Equity Impact Assessment of Interventions to Promote Physical Activity among Older Adults: A Logic Model Framework

Lehne, Gesa; Voelcker‐Rehage, Claudia; Meyer, Jochen; Bammann, Karin; Gansefort, Dirk; Brüchert, Tanja; Bolte, Gabriele

doi:10.3390/ijerph16030420

Cited by 13 publications

(16 citation statements)

References 63 publications

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“…Such differential effects (so-called "equity effects") of public health interventions according to socioeconomic position pose a considerable challenge to population health interventions promotion and disease prevention, as they indicate that interventions to improve health behaviours could inadvertently increase health inequalities (12)(13)(14)(15). A logic model framework (13) suggests that equity effects of public health interventions could be due to differential recruitment into interventions, differential engagement with intervention material, differential retention, or differential effects of intervention components.…”

Section: Introductionmentioning

confidence: 99%

Equity Effects of Dietary Nudging Field Experiments: Systematic Review

Schüz

Meyerhof

Hilz

et al. 2021

Front. Public Health

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Background: Dietary behaviours are among the key modifiable risk factors for non-communicable diseases. Importantly, dietary behaviours vary substantially between groups and individuals with different socioeconomic positions, with more disadvantaged groups and individuals being exposed to more dietary risk factors. The goal of this review is to summarise the existing research on equity effects of dietary nudging interventions.Methods: Systematic review of nudging interventions conducted in a field setting that report an observable indicator of dietary behaviour, include a control group, and report effect sizes stratified by indicators of socioeconomic status as outlined in the PROGRESS-Plus framework. Two databases (scopus, Pubmed) were searched (last search June 2021), and 18 articles with 19 studies (k = 46 equity comparisons) were included. Risk of bias was assessed using the ROBINS-I tool. Due to heterogeneity in equity dimensions and study outcomes, a harvest plot was used to summarise data.Results: The majority of equity comparisons (38 out of 46) were available for cognitive nudges. Most of these (22 out of 38 comparisons) found that cognitive nudges worked equally well in more and less disadvantaged populations; however, in 12 out of the 38 comparisons, they favoured those who were less disadvantaged. Two out of four comparisons on behavioural nudges favoured more disadvantaged persons.Conclusions: The differential effects of dietary nudging interventions in this review can contribute to increases in health inequalities. At the same time, a substantial number of interventions showed no equity effects. Importantly, this review suggests that more research on nudging interventions and health equity is needed. Future interventions should report effect sizes stratified by indicators of social inequality.Systematic Review Registration: PROSPERO (CRD42019137469)

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Section: Introductionmentioning

confidence: 99%

Equity Effects of Dietary Nudging Field Experiments: Systematic Review

Schüz

Meyerhof

Hilz

et al. 2021

Front. Public Health

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“…Step four comprises to specify the statistical methods and modeling strategies for the equity-specific effect analyses. Not only intervention effects, but also intervention reach, adherence, and dropout may also differ by socio-demographic characteristics and therefore should be considered for a comprehensive assessment of equity-specific intervention benefits [ 15 , 75 ].…”

Section: Resultsmentioning

confidence: 99%

Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy

Czwikla

Boen

Cook

et al. 2021

Int J Behav Nutr Phys Act

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Background Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. Methods The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. Results The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. Conclusions To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of ‘hard to reach’ groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.

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“…SEP and gender inequalities in intervention adherence and dropout will be assessed given that both may lead to social inequalities in intervention benefit [16,73]. Depending on the characteristics of the intervention (Table 1) and availability of data, adherence will be defined as, amongst others, use of intervention materials, attendance at group meetings, and completion of PA diaries.…”

Section: Results: the Joint Equity-specific Re-analysis Strategymentioning

confidence: 99%

“…To our knowledge, this international interdisciplinary collaboration is the first to jointly develop and apply a strategy for systematically re-analyzing the effects of existing intervention studies on social inequalities in PA among community-dwelling middle-aged and older adults. Besides inequalities in intervention efficacy, the developed strategy will be used to investigate social inequalities in intervention adherence and dropout, allowing for a comprehensive assessment of social inequalities in intervention benefit [16,73].…”

Section: Discussionmentioning

confidence: 99%

Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy

Czwikla

Boen

Cook

et al. 2019

IJERPH

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Reducing social inequalities in physical activity (PA) has become a priority for public health. However, evidence concerning the impact of interventions on inequalities in PA is scarce. This study aims to develop and test the application of a strategy for re-analyzing equity-specific effects of existing PA intervention studies in middle-aged and older adults, as part of an international interdisciplinary collaboration. This article aims to describe (1) the establishment and characteristics of the collaboration; and (2) the jointly developed equity-specific re-analysis strategy as a first result of the collaboration. To develop the strategy, a collaboration based on a convenience sample of eight published studies of individual-level PA interventions among the general population of adults aged ≥45 years was initiated (UK, n = 3; The Netherlands, n = 3; Belgium, n = 1; Germany, n = 1). Researchers from these studies participated in a workshop and subsequent e-mail correspondence. The developed strategy will be used to investigate social inequalities in intervention adherence, dropout, and efficacy. This will allow for a comprehensive assessment of social inequalities within intervention benefits. The application of the strategy within and beyond the collaboration will help to extend the limited evidence regarding the effects of interventions on social inequalities in PA among middle-aged and older adults.

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Equity Impact Assessment of Interventions to Promote Physical Activity among Older Adults: A Logic Model Framework

Cited by 13 publications

References 63 publications

Equity Effects of Dietary Nudging Field Experiments: Systematic Review

Equity Effects of Dietary Nudging Field Experiments: Systematic Review

Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy

Equity-Specific Effects of Interventions to Promote Physical Activity among Middle-Aged and Older Adults: Development of a Collaborative Equity-Specific Re-Analysis Strategy

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