Effect and implementation research in the prevention of obesity : a practice based research approach in Flanders

The high prevalence rates of overweight and obesity, and the related health problems, stress out the need for obesity prevention. As in other countries, in Belgium, the urgency for action was picked up by the Flemish government and resulted in a health target on nutrition and physical activity, two important health behaviors related to overweight and obesity. The subject of this doctoral thesis was the evaluation of projects funded by the Flemish government as part of the action plan for the health target on nutrition and physical activity. Two major types of projects are incorporated in the Flemish action plan on nutrition and physical activity. The first type of projects is about the development and evaluation of new interventions and the second type of projects is about the implementation of evidence-based projects in Flanders. The overall purpose of this thesis was to report on the evaluation of these projects. For the evaluation of the different projects, a form of practice based research in which researchers and practitioners collaborate, was used. Further the thesis deals with the challenges experienced during the evaluation and collaboration between researchers and practitioners. The first three studies in the thesis report on the effectiveness of the first type of projects (i.e. newly developed interventions). The projects ‘Health Scores!’, ‘Physical activity prescription’ and ‘Crazy about Health’ are discussed. The project ‘Health Scores!’ aimed at increasing physical activity and improving the nutrition of children and adolescents (10-14 year) of a lower socio-economic background. This project combined a school program with professional football players as a credible source to deliver health messages on physical activity and nutrition. The study findings indicated that the intervention was mainly successful in increasing the psychosocial correlates of physical activity and a healthy diet. The second project ‘Physical activity prescription’ had as objective to increase physical activity levels and several related quality of life indicators in adults from socially disadvantaged neighborhoods. The intervention consisted of a physical activity prescription delivered by a physician and a counseling program by a personal physical activity coach. The six months intervention was able to accomplish positive effects on both physical activity and several quality of life indicators. The third project, ‘Crazy about Health’ targeted the local health policy of small sized municipalities. Based on the key community principles, nine dimensions relevant for local policy development were identified. The development of a local health policy on physical activity and nutrition was stimulated through an online self-assessment tool followed by guidance from the local-regional networks for prevention. The project was able to create a positive change to a higher quality level on each dimension in the intervention municipalities. The final two studies included in this doctoral thesis, report on the evaluation of so called implementation projects. The first study evaluated the state-wide dissemination of the ‘10 000 Steps Flanders’ project and the second study reports on the dissemination of the commuter cycling