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Height and labor market outcomes appear to be related to one another. The taller people are, the more likely they are to have better jobs and to earn more money. This is especially the case for men. However, whether height is causally related to labor market outcomes is an open question, which instrumental variable (IV) analysis may help to answer. To our knowledge, no study has yet used IV analysis to test these relationships in a historical context. The present study addressed this gap, by examining height’s relationship to occupational status and intergenerational mobility in a sample of Dutch men, birth years 1850 through 1900. Data were drawn from: the Historical Sample of the Netherlands, providing life course information on the research person; the Heights and Life Courses Database, providing information on the research person’s height at conscription; and the Male Kin Height Database, providing information on the average height of the research person’s full brothers. This combination of data sources yielded a sample of 1,465 men. Height z-score’s relationships to occupational status (characterized as HISCAM score), and to intergenerational mobility (characterized as the difference between research person’s HISCAM score and father’s HISCAM score) were examined. The average of brothers’ heights z-score was used as an instrumental variable. In terms of results, one standard deviation increase in height was associated with a 1.370 increase in HISCAM score (95% CI: 0.310–2.429), and a 1.127 increase in intergenerational mobility score (95% CI: −0.114–2.368). As Dutch men were growing taller and had greater abilities to choose their occupations, it appeared that tallness was associated with a better job, and increased intergenerational occupational mobility. This study thus offered preliminary evidence that height and labor market outcomes were perhaps causally related during the late nineteenth and early twentieth centuries.

This systematic review aims to provide an overview of the current knowledge regarding life skills development (LSD) and life skills transfer (LST) in sports programs serving adults in a socially vulnerable position. It identifies factors influencing LSD and LST in these sports programs, as well as possible differences in this regard between the various subgroups of social vulnerability. Potentially relevant studies were identified by searches of five databases, complemented by backward and forward snowballing. The 26 articles included reported the development of cognitive, emotional and/or social skills amongst socially vulnerable adults through participation in a sports program. In 20 studies, transfer was reported for at least one of the life skills developed. Potential factors that may influence the process of LSD and LST were related to the individual, the staff, the program design, the inherent demands of sport, a safe environment and social cohesion. Some differences in LSD and LST were found between subgroups of social vulnerable adults. However, because some subgroups were hardly represented, a comparison was difficult to make. This review showed that sports programs have the potential to help socially vulnerable adults develop and transfer life skills. Recommendations for future research are given.

Summary The COVID-19 crisis impacts populations globally. This impact seems to differ for groups with low- and high-socioeconomic status (SES). We conducted a qualitative study in the Netherlands using a salutogenic perspective to examine experiences with stressors and coping resources during the pandemic among both SES groups to gain insight on how to promote the health and well-being of these groups. We conducted 10 focus group discussions and 20 interviews to explore the experiences, including resources and stressors, of respondents from low- (N = 37) and high-SES (N = 38) groups (25–55 years, Dutch speaking). We analyzed the findings at individual, community, and national levels. The results show that coping depends on government-imposed measures and the way individuals handle these measures; restriction to the home context with positive and negative consequences for work and leisure; psychological negative consequences and resourcefulness; and social effects related to unity (e.g. social cohesion or support) and division (including polarization). Respondents with lower SES expressed more problems with COVID-19 measures and experienced more social impact in their neighborhood than those with higher SES. Where low-SES groups especially mentioned the effects of staying at home on family life, high-SES groups mentioned effects on work life. At last, psychological consequences seem to differ somewhat across SES groups. Recommendations include consistent government-imposed measures and government communication, support for home schooling children, and strengthening the social fabric of neighborhoods.

Objectives: Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). Design: In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. Results: Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. Conclusion: Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.

Op grond van aanwijzingen dat zorginterventies in de natuur positieve effecten kunnen hebben op het herstel na burn-outklachten, gaan steeds meer GZ-psychologen in de behandeling daarvan de natuur inzetten. Door gebrek aan onderzoek weten we nog maar weinig over hoe dit werkt. Deze bijdrage reflecteert op de werking aan de hand van een eerste evaluatiemodel van mogelijke werkzame elementen, gebaseerd op de casus De Buitenpsychologen.

Among 145 individuals surveyed in Tanzania, 42% indicated willingness to test for human immunodeficiency virus in response to a confidential, phone-based text message. On average, participants were likely to provide contact information for 1.5 members of their social networks, suggesting high feasibility and moderate acceptability of a novel mHealth human immunodeficiency virus testing intervention.

Nutrition health professionals play important roles in developing and implementing healthy eating strategies for socioeconomically disadvantaged populations. However, the values of nutrition health professionals that inform and underly their everyday decisions and practices are not explicit. The purpose of this study was to identify and synthesize the key values of nutrition health professionals. An explorative qualitative research design was used in which a purposive sample of nutrition health professionals (n = 29) were interviewed. The ‘Values Wheel of Nutrition Health Professionals (VWNHP)’ was created, consisting of 16 values organized into six groups of complementary values – self-transcendence, self-enhancement, openness to change, conservation, connection, and perseverance. The VWNHP may be utilized as a tool to support the critical reflection in health promotion training and practice needed to address nutrition inequities.

Health inequalities still exist between people with a low socioeconomic status (SES) and people with a high SES. Combined lifestyle interventions (CLIs) could benefit the health of people with a low SES. However, it is unclear which CLI elements are effective for this group. Therefore, this study aimed to determine the effective elements X‑Fittt 2.0, a CLI for people with a low SES. Nine professionals and one participant of X‑Fittt 2.0 participated in a concept mapping (CM) process to develop an overview of the effective elements of X‑Fittt 2.0. CM consists of six steps: preparing, brainstorming, clustering, scoring, analysing, and discussing and interpreting. This process resulted in 72 effective elements, grouped in nine clusters, focused on monitoring (12), internal (7) and external (4) collaborations, structure and guidance (10), agreements with participants (5), sports options in the first 12 weeks (10), the sports environment (10), recruitment strategies (5) and the preconditions for X‑Fittt 2.0 (9). These results provide a valuable first overview of effective elements of CLIs for people with a low SES.

Background Since 1986, WHO has advised that applying action principles such as citizen participation and intersectoral collaboration leads to better health. However, less is known about the workability of these principles and how they trigger specific outcomes in interaction with the context. A critical realist perspective was applied to get a better understanding of what worked, and why it worked, in the context of a Dutch community-based health promotion programme (CBHPP). The aim of the study was to unravel the mechanisms underlying the action principles and find combinations of contextual factors and mechanisms that trigger outcomes in a CBHPP. Methods In this single case study, a critical realist methodology was followed. Qualitative data used in this study originated from multiple sources and methods to ensure validity. They include evaluation sessions with coalition members (n = 6) and individual interviews (n = 6); group sessions with community workers (n = 1), a health broker (n = 1), and citizens (n = 12); and seven semi-annual progress reports and minutes of the coalition meetings. The collected data were then compared with the programme theory through a heuristic process of constructing, exploring, and refining context-mechanism-outcome configurations. Results The programme initiated a variety of new activities that differed in content, intensity, duration, and number of participants, organised and implemented together with citizens. The most prominent mechanism underlying both action principles were programme-related, namely, patience, personal contact, contribution of budget, and the programme coordinator’s leadership. Another important mechanism was creating visibility, which resulted in the involvement of the municipality and a budget to sustain the programme. Conclusion In this case study, personal contact, patience, perseverance, participatory action research activities, and visibility were found to be the most notable mechanisms underlying the citizen participation and intersectoral collaboration action principles. As the principle-based approach added value to the existing context and introduced most of the mechanisms that triggered the outcomes, it is recommended to include citizen participation and intersectoral collaboration not only as action principles but explicitly as targets in a CBHPP.

BackgroundThe built environment is increasingly recognized as a determinant for health and health behaviors. Existing evidence regarding the relationship between environment and health (behaviors) is varying in significance and magnitude, and more high-quality longitudinal studies are needed. The aim of this study was to evaluate the effects of a major urban redesign project on physical activity (PA), sedentary behavior (SB), active transport (AT), health-related quality of life (HRQOL), social activities (SA) and meaningfulness, at 29–39 months after opening of the reconstructed area.MethodsPA and AT were measured using accelerometers and GPS loggers. HRQOL and sociodemographic characteristics were assessed using questionnaires. In total, 241 participants provided valid data at baseline and follow-up. We distinguished three groups, based on proximity to the intervention area: maximal exposure group, minimal exposure group and no exposure group.ResultsBoth the maximal and minimal exposure groups showed significantly different trends regarding transport-based PA levels compared to the no exposure group. In the exposure groups SB decreased, while it increased in the no exposure group. Also, transport-based light intensity PA remained stable in the exposure groups, while it significantly decreased in the no exposure group. No intervention effects were found for total daily PA levels. Scores on SA and meaningfulness increased in the maximal exposure group and decreased in the minimal and no exposure group, but changes were not statistically significant.ConclusionThe results of this study emphasize the potential of the built environment in changing SB and highlights the relevance of longer-term follow-up measurements to explore the full potential of urban redesign projects.Trial registrationThis research was retrospectively registered at the Netherlands Trial Register (NL8108).

BackgroundThe built environment is increasingly recognized as a determinant for health and health behaviors. Existing evidence regarding the relationship between environment and health (behaviors) is varying in significance and magnitude, and more high-quality longitudinal studies are needed. The aim of this study was to evaluate the effects of a major urban redesign project on physical activity (PA), sedentary behavior (SB), active transport (AT), health-related quality of life (HRQOL), social activities (SA) and meaningfulness, at 29–39 months after opening of the reconstructed area.MethodsPA and AT were measured using accelerometers and GPS loggers. HRQOL and sociodemographic characteristics were assessed using questionnaires. In total, 241 participants provided valid data at baseline and follow-up. We distinguished three groups, based on proximity to the intervention area: maximal exposure group, minimal exposure group and no exposure group.ResultsBoth the maximal and minimal exposure groups showed significantly different trends regarding transport-based PA levels compared to the no exposure group. In the exposure groups SB decreased, while it increased in the no exposure group. Also, transport-based light intensity PA remained stable in the exposure groups, while it significantly decreased in the no exposure group. No intervention effects were found for total daily PA levels. Scores on SA and meaningfulness increased in the maximal exposure group and decreased in the minimal and no exposure group, but changes were not statistically significant.ConclusionThe results of this study emphasize the potential of the built environment in changing SB and highlights the relevance of longer-term follow-up measurements to explore the full potential of urban redesign projects.Trial registrationThis research was retrospectively registered at the Netherlands Trial Register (NL8108).

Group A streptococcal (GAS) infections are caused by the Gram-positive bacterium Streptococcus pyogenes. Infection can occur via droplet infection from the throat and via (in)direct contact with infected people. GAS can cause a wide variety of diseases, ranging from superficial skin infections, pharyngitis and scarlet fever, to serious invasive diseases such as puerperal sepsis, pneumonia, necrotising soft tissue infections (NSTI) (also known as necrotising fasciitis/myositis), meningitis and streptococcal toxic shock syndrome (STSS). In invasive GAS infections, the bacteria has penetrated into a sterile body compartment (such as the bloodstream, deep tissues, or the central nervous system). Invasive GAS infections are rare but serious, with high morbidity and mortality. Since March 2022, the National Institute for Public Health and the Environment (RIVM) reported a national increase in notifiable invasive GAS infections (NSTI, STSS and puerperal fever). Particularly NSTI has increased compared to the years before the SARS-CoV-2 pandemic. Remarkably, the proportion of children aged 0 to 5 years with invasive GAS-infections is higher in 2022 than in the previous years (12% compared to 4%). While seasonal peaks occur, the current elevation exceeds this variation. To promote early recognition and diagnosis of invasive GAS infections different clinical cases are presented.

Group A streptococcal (GAS) infections are caused by the Gram-positive bacterium Streptococcus pyogenes. Infection can occur via droplet infection from the throat and via (in)direct contact with infected people. GAS can cause a wide variety of diseases, ranging from superficial skin infections, pharyngitis and scarlet fever, to serious invasive diseases such as puerperal sepsis, pneumonia, necrotising soft tissue infections (NSTI) (also known as necrotising fasciitis/myositis), meningitis and streptococcal toxic shock syndrome (STSS). In invasive GAS infections, the bacteria has penetrated into a sterile body compartment (such as the bloodstream, deep tissues, or the central nervous system). Invasive GAS infections are rare but serious, with high morbidity and mortality. Since March 2022, the National Institute for Public Health and the Environment (RIVM) reported a national increase in notifiable invasive GAS infections (NSTI, STSS and puerperal fever). Particularly NSTI has increased compared to the years before the SARS-CoV-2 pandemic. Remarkably, the proportion of children aged 0 to 5 years with invasive GAS-infections is higher in 2022 than in the previous years (12% compared to 4%). While seasonal peaks occur, the current elevation exceeds this variation. To promote early recognition and diagnosis of invasive GAS infections different clinical cases are presented.

When children drop out of school, either temporarily or permanently, this poses a significant problem for both children and society. In the Netherlands, care farms offering care-education programs for school dropouts are emerging. While there is evidence for their effectiveness, models explaining how such outdoor interventions may facilitate positive developments of children and their return to school are lacking. Using the generic Context-Intervention-Mechanisms-Outcome Model as an overarching deductive frame, this study inductively examines how care-educational programs facilitate the positive development of children who have dropped out of school. Focusing on nine educational care farms, we conducted observations and interviews with children, parents, teachers, and farmers. We conclude that the outdoor learning intervention in combination with the underlying farm context enables children to enjoy rest, freedom, tailored education, and a feeling of acceptance. These mechanisms support children to develop themselves, particularly regarding their socio-environmental functioning.

We know little to what extent peer feedback strategies can be applied on a large scale in higher education for complex tasks. This study aimed to design, implement, and evaluate an online-supported peer feedback module for large-scale use to enhance higher education students’ argumentative essay writing performance. To do this, 330 students from five different courses at bachelor and master levels followed the online supported peer feedback module. In this module, students were asked to write an argumentative essay about a controversial issue, provide peer feedback for two peers, and revise their original essays based on the received feedback. Three types of data including original essay (pre-test) data, peer feedback data, and revised essay (post-test) data collected. Students also filled out the learning satisfaction questionnaire at the end of the module. The findings showed that the suggested online-supported peer feedback module was effective in improving students’ argumentative essay quality in all courses at the bachelor and master levels. The findings also showed there is a difference in the level of students’ satisfaction with the module among the courses and between the education levels. The findings of this study provide insights into and add value to the scalability of online peer feedback tools for argumentative essay writing in different contexts. Based on the findings, recommendations for future studies and educational practice are provided.

Highlights • Sense of coherence (SOC) was stronger after a physical activity intervention. • Adults’ SOC may be strengthened, particularly when SOC is initially low. • SOC may be an alternative success indicator for physical activity interventions., Sense of coherence (SOC), a concept that refers to individuals’ abilities to manage, comprehend, and find meaning in their lives and the world around them, has been shown to be an important predictor of health outcomes. While SOC was initially hypothesized to be static after early-adulthood, there is growing evidence that health interventions can strengthen SOC. In this study, we accordingly examined whether SOC could be strengthened among adults in the context of a physical activity intervention. This intervention, Communities on the Move, was conducted in the Netherlands, and was primarily targeted at older adults from socially vulnerable backgrounds. Four cohorts were followed for 18 months each, between 2012 and 2016. The SOC-3 questionnaire was used to collect data on SOC at baseline (T0) and after eighteen months (T3), with information on 117 participants in both of these waves. To assess the change in SOC between T0 and T3, ordered logistic regressions were performed, as well as mixed ordered logistic regressions with random intercepts for group and program location. This study found evidence that SOC significantly changed from T0 to T3. Participants with weak SOC at baseline reported a median one-point stronger SOC at T3 (on a 6-point scale), while those with moderate or strong SOC at baseline reported a median change of zero points between T0 and T3. Further, based on the results of the regression analyses, those with weaker SOC scores were most likely to have stronger SOC at T3: having a weak SOC at baseline was associated with a 76% probability of stronger SOC, and a 4% probability of weaker SOC at T3. These results indicated that SOC may be strengthened in vulnerable older adults, particularly when their SOC is initially low.

The evidence is piling: contact with nature is good for our health. But today’s reality is that nature is not by default part of our lives, particularly not for citizens living in deprived urban neighborhoods. One strategy to increase nature contact locally, is through green citizen initiatives: gardens and urban agriculture projects initiated and run by citizens. We studied eight green citizen initiatives in Arnhem and Nijmegen in The Netherlands to explore what well-being benefits residents experience with regards to their participation in local green initiatives. This paper presents the methods developed to measure well-being outcomes, plus the first results. We conducted a questionnaire among 109 participants of green citizen initiatives in 2020. We found that participation in green initiatives creates positive experiences for six dimensions of well-being: meaningful involvement, personal development, social connection, sense of ownership, sense of safety and trust, and healthy lifestyle. Participants feel part of the initiative, gain social contacts and get to spend time outdoors. The greatest wellbeing benefit of green initiatives turned out to be a sense of safety and trust. We found less evidence of increased healthy food intake and other lifestyle aspects. This raises the question whether participants have already adopted relatively healthy lifestyles and/or whether the green initiatives attract a certain group of residents – and other groups not. With our study we provide a method and the first evidence on the value of green citizen initiatives as a bottom-up strategy to improve the health and well-being of citizens in deprived urban neighborhoods.

Over the past two centuries, the Dutch experienced a tremendous secular trend in height, and ultimately became the tallest nation in the world. Improving environmental conditions likely played the largest role in explaining these developments. But it is not yet precisely clear what factor set the Dutch head and shoulders above other nations, who were also experiencing improving environmental conditions. Could fertility also have played a role? To understand this, we would first need to know whether height and fertility were related during the secular growth trend. In this study, we investigated whether this was the case. A sample of Dutch men, birth years 1850–1900 (n = 3396), was examined. We tested the extents to which height was associated with having a certain number of children, and with having a certain number of children survive infancy. Multinomial logistic regressions were used. In terms of findings, height's relationship to fertility outcomes was curvilinear: being shorter-than-average (0.75–0.5 standard deviations below the mean height) was associated with a higher probability of being married and having five to seven children, while being moderately tall (0.5 standard deviations above the mean height) was associated with the lowest probability of being unmarried. There was no relationship between paternal height and children surviving infancy in the sample overall, but taller height was associated with a decreased risk of being in a high-mortality family among men born between 1880 and 1900. If paternal fertility played a role in the secular growth trend, we would expect to see very tall men have the most children, and clearly have the most children surviving infancy. Given this study's findings, it is unlikely that this was the case.

In coming years, the percentage of people who are overweight will increase most among vulnerable people, such as people with a low socio-economic status (SES) and/or a non-Western migration background. Overweight is a complex problem that requires an integrated approach. The aim of this research is to determine potentially effective elements of an integrated approach aimed at overweight for these specific target groups. In this explorative qualitative research twelve group interviews with professionals (n = 25) and four group interviews (n = 24) with people from the target group were conducted. In total 41 potentially effective elements have been identified for a successful integrated approach. These elements can be classified at the individual, program, municipal and national level, and the social and physical environment. Of these, 18 potentially effective elements relate specifically to people with a low SES and/or non-Western migration background. In addition, there are four competencies regarding the professional that can potentially contribute to an integrated approach: connect, dare, work in an integrated manner, persevere. The two preconditions of time and financial resources seem relevant. This study shows that an integrated approach not only requires professionals to deploy various effective elements (simultaneously), but also a continuous and proactive effort to achieve this. Het percentage mensen met ernstig overgewicht neemt de komende jaren toe, vooral onder mensen met een kwetsbare positie, zoals groeperingen met een lage sociaaleconomische status (SES) en/of een niet-westerse migratieachtergrond. Overgewicht is een complex probleem dat vraagt om een integrale aanpak. Het doel van dit onderzoek is het voor deze doelgroepen identificeren van potentieel werkzame elementen van een integrale aanpak gericht op overgewicht. In dit exploratief kwalitatieve onderzoek zijn twaalf groepsinterviews met 25 professionals en vier focusgroepgesprekken met 24 mensen uit de doelgroep gehouden. In totaal zijn 41 potentieel werkzame elementen geïdentificeerd voor een succesvolle integrale aanpak. Deze zijn ingedeeld op het individuele, programma, gemeentelijk en landelijk niveau, en op de sociale en fysieke omgeving. Hiervan hebben achttien potentieel werkzame elementen specifiek betrekking op mensen met een lage SES en/of niet-westerse migratieachtergrond. Daarnaast zijn vier competenties van professionals geïdentificeerd die in potentie kunnen bijdrage aan een werkzame integrale aanpak: verbinden, durven, integraal werken, volhouden. De twee randvoorwaarden tijd en financiële middelen lijken relevant op alle niveaus. Dit exploratieve onderzoek laat zien dat een integrale aanpak van professionals niet alleen vraagt dat zij verschillende potentieel werkzame elementen (tegelijkertijd) inzetten, maar ook dat ze zich continu en proactief inspannen om dit te realiseren.

Despite the highest ranks on pandemic preparedness assessments European welfare states encounter great difficulty in responding effectively to the COVID-19 outbreak. In this article we compare the governance of COVID-19 response in 48 Eurasian countries and a selection of European and SARS (2003) exposed Asian countries during the first wave of the COVID-19 outbreak until 1 June 2020, using data from the COVID-19 Health System Response Monitor and the Oxford COVID-19 Government Response Tracker, recent scientific literature and policy documents.Pandemic preparedness during the first wave of COVID-19 evolved from specialist infectious disease control to a broad governance of population mitigation, which in at least half of Eurasian countries lacked appropriate authority and capacity. In the directly operational response in Asian countries, preparedness encompasses a whole of government approach, an engaged and active community and private actors. Preparedness requires and reflects both vertical and horizontal coordination as well as policies that fit with the political economy of a country and region.

High consumption of animal-source foods, specifically meat, adversely affects human health and the environment. Dietary habits are shaped at younger ages and a reduction in meat consumption may be facilitated by the life course transitions in early adulthood, but studies are limited. This study among young Dutch adults aimed to describe their perceptions on the influence of life course transitions on meat consumption, barriers and enablers to reduce meat consumption, and strategies for reducing meat consumption. Barriers and enablers were grouped applying the COM-B model that includes capability, opportunity, and motivation. This quantitative cross-sectional study included a representative sample of 1806 young adults from two Dutch consumer panels who completed an online survey. Young adults frequently reported life course transitions, especially those related to moving house, to have decreased their meat consumption. Barriers and enablers to reduce meat consumption were identified for all three factors of the COM-B model. Important barriers included taste, perceived high prices of meat alternatives, and habits. In contrast, important enablers included care for the environment and animal welfare, enjoyment of smaller portions of meat and saving money. However, barriers and enablers largely differed by groups of meat consumption frequency. Self-perceived effective strategies for reducing meat consumption were price reduction of meat alternatives, recipes for vegetarian meals, and more attractive meat alternatives. The findings of this study are relevant for the development of targeted behaviour-change programmes including interventions in the physical and the social environment (like lowering prices and improving the offer of meat alternatives).

In the global south, the use of firewood and LPG as dominant energy sources for cooking contributes to socio-ecological issues. Alternatively, biogas is considered a clean energy source generated from organic waste. However, in Indonesia, until 2018, only less than 2% of households utilized biogas for cooking fuel. This research aims to explore the landscape of biogas governance in Indonesia, its fragmentation, and its relation with biodigester dissemination. This study found that there is fragmentation within small-medium scale national biogas programs in Indonesia. Seven national government biogas programs have similar governance arrangements and characteristics; scattered in different departments within the ministry, using the grant approach with two main vendors, often overlapping with local government programs, and not providing proper monitoring and evaluation mechanism, as well as proper training for users. Meanwhile, the biogas program by a non-government organization utilizes a semi-commercial approach; collaborating with multiple stakeholders (governments, local construction partner organizations, cooperatives, and private sectors-companies and banks); and has standardized training and after-sale services. Within those biogas programs, there are multiple barriers along the supply chain process of biodigester dissemination. These barriers relate to the governance aspect of biogas programs. Fragmented governance affected the capability of each program to tackle barriers in biogas digester dissemination. Besides, heavy subsidy on LPG by the government reduced attraction to biogas. This study shows technology adoption barriers beyond the user/individual aspects. It shows interaction among different factors such as policy, the governance of technology transfer, technical production issues, and socio-cultural problems.

SamenvattingIn 2012 werd in Nederland de buurtsportcoach geïntroduceerd. Sommige buurtsportcoaches hebben als doel de eerstelijnszorg en sport- en beweegsector met elkaar te verbinden en patiënten uit de eerstelijnszorg te verwijzen naar het lokale sport- en beweegaanbod. Dit onderzoek brengt in kaart op welke wijze de buurtsportcoach deze samenwerking realiseert en wat de impact is van de structurele inbedding van de buurtsportcoach op deze samenwerking. In drie interviewronden werden dertien buurtsportcoaches gedurende twee jaar in hun werkzaamheden gevolgd. Het netwerk van de buurtsportcoaches werd in kaart gebracht en uitgesplitst naar de wijze waarop ze structureel werden ingebed: in de sport- en beweegsector (type A), verschillende sectoren (type B) of een samenwerkingsverband (type C). Alle buurtsportcoaches realiseerden een samenwerking tussen beide sectoren. Type A‑buurtsportcoaches organiseerden de samenwerking rond eigen activiteiten waarin ze vaak samenwerkten met eerstelijnszorgprofessionals en sportorganisaties ondersteunden door bewoners naar hun activiteiten te begeleiden. Type B en C werkten gemiddeld met meer diverse organisaties samen, waardoor zij de samenwerking rond meer verschillende soorten activiteiten gericht op uiteenlopende doelgroepen realiseerden, waaronder de doorverwijzing van patiënten vanuit de eerstelijnszorg naar het sport- en beweegaanbod. Een structurele inbedding van de buurtsportcoach op integrale wijze (type B en C) lijkt het meest kansrijk voor het bereiken van de gewenste uitkomsten.

Background Social determinants of health (SDoH) are known to have a large impact on health outcomes, but their effects are difficult to make visible. They are part of complex systems of variables largely indirect effects on multiple levels, constituting so-called wicked problems. This study describes a participatory approach using group model building (GMB) with stakeholders, in order to develop a qualitative causal model of the health effects of SDoH, taking poverty and debt in the Dutch city of Utrecht as a case study. Methods With GMB we utilised the perspective of stakeholders who are directly involved in policy and practice regarding poverty, debt, and/or health. This was done using system dynamic modelling, in three interactive sessions lasting three hours each. In these sessions, they constructed a model, resulting in a system of variables with causal relationships and feedback loops. Subsequently, the results of these GMB sessions were compared to scientific literature and reviewed by a panel of researchers with extensive experience in relevant scientific fields. Results The resulting model contains 71 causal relationships between 39 variables, 29 of which are present in feedback loops. The variables of participation in society, stress, shame, social contacts and use of services/provisions appear to hold prominent roles in the model’s mechanisms. Most of the relationships in the model are supported by scientific literature. The researchers reviewing the model in the scientific meeting agreed that the vast majority of relationships would concur with scientific knowledge, but that the model constructed by the stakeholders consists mostly of individual-level factors, while important conditions usually relate to systemic variables. Conclusions Building a model with GMB helps grasp the complex situation of a wicked problem, for which it is unlikely that its interrelationships result in a fully intuitive understanding with linear mechanisms. Using this approach, effects of SDoH can be made visible and the body of evidence expanded. Importantly, it elicits stakeholders’ perspectives on a complex reality and offers a non-arbitrary way of formulating the model structure. This qualitative model is also well suited to serve as conceptual input for a quantitative model, which can be used to test and estimate the relationships.

BACKGROUND: Most research on burnout has focused on its antecedents, correlates, and consequences. However, little empirical attention has been paid to what constitutes successful rehabilitation after burnout, especially among young employees. OBJECTIVE: The present study empirically examined resources supporting successful rehabilitation after burnout among young employees (between 18 and 35 years of age) from a salutogenic perspective. METHODS: Interpretative phenomenological analysis was used as a methodological framework to explain the experiences of young employees underlying their rehabilitation after burnout. RESULTS: The analysis showed that the rehabilitation process comprises four phases: 1) facing the crisis; 2) addressing the root causes; 3) seizing and achieving the opportunity; and 4) staying at work. Essential overarching resources facilitating successful recovery after burnout included receiving social support from family, friends, and colleagues, as well as having a feeling of control over the rehabilitation process. Participants learned to be aware of potential pitfalls that could trigger burnout symptoms, while having confidence in their ability to prevent burnout from reoccurring. These continuous learning processes were experienced as a prerequisite to remain at work. CONCLUSIONS: Receiving social support and experiencing a feeling of control over the rehabilitation process appear to be key resources in facilitating a stable, meaningful return to work after burnout.

In the global south, the use of firewood and LPG as dominant energy sources for cooking contributes to socio-ecological issues. Alternatively, biogas is considered a cleaner energy source generated from organic waste. However, in Indonesia, until 2018, only less than 2 percent of households utilized biogas for cooking fuel. This research aims to explore the landscape of biogas governance in Indonesia, its fragmentation and its relation with biodigester dissemination. This study found that there is fragmentation within small-medium scale national biogas programs in Indonesia. Seven national government biogas programs have similar governance arrangements and characteristics; scattered in different departments within the ministry, using the grant approach with two main vendors, often overlapping with local government programs and not providing proper monitoring and evaluation mechanism, as well as proper training for users. Meanwhile, the biogas program by a non-government organization utilizes a semi-commercial approach; collaborating with multiple stakeholders (governments, local construction partner organizations, cooperatives and private sectors-companies and banks); and has standardized training and after-sale services. Within those biogas programs, there are multiple barriers along the supply chain process of biodigester dissemination. These barriers relate to the governance aspect of biogas programs. Fragmented governance affected the capability of each program to tackle barriers in biogas digester dissemination.

Background Healthy eating can improve the course of type 2 diabetes mellitus (T2DM) considerably. As changing eating behaviors in everyday is challenging, there is a need for a nutritional strategy with an eye for everyday life of people with T2DM. A theory centered around the everyday life context is salutogenesis. Salutogenic principles have been operationalized in a new nutritional program for T2DM on food literacy and well-being: the Salutogenic Intervention for Type 2 Diabetes (SALUD) program. Objective This study aims to describe the protocol of the invention study that will examine the quantitative and qualitative effects of the SALUD program. Methods A semiblinded randomized controlled trial will be performed in the Netherlands. A sample size of 56 (including a 30% dropout rate) people with T2DM has been calculated, of whom half (n=28, 50%) will follow the SALUD program (intervention) and half (n=28, 50%) will receive usual care (control). Recruitment strategies consist of advertisement via local health care professionals, posters, social media, and local newspapers. The SALUD program consists of 12 weekly web-based group sessions under the supervision of a certified lifestyle coach. Fidelity of the delivery is guaranteed by selecting a salutogenic coach, use of an intervention manual, training of the coach, weekly evaluation forms, and recording several sessions. The theoretical salutogenic principle of the intervention is mobilizing 2 important psychosocial resources required for organizing healthy eating in everyday life: self-identity and social support. Measurements will be performed at 3 times: at baseline (T0), after 12 weeks (postintervention; T1), and after 24 weeks (follow-up; T2). The primary outcome is food literacy, measured with the self-perceived food literacy scale questionnaire (expected effect size=0.9). Secondary outcomes are self-efficacy, quality of life, sense of coherence, diet quality, body weight, BMI, and waist-hip ratio. All outcomes will be tested with linear mixed models, following an intention-to-treat approach and standard principles of randomized controlled trials. In addition, a qualitative analysis will be performed. Results The proposed study will provide useful information on the effects of a salutogenic program on healthy eating and well-being in people with T2DM in everyday life. Recruitment started on October 1, 2021. The intervention participants followed the SALUD program between January and August, 2022. The acquisition of the data was completed on August 1, 2022; publications are expected in 2023. Conclusions This study will be one of the first salutogenic interventions for T2DM, which will provide valuable information on what salutogenic intervention entail. The SALUD program may serve as a concrete, web-based tool. The combination of quantitative and qualitative measures allows a comprehensive evaluation of effects. These insights can be used for further optimalization of T2DM interventions. Trial Registration Netherlands Trial Registry, NL8963; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8963 International Registered Report Identifier (IRRID) DERR1-10.2196/40490

This study examined whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). Findings revealed that increased frequency of participation in religious activities was significantly associated with decreased HbA1c levels, whereas increased use of TM practitioners was significantly associated with increased HbA1c levels. These findings suggest that strategically integrating religious activities into disease management plans for Ghanaians with T2DM who identify as being religious may be a viable intervention mechanism.

Despite the increasing interest in the determinants of adolescent undernutrition in low- and middle-income countries, a comprehensive multi-level overview at the country level is missing. Using the nationally representative 2014 Nepal Adolescent Nutrition Survey, this study aimed to provide a comprehensive overview of the sociocultural and economic determinants of stunting and thinness of adolescent boys and girls in Nepal. Multivariate logistic regression models were used to estimate the associations between multiple individual, household and community determinants and stunting and thinness among 3773 adolescents aged 10–19 years (1888 boys and 1885 girls). The prevalence rates of stunting and thinness indicated suboptimal nutritional status and an inadequate growth environment in Nepali adolescents. The results highlighted an association of paternal occupation and education, household income, number of earning household members, geographical place of residence, caste/ethnicity and nutritional knowledge with stunting, with higher odds for males and older adolescents. Paternal occupation, education, household income, geographical region, caste/ethnicity and nutrition knowledge were associated with thinness, with higher odds for males and younger adolescents. The findings underscore the importance of involving adolescents, their parents and their communities in interventions. Such interventions should not only be aimed at improving adolescent nutrition but also at optimizing adolescents’ growth environment for better health and development. Future research should focus on context-specific causal pathways and mechanisms through which sociocultural and economic determinants influence nutritional outcomes within broader societal, cultural and political settings. A longitudinal approach, including a range of dietary and nutrition indicators would allow understanding how and when the relative importance of these factors change during adolescence.

Summary Care Sport Connectors (CSCs) have been appointed to create a connection between primary care and physical activity (PA) sectors to stimulate inactive residents into becoming physically active. Adequate recruitment strategies are necessary to reach the intended target group in order to foster the sustainability of lifestyle interventions. The objective of this study is to explore PA behavior and health characteristics of the target group reached by CSCs and if these characteristics differ between participants when grouped based on how they were recruited. Participants from lifestyle interventions were included between September 2014 and April 2016 using a purposive sampling method. Participants were recruited through CSCs via public relations (n = 135), a personal letter (n = 136), or a referral (n = 98) and compared based on their PA level, health-related quality of life, motivation, self-efficacy, morbidity and health-related fitness. Scores were analyzed with a multi-level (mixed model) analysis measured before the intervention. The three groups were different in PA level (p = 0.002). The outcomes regarding health-related quality of life, motivation, and number of somatic disorders were also significantly different for the three groups, except for the categories of mental health (p = 0.145) and self-efficacy (p = 0.464). For all dimensions, the referral group scored the least favorable. The investment in time and money for an active recruitment strategy like referrals is worthwhile because it provides CSCs the opportunity to reach people who are inactive and at risk of chronic disease. Future studies are necessary to reveal the effect on PA levels and health in the long-term.

BackgroundThe COVID-19 pandemic has a potential negative impact on mental health. Adopting the salutogenic model of health, this study examined the predictive value of personal (sense of coherence), social (social support, trust in institutions), and national (sense of national coherence) resources for mental health in the Netherlands during the COVID-19 pandemic.Participants and procedureAn online survey was administered in the Netherlands (N = 622) in April 2020. A multiple regression analysis was performed to test the predictive value of the resources for mental health.ResultsMental health was significantly predicted by the sense of coherence, social support and sense of national co-herence, but not by trust in institutions. The results showed that personal and social resources were most strongly related to mental health.ConclusionsThe results suggest that mental health is predicted by various resources. Hence, strengthening resources seems vital in promoting mental health in times of crisis.

The COVID‐19 pandemic and remote working challenge employees’ possibilities to recover from work during their off‐job time. We examined the relationship between off‐job crafting and burnout across the COVID‐19 crisis. We used a longitudinal research design, comprising one wave collected before the onset of the pandemic, in March 2019 (T1), and one wave collected during the first lockdown of the crisis in April 2020 (T2). We measured the six off‐job crafting dimensions (Crafting for Detachment, Relaxation, Autonomy, Mastery, Meaning, and Affiliation) and burnout (fatigue/exhaustion) via a questionnaire among German and Swiss employees (N = 658; Age M = 47; 55% male). We found that both burnout levels and crafting for affiliation significantly decreased at T2 compared to T1. All off‐job crafting dimensions and burnout correlated negatively cross-sectionally and longitudinally. Regression analyses showed that employees who crafted in their off-job time before and during the crisis experienced fewer burnout complaints during the crisis. Looking more closely at the subdimensions of off‐job crafting, employees who crafted for detachment before and during, and for affiliation before the crisis, reported less burnout during the crisis. We conclude that off‐job crafting may act as a buffer mechanism against burnout during the COVID‐19 crisis. publishedVersion

The complex nature of Sport for Development (SfD) programmes makes impact evaluation challenging. Realist evaluation has been proposed as a new, theory-driven approach to evaluate complex programmes. The present study aimed to explore the value of conducting realist interviews to gain improved insight into the mechanisms and outcomes of three SfD programmes in the Netherlands: a programme that promotes sports participation among socially vulnerable youth; a combined lifestyle intervention for adults of low social economic status; and a sports-based programme for marginalised adults. In addition, the study aimed to investigate the applicability of a conceptual model from the field of social enterprise (Roy, Baker, & Kerr, 2017) as the preliminary programme theory for those interviews. First, for each programme, a realist interview was conducted with one researcher as the key informant. Thereafter, the findings from and experiences with the individual realist interviews were discussed among the informants in a group meeting. The results revealed that the conceptual model functioned well as preliminary programme theory for the SfD programmes. The realist interviews contributed to theoretical awareness and trustworthiness. Importantly, the interviews highlighted knowledge gaps and generated ideas for programme improvement. Hence, the realist interview technique is recommended as a methodological tool to generate, validate, and improve programme theory in the field of SfD. This study had, however, an explorative character, and more research is needed to confirm and generalize the findings and to learn how a greater number of stakeholders might contribute to this type of realist evaluation.

We can no longer claim that academic interest in the area of sport and social inclusion is lacking. Dedicated books, special issues, commissioned reports, and landmark articles on the topic of social inclusion and sport have been produced by devoted scholars. The same can be said for the burgeoning area of sport for development and peace. These relatively young academic fields seem to be struggling to create new fundamental theoretical insights about how organized sport can both act as an inclusive space and as a vehicle for broader developmental outcomes. Despite scholarly advancements, there remains a number of empirical and theoretical gaps. The aim of this special issue is to critically reflect on issues related to sport, development, and inclusion, and to do so via transdisciplinary and intersectoral perspectives. By making such a contribution, we aim to open up new research pathways.

Background: In light of worrying public health developments such as declining life expectancy gains and increasing health inequalities, there is a heightened interest in the relationship between politics and health. This scoping review explores the possible welfare policy consequences of populist radical right (PRR) parties in Europe and the implications for population health. The aim is to map the available empirical evidence regarding the influence of PRR parties on welfare policy reforms and to understand how this relationship is mediated by political system characteristics in different countries. Methods and Analysis: A scoping review of peer-reviewed empirical literature addressing the relationship between PRR parties, political systems and welfare policy in Europe was performed using the methodology by the Joanna Briggs Institute. Data was charted on main study characteristics, concepts and relevant results, after which a qualitative content analysis was performed. The data was categorised according to the political system characteristics: constitution, political economy, interest representation and partisanship. Five expert interviews were conducted for validation purposes. Early evidence from 15 peer-reviewed articles suggests that exclusionary welfare chauvinistic positions of PRR parties are likely to have negative effects on the access to welfare provisions and health of vulnerable population groups. Differences in implementation of welfare chauvinistic policy reforms are partly explained by mediation of the constitutional order (judicial institutions at national and European Union [EU] level), political economy (healthcare system funding and European single market) and partisanship (vote-seeking strategies by PRR and mainstream parties). No clear evidence was found regarding the influence of interest representation on welfare chauvinistic policies. Discussion: While early evidence suggests that the welfare chauvinistic ideology of PRR parties is harmful for public health, the possible mediating role of political system characteristics on PRR welfare policy influence offers risk and protective factors explaining why the PRR ideology plays out differently across Europe.

Background Forty-three out of 53 of the WHO European Member States have set up political and institutional mechanisms to implement the United Nations (UN) 2030 Agenda for Sustainable Development. This includes governance and institutional mechanisms, engaging stakeholders, identifying targets and indicators, setting governmental and sectoral priorities for action and reporting progress regularly. Still, growing evidence suggests that there is room for advancing implementation of some of the Sustainable Development Goals (SDGs) and targets at a higher pace in the WHO European Region. This article proposes the E4A approach to support WHO European Member States in their efforts to achieve the health-related SDG targets. Methods The E4A approach was developed through a 2-year, multi-stage process, starting with the endorsement of the SDG Roadmap by all WHO European Member States in 2017. This approach resulted from a mix of qualitative methods: a semi-structured desk review of existing committal documents and tools; in-country policy dialogs, interviews and reports; joint UN missions and discussion among multi-lateral organizations; consultation with an advisory group of academics and health policy experts across countries. Results The E—engage—functions as the driver and pace-maker; the 4 As—assess, align, accelerate and account—serve as building blocks composed of policies, processes, activities and interventions operating in continuous and synchronized action. Each of the building blocks is an essential part of the approach that can be applied across geographic and institutional levels. Conclusion While the E4A approach is being finalized, this article aims to generate debate and input to further refine and test this approach from a public health and user perspective.

There is growing recognition that traditional dementia care models fall short for people with dementia and their family caregivers. This has led to a call for new dementia care approaches. In response to this call, innovations in long-term dementia care are taking place both in the community and in residential care. One of these innovations is the care concept called “care farming”. Care farms are farms that combine agricultural activities with care and support services for a variety of client groups, including people with dementia. Although the concept is being implemented in an increasing number of countries, the Netherlands and Norway are still front-runners in providing and researching this innovative dementia care approach. Over the last couple of years, several research projects have been carried out in these countries addressing a wide range of issues related to dementia care provision at care farms and using a wide range of research methods. This paper synthesizes the knowledge that has been generated in these research projects. By sharing the knowledge obtained in the Netherlands and Norway, we hope to inspire leaders in healthcare undertaking similar efforts to innovate care for the increasing number of people with dementia. By providing starting-points for future research, we additionally hope to contribute to a research agenda to further advance the field.

Background Do political parties matter to health? Do they affect population health either directly or through welfare states’ social policies and the eligibility, affordability and quality of health systems? And if they do, how? These are crucial questions if we are to understand health politics or shape public health policy, particularly given the changing landscape of political parties, party dominance in the executive and the mediating influence of the legislature. Methods Using a systematic approach, this review examines 107 peer-reviewed articles and books published after 1978 focusing on high-income countries asking the overarching question: Do political parties matter to health and the welfare state? Results The literature relating parties to health directly was surprisingly thin, thus, the welfare state was used as a ‘proxy’ variable. An overwhelming majority of the literature sample suggests that Left parties are inclined to expand the welfare state without cutting benefits, while the Right does not expand and tends to reduce benefits. There was an inflection in the 1980s when Left parties shifted from expansion to maintaining the status quo. Conclusion Considering current health trends in the form of measles outbreaks, the ‘Deaths of Despair’, the rise of previous eradicated infectious diseases and the declining health expectancy rates in some Western countries as well as the rise of Populist Radical Right parties in office we question the current partisanship thesis that political parties matter less and less.

The aim of this study was to explore effects of a major urban reconstruction on physical activity (PA) behavior by comparing PA intensity hotspots before and after the tunneling of a highway with a new infrastructure prioritized for walking and cycling. In total, 126 individuals participated before and after the tunneling. GPS loggers and accelerometers were used to assess location and PA levels. A geographic information system (GIS) was used to perform optimized hotspot analyses on PA data, both on transport and stationary data points. The results showed several changes in PA hotspots on trip data, even if total PA levels did not change. At follow-up, PA intensity hotspots were more connected, with the new infrastructure as a central connection. This was true for higher and lower educated individuals. Therefore, if changes in the built environment do not result in changes on population-level outcomes, this does not imply that they have no impact on behavior.

In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. A health broker role is recognized as being helpful in connecting the coalition with the broader network, and participatory action research (PAR) is deemed supportive because it facilitates evaluation, reflection, learning and action. However, there is a lack of insight into how processes that affect collaboration develop over time. Therefore, this study aimed to provide insights into the coalition's processes that facilitate building and maintaining intersectoral collaboration within a HPP coalition and network and how these processes contribute to the coalition's ambitions. As part of PAR, the coalition members used the coordinated action checklist (CAC) and composed network analysis (CNA) in 2018 and 2019. The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on pro-gress and future planning. Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership and the importance of visibility and trust leading to investment in continuation. The combined research instruments and group sessions supported discussion and reflection, sharing visions and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.In this study, we explored collaboration between professionals working in different sectors within and outside healthcare. We looked at the processes that facilitate the building and maintenance of intersectoral collaboration within a coalition that developed a health promotion programme together with a network of contacts in the community. Participatory action research (PAR) was used, which means that results from research tools like questionnaires and interviews were discussed with workers and inhabitants involved, so that they could adjust their working strategy and ambitions. The most important processes appeared to be the organization of the coalition, how the members of the coalition interacted with the context and built the network, and how they publicized their activities. Important findings concerned the health broker’s role, the programme coordinator’s leadership and the importance of visibility and trust. The collaboration in this programme delivered the following achievements: increased capacities of group members, health promoting activities, a broader and strengthened network and a shift in community workers’ thinking about health, resulting in the involvement of the municipality, which provided budget to invest in the continuation of the programme. We concluded that PAR was useful for evaluating and simultaneously facilitating the processes that affect collaboration.

Background In general during pregnancy, women are aware of the importance of good diet quality, interested in nutrition, and receptive to changing dietary intake. However, adherence to dietary guidelines is sub-optimal. A pregnant woman’s first information source regarding nutrition information is her midwife. Healthy nutrition promotion by midwives may therefore be very promising, but midwives face multiple barriers in providing nutritional support. Empowering pregnant women to improve their diet quality is expected to improve their health. Therefore an empowerment intervention has been developed to improve diet quality among pregnant women. The objective of this study is to evaluate the effectiveness and feasibility of Power 4 a Healthy Pregnancy (P4HP). P4HP aims to empower pregnant women to have a healthier diet quality. Methods/design This study applies a mixed methodology consisting of a non-blinded cluster randomized trial with an intervention (P4HP) group and a control group and a process evaluation. Midwifery practices, the clusters, will be randomly allocated to the intervention arm (n = 7) and control arm (n = 7). Participating women are placed in intervention or control conditions based on their midwifery practice. Each midwifery practice includes 25 pregnant women, making 350 participants in total. Health related outcomes, diet quality, empowerment, Sense of Coherence, Quality of Life, and Self-Rated Health of participants will be assessed before (T0) and after (T1) the intervention. The process evaluation focuses on multidisciplinary collaboration, facilitators, and barriers, and consists of in-depth interviews with midwives, dieticians and pregnant women. Discussion This study is the first to evaluate an empowerment intervention to improve diet quality in this target population. This mixed method evaluation will contribute to knowledge about the effectiveness and feasibility regarding diet quality, empowerment, health-related outcomes, multidisciplinary collaboration, facilitators and barriers of the empowerment intervention P4HP. Results will help inform how to empower pregnant women to achieve improved diet quality by midwives and dieticians. If proven effective, P4HP has the potential to be implemented nationally and scaled up to a long-term trajectory from preconception to the postnatal phase. Trial registration The trial is prospectively registered at the Netherlands Trial Register (NL9551). Date registered: 19/05/2021.

Purpose: Malnutrition is a pressing public health challenge in South Asia with adverse consequences for adolescent girls' well-being and, potentially, aspirations as drivers of developmental progress. This study aimed to investigate associations between changes in malnutrition and changes in girls' aspirations in key life domains.Methods: We analyzed two-period panel data from the Suaahara II Adolescent Girls Panel (10–19 years) in Nepal (2018–2019, n = 613). Height, weight, blood samples, 24-hour dietary recalls, and indicators of girls' educational, occupational, marital, and fertility aspirations were collected. Height-for-age z-scores, body mass index–for-age z-scores, hemoglobin concentration (Hb g/dL), and dietary diversity scores for women were calculated. Through cluster-robust fixed-effects regressions, we examined whether changes in thinness (body mass index–for-age z-scores < −2 standard deviation), anemia (Hb 12 years; Hb

Adolescents’ aspirations are important for a healthy transition into adulthood. Knowledge about girls’ aspirations and their formation in a low-income context is scant. Framed within life course theory, this qualitative study aimed to understand adolescent girls’ life aspirations, with a specific focus on school, work, family life, health and diets, and explore how aspirations are shaped within girls’ everyday life context, in Nawalpur and Parasi, two districts in the plains of Western Nepal. Data collection involved interviewing 17 adolescent girls (11–19 years) using creative elicitation techniques: timeline drawing and network mapping. Thematic analyses revealed unique aspiration profiles of younger, older, and married adolescent girls. While younger girls were present-oriented and aspired high, older girls balanced aspirations with reality and in turn, adjusted their aspirations. Married women had mostly resigned themselves to their present lives and transferred their lost aspirations onto their children. Findings underscore how girls’ feelings, others in their daily lives, gendered norms, and structural factors, are related to different domains of aspirations during different stages of adolescence. Results give direction to integrated policies and programs that aim to sustain and cultivate adolescent girls’ aspirations at specific stages of adolescence.

The original publication of this article [1] contained several errors in the author names. The incorrect and correct author names are listed in this correction article. The original article has been updated.

IntroductionThe overweight and obesity rates of today are unfavourable, have increased over the past years and are expected to further increase in the future. Overweight and obesity appear more among citizens with a low socioeconomic status (SES) compared with citizens with a higher SES, leading to health inequalities. Therefore, care–PA initiatives have been developed, in which the healthcare sector and the PA sector collaborate to improve the health and lifestyle of citizens by increasing daily PA and improving dietary behaviours. However, much is still unknown regarding the effectiveness and funding of care–PA initiatives for citizens with a low SES. Therefore, X-Fittt 2.0 has been developed, which is being studied in this thesis.X-Fittt 2.0 is a 2-year programme consisting of two phases: a 12-week intensive programme and a 21-month aftercare phase. During the first 12 weeks, participants receive intensive guidance in developing a healthy lifestyle, which consists of four parts: per week two sports sessions in a group guided by a sports coach and one individual sports session; dietary advice and monitoring by a dietitian; coaching by a lifestyle coach; and two appointments with a physiotherapist. The remaining 21 months comprise the aftercare phase, during which participants receive coaching by a lifestyle coach to work on their personal goals and to encourage behavioural maintenance regarding a healthy lifestyle.AimThe aim of this thesis is to contribute knowledge and insights about care–PA initiatives for citizens with a low SES, so that existing and future initiatives can better suit this group. In the light of this aim, seven research questions were addressed:What are the short- and long-term outcomes of participation in X-Fittt 2.0, in terms of health, quality of life (QoL) and societal participation?What is the impact of participation in X-Fittt 2.0 on the healthcare utilisation of citizens with a low SES?What are the experiences of the participants in the combined lifestyle intervention X-Fittt 2.0?What are the effective elements of X-Fittt 2.0, a combined lifestyle intervention for people with low SES?What are the effective elements of care–PA initiatives for adults with a low SES in the Netherlands, based on the experiences of health promotion experts?What are citizens’ preferences regarding the public funding of projects that promote a healthy body weight among people with a low income, and do these preferences differ between people with different incomes?Why do citizens prefer certain projects that promote a healthy body weight among people with a low income over others?MethodsThis study adopted a mixed-methods approach. To study the short- and long-term impact of X-Fittt 2.0 on health, quality of life (QoL) and societal participation, data from 208 participants were collected using questionnaires and body measurements, 17 group discussions (n=71) and 68 semi-structured interviews over a 2-year period. In addition, to study the impact of X-Fittt 2.0 on healthcare utilisation, healthcare claims data of 44 X-Fittt 2.0 participants were used, comparing the 2 years before the start of X-Fittt 2.0 with the 2 years after the start. The 17 group discussions (n=71) and 68 semi-structured interviews with participants were also used to evaluate the experiences of participants with X-Fittt 2.0. To unravel the effective elements of X-Fittt 2.0 and care– PA initiatives for citizens with a low SES in general, two concept mapping studies were conducted, using nine public health practice professionals and one participant, and 19 health promotion experts. Additionally, to explore citizen preferences regarding the public funding of projects promoting a healthy body weight among people with a low income, to identify whether such preferences differ between citizens with a low income and those with a higher income and to identify the reasons underlying these preferences, a participatory value evaluation among 1,053 Dutch citizens was used.Conclusions and recommendationsThis thesis has extended the understanding of care–PA initiatives for citizens with a low SES, which resulted in three important insights. First, support and guidance from professionals appears to play an important role in learning and maintaining new health behaviours, motivating participants and overcoming barriers to a healthy lifestyle, such as being physically active. Second, highly accessible initiatives are needed that address different barriers experienced by citizens with low SES. For example, an initiative that is offered at low cost, at a location close to the participants’ homes where participants feel comfortable, and that participants can easily combine with their daily activities. Third, offering group-based initiatives also seems valuable for motivation and support and for sharing knowledge and experiences, which might help in improving participants’ lifestyles. These insights led to implications for policy, practice and research.Implications for policy include for example: prioritising health promotion programmes for citizens with a low SES, such as care–PA initiatives; and including the PA portion of care–PA initiatives in the basic healthcare insurance scheme or offering the PA portion at an affordable price.Regarding practice, implications include: providing a long and intensive period of support and guidance in care–PA initiatives, followed by a long period of aftercare; and involving citizens with a low SES in the development of care–PA initiatives.Recommendation for future research are: to include a larger study population and, regarding healthcare utilisation, a longer study period as well, to study the effectiveness of care–PA initiatives for citizens with a low SES; to study whether overweight and obese citizens with low SES who start a care–PA initiative after a long period of physical inactivity are more at risk of developing PA-related injuries.We need to care to move citizens with a low SES to a healthier lifestyle. This means governments that care about the health of citizens; policies that encourage healthy behaviour; healthcare and PA sectors that move towards an integral approach to health promotion; and governments and practitioners that acknowledge the barriers that limit citizens with a low SES to live healthily. And then, if accessible care–PA initiatives exist, people with low SES can care to move.

BackgroundEvidence about the impact of the COVID-19 pandemic on existing health inequalities is emerging. This study explored dif-ferences in mental health, sense of coherence (SOC), sense of community coherence (SOCC), sense of national coherence (SONC), and social support between low and high socioeconomic (SES) groups, and the predictive value of these predictors for mental health.Material and methodsA cross-sectional study was conducted using an online survey in the Netherlands in October 2021, comprising a total of 91 respondents (n = 41, low SES; n = 50, high SES).ResultsThere were no differences in mental health, SOC, SOCC, SONC, and social support between the groups. SOC was a predictor for mental health in both groups and SOCC for the low SES group.ConclusionsWe found that both SOC and SOCC predict mental health during the pandemic. In the article we reflect on possible path-ways for strengthening these resources for mental health.