’ impact on stimulating PA among primary care patients, and the development of CSC’ role and the connection between both sectors over time.

Lezingenreeks 2017: Kracht van Sport in de WijkBiedt sport kwetsbare jongeren meer structuur in hun dagelijkse leven? Voelt een vluchteling zich eerder welkom door sportdeelname? Leert sport mensen met psychiatrische problemen beter om te gaan met tegenslag? In de vijfdelige lezingreeks ‘Kracht van Sport’ stond in 2017 de problematiek en inzet van sport bij diverse doelgroepen in de wijk centraal.In de lezingenreeks Kracht van Sport in de Wijk gingen experts op zoek naar manieren waarop welzijnswerkers, zorgverleners en professionals sport gezamenlijk als middel kunnen inzetten om de leefkwaliteit van wijkbewoners te verhogen.