File Name: physical activity and health promotion evidence based approaches to practice .zip
Phillip B. Sparling, Neville Owen, Estelle V. Lambert, William L.
Evidence-based public health: concepts, principles and applications to promote physical activity in the Brazilian context. Graduate Program in Physical Education. Curitiba, PR. Sports Center. Brown School. Louis, United States of America. Graduate Program in Urban Management. EBPH stages comprise aspects widely disseminated in the public health area, which are beginning to be used for the promotion of PA in Brazil.
The use of these concepts can improve Evidence-Based Decision Making EBDM through various aspects, including greater access to key scientific evidence, communication between those responsible for EBDM and researchers, in addition to investments in qualification of health professionals. In the last decades, there has been an increase in the proportion of deaths attributed to chronic noncommunicable diseases CNDs worldwide 1 , 2.
In Brazil, it is estimated that In view of the magnitude of this problem, initiatives to mitigate and even reverse this condition, mainly through the Unified Health System, have been proposed and some implemented 4.
Although these initiatives present consistent evidence, it is suggested that they could be improved with the use of current scientific evidence during the decision-making process related to the definition, prioritization and use of resources for health promotion strategies and programs 5. In fact, international studies indicate that interventions based on scientific evidence may be more effective in solving community health problems 6 , 7. It is believed that the application of concepts and principles of Evidence-Based Public Health EBPH in programs to promote physical activity PA is able to improve the use of resources human and financial and identify strategies to make these programs more effective 1 , 2 , 8.
Actions such as providing websites with health content and training on health management have been carried out in order to disseminate this concept among managers However, the implementation of EBPH concepts presents important barriers such as lack of professional qualification, lack of planning time, lack of incentive and support by health managers, as well as lack of knowledge about the EBPH process 9 , 11 , In addition, organizational aspects such as infrastructure, financing and legislation aspects may also limit the effectiveness of this concept 9 , 11 , It is suggested that the use of EBPH in Latin America is limited, at least in part, by the lack of knowledge of concepts, principles and stages of application in public health 5 , 9.
Therefore, the understanding of these elements can stimulate researchers and managers to adopt evidence-based decision making in a systematic way in the field of research and health service, including the promotion of PA. The growing concern about the impact of physical inactivity on CNDs has been observed through policy formulation 4 , program implementation 13 and human resource training in the Brazilian context. Therefore, the present study aims to: a describe concepts, principles and applications of EBPH; b discuss the possibilities of application of EBPH in the promotion of physical activity in Brazil.
Evidence-based decision making EBDM and EBPH are widespread concepts in the health area, especially in medicine and other professions in the public health area 15 , However, in relatively new areas, such as promotion of PA, such knowledge is still incipient.
Therefore, a literature review on the subject was carried out in order to describe concepts, phases and methods used in EBPH, as well as the implications of this subject for EBDM for the promotion of PA in Brazil.
The search was performed at PubMed databases in August and comprised the entire period available on databases. The application of EBPH concepts is directly related to the identification of the best available scientific evidence, i. In general, EBDM understands the use of complex data and occurs in one cycle.
Initially, the phenomenon to be investigated is observed, and a theory that can explain the phenomenon is established and an experiment is carried out. In addition, it is worth mentioning that in some cases, especially in the context of PA promotion, conducting an experiment is ethically questionable and operationally infeasible.
For example, a number of policy and environmental modifications aimed at PA promotion e. In these situations, the use of natural experiments and serial cross-sectional studies, as well as other designs, can provide important scientific evidence and should be considered 7.
One of the central principles of EBPH is to identify the best evidence in health. In this sense, Brownson et al. Type I evidence comes from longitudinal studies randomized, retrospective, cohort studies. They are characterized as the most appropriate evidence to test the causal relationship between two variables. In these studies, a group of individuals is followed for a period and the relationship between exposure and the health outcome is analyzed.
These evidences have been used as a basis for the implementation of community programs, since in addition to establishing the cause s of diseases, they allow analyzing the magnitude of intervention consequences, as well as its determinants and mediators. A classic example of this type of evidence is observed in tobacco control interventions. By establishing the causal relationship between smoking exposure and increased risk of lung cancer outcome , campaigns, programs, and laws were developed to reduce tobacco use.
Although it is the highest level of evidence, there are difficulties in elaborating studies at this level, since they are complex, require human and financial resources, and some follow-up time Type II evidence results from the description of interventions based on type I evidence. That is, after being supported by type I evidence, interventions are put into practice and their impacts are evaluated, thus obtaining type II evidence.
At this level, evidence is still in the consolidation process and a thorough analysis of its applicability needs to be carried out. For example, increasing the price of cigarette packet and restricting media campaigns to encourage cigarette smoking could reduce the number of smokers exposure and consequently decrease the number of cases of lung cancer outcome. However, the application of this level of evidence may be limited due to the small number of interventions performed at community level, so little is known about its effectiveness Finally, type III evidence comes from intervention programs that have resulted in positive changes in the health of individuals.
However, implementing such interventions elsewhere requires adequate adaptation according to local and population characteristics. For example, the ban on smoking indoors has been successfully applied in Brazil, but its application in other Latin American countries requires adaptation The advance in the production of knowledge in the area of health promotion has not proportionally reflected in improving the conditions of care provided to the population and professional practice.
In part, this may be related to the fact that less than half of health professionals worldwide have never had training on public health In this way, the lack of specific training can hinder the interpretation of scientific evidence. In order to extend the use of the EBPH concept, seven phases are considered necessary to disseminate and apply scientific knowledge to practical actions in the community 6 , 7 Figure 2.
The first phase consists of assessing the community: Initially, the project manager and team should identify health priorities in the community. To do so, the review of data from the country or city surveillance system may be of great value in identifying the magnitude of the problem. For example, identifying the prevalence of physically inactive individuals in the area covered by the intervention may indicate the local situation of the problem.
The next phase is to identify the problem: It is suggested to elaborate guiding questions related to the problem. For example, which organization s is are responsible for developing strategies to promote physical activity?
What is the best strategy to promote the practice of physical activity? This phase is extremely important as it defines the responsibilities in the decision-making process and makes it clearer what the real extent of the problem is. After assessing the community, identifying the problem and quantifying the number of physically inactive people, it is recommended to identify the evidence in literature on actions to promote physical activity.
The use of scientific literature at this phase is of great value, since scientific journals are the main vehicles in which researchers disseminate research results Based on previous phases, it is necessary to develop and prioritize actions considering five aspects: a political: Who are the decision makers to promote physical activity? Is there a consensus among the workforce that promoting physical activity is a priority?
Will decisions about planning, implementation, and development of the physical activity promotion program be defined by the entire workforce or by the program manager? Is it necessary to seek partners for the intervention? Example: gender, age group, socioeconomic level, schooling e technology: what technology will be needed for intervention?
Example: infrastructure gym equipment, courts, balls and hiking trail. One of the key phases in the development of EBPH is the development of the action plan and the implementation of the intervention. At this phases, it is suggested to develop a logical model. The logical model is a tool in which the stages to be performed in the physical activity promotion program are described. The logical model contributes to the program development, implementation and evaluation process. How the evaluation of program participants will be carried out?
What activities will be offered in the program? Examples: hiking, gymnastic classes, group classes and counseling for physical activity. Where activities will be offered? Example: parks, squares, gymnasiums, health academies, schools and basic health units. Who are the creators of the project? What is the responsibility of the program coordinators? Example: program planning, development and implementation. What is the cost of the intervention? Example: resources needed to improve the intervention site, purchase of materials and pay for program professionals.
Which is are the partner s of the program. Example: Institutions that can assist in the development of the program universities, research groups, government institutions and companies Figure 3. In this sense, there are different ways to evaluate a program. Evaluation of the program implementation process: Are interventions consistent with the proposed objectives?
How many people are participating in the program? What methodology is used to develop the program? Are the resources sufficient for the program continuity? What materials are available to disseminate the program? Is there adequate infrastructure for the program? Example: Intellectual knowledge about risk factors related to physical inactivity and behavioral development changes in population behavior, incentive to active commuting and leisure physical activity.
Evaluation of results: The results are usually analyzed according to the study design cross-sectional, longitudinal, quasi-experimental or experimental.
In the area of PA promotion, programs need to be of long duration therefore requiring longitudinal design to verify the mortality rate, morbidity and gain in life expectancy. Evidence-based decision making for the promotion of physical activity in Brazil. Physical inactivity is a public health problem that affects one in three adults 23 and contributes to the increase in the number of deaths related to CNDs worldwide 24 , generating a high cost for the economy 14 , The review identified the best evidence-based strategies to promote PA in the context Brazilian.
Interventions were classified into three categories. According to Hoehner et al.
Duncan S. Buchan, Stewart Ollis, Non E. Thomas, Julien S. Physical activity research has been dominated by traditional cognitive rationale paradigms utilized within other domains. Though this approach to physical activity behavior has greatly enhanced our understanding of the key determinants, it has done little to eradicate the health problems we currently face. In order to achieve lasting change though, multilevel interventions may prove effective.
PDF | Worldwide it has been estimated that physical inactivity alone accounts for the premature loss of Approaches that demonstrate an acceptable level of effectiveness in increasing physical Provided for non-commercial research and educational use only. efforts and has emerged as a promising practice for PA.
The important role that the environment plays in health and well-being is widely accepted, as is the impact that the built and natural environment can have on levels of physical activity. As levels of physical activity are a key determinant of health, promoting physical activity through actions to improve the environment is a priority for public health action. The challenge for public health is to ensure that the way the environment is shaped and transformed by a range of professionals, organisations and agencies, maximises health gain in relation to health, including physical activity.
Health promotion is, as stated in the World Health Organization WHO Ottawa Charter for Health Promotion , "the process of enabling people to increase control over, and to improve, their health. The WHO 's Bangkok Charter for Health Promotion in a Globalized World defines health promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health".
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It is a well-rounded, evidence-based analysis of interventions for physical activity practice, covering a range of settings and target groups. Expert contributors.
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Physical Activity and Health Promotion: Evidence-based Approaches to Practice evaluates the realities and complexities of working to reverse the adverse trend.