Author:

Abstract:

The last three decades the World Health Organization has advocated the use of the settings-based approach as the optimal strategy for health promotion. Aligned with an ecological model of health promotion, this approach emphasizes the importance of factors at the level of the individual, the organization and the environment, and the complex interactions between these levels. While the ultimate goal remains the improvement of the health status and behaviour of individuals, changes at the level of the environment and the organization are considered the most effective strategies to accomplish this objective. Over the intervening years, this settings-based approach has been applied to a variety of settings, but leisure time settings had long been ignored. This has changed in the last decade, with an increasing interest in the sports club as a ‘new’ setting for health promotion. It was the concerted efforts of Kokko and colleagues that resulted in the genesis of the Health Promoting Sports Club concept, which entails that sports clubs should adopt health promotion as a core aspect of their activities, for instance by cooperating with parents and health organizations, developing health enhancing policies, including changing the environmental conditions, and implementing health education (Kokko et al, 2006). Building on this foundation, the current doctoral research project has three overarching objectives. The first objective was to apply this concept in Flanders to study the health promotion orientation of Flemish youth sports clubs as measured by the Health Promoting Sports Club Index (Kokko et al, 2009). The second objective was to extend the scope of this field of research by adding an explicit focus on the motives and barriers reported by club officials regarding the implementation of health promotion in their youth sports club. Two new instruments were developed for this purpose as part of the first study. The third objective was to propose strategies that can be used to assist sports clubs to improve their health promotion profile. As the environment is one of the main pillars in the ecological model but most sports clubs do not own or manage their own sports infrastructure, a fourth objective is to explore if and how health promotion is implemented in sports facilities. The data for the first study (chapter two) was collected in 2011, with 154 youth sports clubs participating. Results indicate that these clubs were positively disposed towards health promotion, but this is not reflected in their policies and practices. This study also resulted in two new instruments. The Perceived Motives Index explores the reasons why the board of sports clubs would want to implement health promotion. In contrast, the Perceived Barriers Index is concerned with the obstacles reported by the representatives of the board of youth sports clubs. Other priorities and lack of expertise and knowledge are reported most often as primary barrier. The second study (chapter three) was conducted in 2012 and involved 156 youth sports clubs. Results of the regression analyses indicate that the perceived motives are important predictors for the health promotion orientation of youth sports clubs, while a lack of resources has an important negative effect. These results underscore the importance of taking perceived motives and barriers into account when developing strategies to support sports clubs. The third study (chapter four) was organized in 2015 with a total of 473 youth sports clubs completing the online questionnaire. The main goal of this study is to investigate the changes over time, if any, in the health promotion orientation of the youth sports clubs and its related motives and barriers. The data collected in the previous two studies was integrated with this new data set to cover a period of four years. Overall, the results of the analyses of variance and the repeated measures analyses confirm that the health promotion orientation of the sports clubs improves from 2011 to 2012, to then remain stable until 2015. In contrast, the motives are supported more strongly in 2011 than in 2012, although the scores recover in 2015 to return to the starting level of 2011. The perceived barriers, however, increase from 2011 to 2012 and remain at that level in 2015. The fourth study (chapter five) stands somewhat apart, exploring the attitudes, policies and activities regarding health promotion in 91 municipal sports facilities. Similar to the sports clubs, representatives of the sports facilities report a positive attitude towards health promotion, but do not consider it a priority. Even though only one in five of the facilities has a health promotion policy, almost all of the sports venues implement health promotion activities regarding one or more health topics. However, these strategies are mainly of the passive type, with awareness campaigns being used most often. In general, these studies indicate that the sports sector seems to have a positive attitude towards health promotion as a new expectation, without, however, considering it a priority. Due to the voluntary nature of their organization, sports clubs may lack necessary resources to implement health promotion in their policies and activities and need to be supported when making this transition.