Introduction: Community-based participatory research (CBPR) is an effective approach to health promotion, especially in relation to socially disadvantaged groups. However, the long-term implementation of CPBR-based projects on a broad scale is often challenging, and research regarding the sustainable transfer of participatory research is lacking. This limits the scaling-up and public health impact of CBPR. Therefore, this study examines the mechanisms utilized to transfer and sustain the BIG project, a multifaceted CBPR project aimed at promoting physical activity among women in difficult life situations. Materials and Methods: Borrowing from the RE-AIM framework, we analyzed project documentation and conducted a reflection workshop to investigate methods of transferring BIG to new sites as well as strategies from researchers to support project implementation and the maintenance of program activities at those sites. Moreover, we analyzed the reasons for discontinuing program activities at some former BIG sites and the costs involved in transferring BIG. Results: Since its establishment in 2005, BIG was transferred to and implemented at 17 sites. As of the winter of 2019, the program activities were maintained at eight sites. The average duration of sites that continue to offer program activities was more than 9 years. Discontinued sites maintained project activities for an average of 4 years. According to the study findings, the extent of scientific support, the provision of seed funding, and the local project coordinator, the person managing the project at the site, all have a significant impact on the sustainability of the transfer. A patchwork of funding agencies was needed to finance scientific support and seed funding in BIG. The transfer of BIG projects accrued annual costs of approximately EUR20,000 per site; however, long-term project implementation resulted in a decline in the annual transfer costs of BIG. Discussion and Conclusion: The sustainable transfer of CBPR is challenging but possible, and increased support of research and seed funding can facilitate long-term transfer. Nevertheless, other factors in the implementation setting are beyond scientific

IntroductionCommunity-based participatory research (CBPR) is an effective health promotion approach for reaching socially disadvantaged groups. However, there is limited evidence on how such interventions and their effects can be reproduced across time and place. The present study examines the effects of BIG (i.e., movement as an investment in health), a long-standing German CBPR project. Since 2005, BIG has aimed to empower women in difficult life situations to increase control over their health determinants and reduce social inequalities by promoting physical activity. One of BIG's key features is its implementation in several German municipalities since 2005. This study explores (a) whether participation could change women's empowerment, and (b) how increased empowerment affects other areas of women's lives.MethodsWith a total of 63 interviewees (i.e., 40 participating women, 7 trainers, 3 project coordinators, and 13 stakeholders), we conducted 53 semi-structured qualitative interviews in five BIG communities between 2007 and 2011. Some interviews were conducted with two people simultaneously. The interview guide contained questions on various dimensions of empowerment (e.g., project engagement, increased self-efficacy, and developed competencies). Framework analysis was used for the analytical process.ResultsBIG contributed to women's empowerment in various ways, including increased self-efficacy, social network promotion, competency development, and increased motivation to change physical activity behavior. Women who took on added tasks and became more involved in project planning also strengthened their organizational empowerment. Furthermore, increased empowerment had a positive influence on the women's quality of life, family, and professional lives.ConclusionThe novel findings helped in understanding the effects of a complex empowerment-based approach that promoted physical activity among women in difficult life situations. Future research should focus on the long-term effects of these programs and their transferability to other sites. Further effort is necessary in the area of public health policy.

Introduction: Community-based participatory research (CBPR) is considered to be of high potential for health promotion among socially disadvantaged groups. However, the long-term implementation and transfer of these approaches remain challenging, and the public health impact they achieve is difficult to study. This also pertains to the potential health effects and cost-effectiveness of CBPR. This study protocol describes the follow-up case study (NU-BIG) after 15 years of the BIG project (“movement as investment in health”), a project to promote physical activity among socially disadvantaged women. Through a participatory approach, BIG empowers the addressed women to plan and implement low-threshold physical activity offers. Since the project started in 2005, it was transferred to 17 communities in Germany.Materials and Analysis: NU-BIG intends to examine the long-term effects, including economic aspects, of the BIG project on individual and structural levels at all project sites, as well as its long-term implementation and transfer. NU-BIG is a cross-sectional and longitudinal study using a mixed method approach. For the longitudinal section, we re-analyze existing data from former BIG evaluations. For cross-sectional data collection, we use questionnaires and conduct qualitative interviews and focus groups. Women who take part in BIG program offers are part of the research team and will use the photo-voice approach to report on the effects of BIG. The study population consists of about 800 women who participate in BIG project offers and 50 persons involved in the implementation of the BIG project at local sites.Discussion: The expected results from NU-BIG are highly relevant for studying the long-term public health impact of CBPR. In particular, this project intends to answer questions on how the transfer of such projects can succeed and which factors determine if a CBPR project can be sustained at the community level. Eventually, these results can contribute to the further development of participatory approaches to provide effective health promotion among socially disadvantaged groups.Conclusion: Although CBPR is seen of having the potential to reduce health disparities, there is still a lack of research on its long-term effects and public health impact. NU-BIG aims at generating knowledge about the economic effects, reach, efficacy, adoption, implementation, and maintenance of a CBPR project. The expected results could be of high interest for BIG and other CBPR-projects.

Zusammenfassung Hintergrund Das Projekt „Bewegung als Investition in Gesundheit“ (BIG) – ein partizipatives Projekt im kommunalen Setting – wurde 2005 entwickelt, um benachteiligten Frauen den Zugang zu körperlich-sportlicher Aktivität zu erleichtern. Seitdem wurde BIG deutschlandweit auf 17 Kommunen übertragen. Ziel Es wird untersucht, ob im BIG-Projekt sozial benachteiligte Frauen erreicht und an Bewegungskurse gebunden werden können. Zudem werden die Angaben der Frauen zu deren Gesundheitszustand und Sporttreiben berichtet. Zuletzt wird geprüft, ob 5 Risikofaktoren einer sozialen Benachteiligung sowie das Sporttreiben mit dem Gesundheitszustand assoziiert sind. Methode Quantitative Querschnittsdaten aus 6 Erhebungswellen (2006–2013) zweier Projektstandorte (Erlangen, Regensburg) wurden aggregiert. Zur Analyse der Zielgruppenerreichung wurden die Charakteristika der Teilnehmerinnen (N = 430) mit Bevölkerungsdaten der Standorte verglichen. Zielgruppenerreichung, Kursbindung und Angaben zu Gesundheitszustand und Sporttreiben wurden darüber hinaus deskriptiv analysiert. Der Einfluss der Risikofaktoren und des Sporttreibens wurde durch multivariate Regressionsanalyen untersucht. Ergebnisse Von den Teilnehmerinnen wiesen 67 % mindestens einen Risikofaktor auf. Die Frauen nahmen im Mittel 2,4 Jahre an den BIG-Kursen teil. Über 50 % der Frauen berichteten einen verbesserten Gesundheitszustand, über 60 % trieben im Vergleich zu der Zeit vor BIG mehr Sport. Die Anzahl vorliegender Risikofaktoren war mit dem Gesundheitszustand im Vergleich zur Zeit vor BIG (p < 0,001) assoziiert. Mangelnde Deutschkenntnisse zeigten einen signifikanten Zusammenhang mit dem aktuellen Gesundheitszustand. Schlussfolgerung Das BIG-Projekt erreicht sozial benachteiligte Frauen. Insbesondere Frauen mit wenig Risikofaktoren berichten positive Veränderung des Gesundheitszustands und Sporttreibens verglichen zur Zeit vor der BIG-Teilnahme. Hier scheinen die Anzahl vorliegender Risikofaktoren, sowie mangelnde Deutschkenntnisse von Bedeutung zu sein.

ZusammenfassungDer vorliegende Artikel beschäftigt sich mit der Bewegungsförderung bei Menschen in schwierigen Lebenslagen und den besonderen Herausforderungen, die an eine erfolgreiche Umsetzung entsprechender Programme und Interventionen für diese Personengruppen gestellt werden. Anhand zweier Praxisbeispiele wird aufgezeigt, wie Bewegungsförderung für schwer erreichbare Adressat*innen durch partizipative Ansätze gelingen kann. Das BIG-Projekt (Bewegung als Investition in Gesundheit) bietet einen Ansatz für Frauen in schwierigen Lebenslagen. Bei GESTALT (GEhen, Spielen und Tanzen Als Lebenslange Tätigkeiten), einem Bewegungsprogramm zur Demenzprävention, werden Personen ab 60 Jahren adressiert, die bislang nur unzureichend oder gar nicht körperlich aktiv sind. Damit solche Projekte auf möglichst viele neue Kommunen übertragen werden können, muss die bisherige enge wissenschaftliche Begleitung durch mehr Verantwortung und Eigenständigkeit in den Kommunen ersetzt werden. Für die Praxis der Bewegungsförderung bedeutet dies, dass eine Erweiterung von Ausbildungsinhalten in Betracht gezogen werden sollte, um die notwendigen Kompetenzen und Strategien zu vermitteln, damit schwierige Zielgruppen adäquat erreicht werden.