Evaluating evaluations of health promotion campaigns in the Netherlands

Nationwide health promotion campaigns are an important part of government-funded health promotion efforts. Valid evaluations of these campaigns are important, but difficult because gold standard research designs are not applicable and budget, personnel, and time for evaluation is often very tight. In the Netherlands, Health Promotion Institutes (HPIs) are responsible for these campaigns. We conducted an exploratory study among the HPIs to gain a better insight into the goals, practices, conditions, and perceived barriers regarding evaluation of these campaigns. A paper reporting this exploration was recently published in Health Promotion International.

We conducted  personal interviews with representatives of six different HPIs who had direct responsibility for the management of the evaluation of their national campaigns. Based on these interviews it became clear that the HPIs typically made use of a pre-test–post-test design with single measurements before and after the campaign without a control group. In campaign preparations, HPIs used qualitative research to pre- and pilot-test some campaign materials or activities, but true formative evaluation was rare. Accountability to their sponsors, peers, and the population at large, was an important reason for evaluation, but the most important intrinsic motivation to evaluate was to inform future campaigns. In terms of the RE-AIM (Reach Efficacy Adoption Implementation Maintenance) framework, evaluation was mostly restricted to reach and effects; hardly any evaluation of adoption, implementation, or maintenance was reported. Budget restrictions and time restraints were reported as the main barriers for more extensive formative and more elaborate interrupted time series design effect evaluation. In conclusion, our exploration indicates that evaluation of nationwide campaigns is standard procedure, but the research designs applied are weak, due to lack of time, budget and research methodology expertise. Next to additional budget and opportunities for longer-term planning, input from external experts regarding evaluation research designs and data management are needed for evaluation improvement.

The ENERGY project is halfway

From August 29-31 we had the 'midterm' meeting of the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) project a Framework 7 European Commission funded project coordinated by the EMGO Institute for Health and Care Research. The midterm meeting was organised by and held at the University of Oslo, department of Nutrition. Halfway through the project we have conducted a series of systematic reviews that have or will soon be submitted for publication on family environmental determinants of obesity related behavioral nutrition and physical activity, on mediators and moderators of obesity prevention intervention effects, and of economic incentives in such interventions. Secondary analyses and focus group interviews have been conducted to gain more insight in the above mentioned determinants. But maybe most importantly, in the firts 18 months a cross European school-based, family involved survey study has been conducted among more than 7000 children in 7 countries across Europe. In this survey study, school children were measured for weight, height and waist circumference, they completed questionnaires on a range of dietary , physical activity and sedentary behaviors, and a sub sample wore accelerometers to assess their physical activity more objectively and gave blood samples for further biomarker evaluation. The data set is now being checked and cleaned and will soon be ready for first analyses. A copy of the design paper van be accessed here. A protocol paper for the survey study will soon be submitted for publication. We celebrated this accomplishment with a nice Norwegian see food dinner that was further enriched with a great musical performance by a Norwegian four female vocal group.

In the second half of the project an intervention to contribute to evidence-based obesity prevention among schoolchildren in Europe will be developed and tested in five countries. The meeting was largely dedicated to the first steps of mapping this intervention.

Voor Dik en Dun ('For thick and thin'): Health Council of the Netherlands report on obesity prevention and eating disorders

Many interventions and initiatives are being undertaken, also on behalf of the Dutch Ministry of Health, Welfare and Sport, to contribute to the prevention of overweight and obesity in the Netherlands. These government initiated or supported interventions are mainly aiming to promote healthier eating and  physical activity behaviors. In the context of these prevention and health promotion projects, the Minister of Health, Welfare and Sport has asked the Health Council of the Netherlands to advise on whether this increased attention that is being paid to overweight and obesity in the public arena may be a risk factor for the development of eating disorders. In the advice, that was published today, a specially appointed Committee, chaired by Professor Inez de Beaufort, and I had the pleasure to be a committee member, concludes that only very limited research has been conducted on this specific topic, but what is known to date suggests that the present day official campaigns and interventions for prevention of overweight are unlikely to cause eating disorders. Therefore, the committee concludes that there is no need to modify the current prevention policy focusing on a healthy diet and sufficient physical activity.
Different articles were published in Dutch news papers today on the publication of this report, for example in 'De Telegraaf', and on 'Nu.NL'. Interestingly, these media put most emphasis on the fact that campaigns may have negative side effects related to eating disorders instead of on the main conclusions described above.

The FoBoNet network for PhD students from the Nordic countries interested in food and nutrition

The FoBoNet seminar series is a podium for PhD students and their advisors from the Nordic countries with an interest in Nutrition research, especially from a social sciences perspective. Dr. Gun Roos, from the National Institute for Consumer Research in Oslo, Norway, is the actual coordinator, and takes care of this series in close collaboration with her sister Dr. Eva Roos from Folkhälsean Research Center, Helsinki, Finland, from.., Professor Margareta Wandel, from the University of Oslo and Professor Lotte Holm from Kopenhagen University. This year the event took place from August 23-25 in Tuusula, near Helsinki, Finland. I was invited to give a keynote lecture. A pdf handout of the presentation can be accessed here.

It is a three day event, but I could unfortunately only be there for the first and part of the second day. Gun Roos did the introductions at the start of the seminar. Then the actual program started with two ‘keynote lectures’. The larger part of the rest of the program was what the network is really about: PhD students presenting part of their work.
Professor Dale Southerton, director of the Sustainable Practices Research Group at Manchester University gave the first keynote in which he presented a theory on determinants of food choice and habits. He posited that we should take a much more practice-based approach, i.e. looking at what people actually do, instead of a more attitude/motivational (i.e. in line with for example the Theory of Planned Behavior)-based approach.

I provided a keynote on environmental influences on behavioral nutrition and physical activity. Both Professor Southerton and myself build a case for the importance of contextual factors, i.e. the physical, social cultural, political and economical environments in explaining food habits.

On the Tuesday morning Carola Ray from the Folkhälsan Research Center in Finland, Kristiina Kainulainen of the University of Helsinki, Hillevi Preli and Stina Olafsdottir, both from the University of Gothenburg presented their work all related to determinants of food and health among children. Eva Roos of the Folkhälsan Center chaired the session. Presentations covered school-based intervention studies to promote healthier lifestyles, social, cultural and personal factors related to easting habits, an analysis of food TV adds in Sweden, and the relation between watching TV and intake of sugar-sweetened drinks among youngsters.


Today I provided a lecture at the FoBoNet network meeting. The FoBoNet seminar series is a podium for PhD students and their advisors from the Nordic countries with an interest in Nutrition research, especially from a social sciences perspective. I talked about personal and environmental determinants of behavioral nutrition & physical activity.

A study to inform interventions to prevent unintentional poisoning of toddlers

A study by Beirens and colleagues published in the International Journal of Pediatrics reports on an explorative study on determinants of safely storing medication and cleaning products by parents to avoid poisoning in their kids. Unintentional poisoning is a major cause of nonfatal injuries in children aged 0-24 months. Associations of self-reported habits regarding 'child safe storage' of medication and cleaning products by parents with a range of family factors and motivations and attitudes were assessed. Data were gathered from a cross-sectional survey using self-administered questionnaires, mailed to a population sample of 2470 parents with toddlers. The study was based on the Protection Motivation Theory. 

The results suggests that health promotion activities promoting safe storage habits should particularly focus on parents' self-efficacy of storing poisonous products in a child safe manner and on the vulnerability of their child in their home concerning an unintentional poisoning incident.

being a participant in the PROOF study

In the Netherlands, approximately half of the working population works regularly with a computer. This concerns over 3 million people. Pain in the neck, shoulders, arms and/or hands, referred to as musculoskeletal disorders (MSDs), are still very common in this group and the size of this group is not decreasing. Previous research has shown that psychosocial work environment and computer use play a role in the development of MSDs. However, through what mechanisms is not known. The purpose of the so-called PROOF study (INTERACTIONS OF BIOMECHANICS AND PSYCHOSOCIAL STRESSORS IN RELATION TO THE DEVELOPMENT OF MSDs IN THE MODERN OFFICE)  is to get better insight in the development of MSDs by exploring the role of psychosocial work environment and computer use. We hope that the results will contribute to the prevention of MSDs in the future. The PROOF study is conducted by Linda Eijckelhof, MSc at the EMGO Institute for Health and Care research. The study is a collaboration with the Harvard School of Public Health in Boston, and is supervised by Professor Allard van der Beek here at EMGO+.

In this study, 120 office workers will be categorized in one of four defined profiles of psychosocial work environment, based on the amount of “reward” one receives at work and their reported level of “overcommitment” (both collected through a questionnaire). Biomechanical exposures (i.e. forces on keyboard and mouse, postural dynamics, and EMG of neck-shoulder muscles and wrist extensors) and computer usage will be measured for two hours during a workday at participants’ own work stations. These biomechanical factors will be compared across the four psychosocial profiles.


With these data a task-based exposure model will be developed to estimate the biomechanical exposures within different psychosocial work environments adjusted for individual factors. This model will be applied to a cohort of about 1000 office workers, of whom computer usage was assessed objectively and health outcome was self-reported in a two-year longitudinal study (PROMO). In this way, we will be able to relate biomechanical exposure to the development of MSDs measured in a large epidemiological study.
Yesterday I participated as one of the research subjects. Being researched instead of being a researcher for a change...

The 2009 annual report of EMGO+ is out

Two weeks ago we send out the 2009 annual report of the EMGO Institute for Health and Care Research (EMGO+). A pdf of the annual report can be accessed via this link. This 2009 report is the first annual evaluation after EMGO became EMGO+. On January 1 the old EMGO Institute of the VU University Medical Center, merged with strong research groups of the VU University faculties of Psychology & Education and of Earth & Life Sciences to conduct excellent research in public and occupational health, primary care, rehabilitation and long-term care.More specifically, by fulfilling its mission EMGO+ is aiming to contribute to improving evidence based:

• public and occupational health;
• primary health care;
• mental health care;
• rehabilitation practice;
• long-term health and health care.

The 2009 annual report shows that the institutes 2009 output in terms of publications, doctorol theses and acquired research funding is stronger than the sum of the 2008 outputs of the groups that merged to form EMGO+.