A health promoting sports club framework: strategies from the field

Abstract

The application of the settings-based approach to sports clubs requires a context-specific framework to develop and operationalize health promotion interventions. Incorporating top-down and bottom-up perspectives into interventions increases their efficiency, success and sustainability. In 2020, the health promoting sports club (HPSC) model and intervention framework were created, including strategies and intervention components. A subsequent concept mapping study generated 35 statements from sports club stakeholders highlighting their needs when developing health promotion initiatives. This commentary integrates the concept mapping results into the HPSC model and intervention framework. The process added new sports club levels, updated existing and developed new intervention components, then classified them into the framework. The revised HPSC model has seven levels while the revised intervention framework includes 13 strategies and 69 intervention components. This revised HPSC framework provides sports club stakeholders, public health experts and researchers a means to develop and implement targeted health promotion interventions.

Introduction

Settings-based approaches are recognized as a successful way to develop health promotion interventions (1). This approach acknowledges that ‘change is not solely focused on individuals and their health problems, but generated in organizations and communities to ensure the development of environments that support population-wide changes in health-related behavior’ (1). Sports clubs are promising settings for health promotion as they welcome individuals practising sport and those volunteering in various capacities across diverse life stages and socio-economic status (2). Beyond providing opportunities for physical activity, sports clubs can also be settings to foster and support healthy behaviours such as social integration, healthy eating and health literacy (3). Health promotion interventions within sports clubs are limited, as shown in a literature review that identified only three rigorously tested health promotion interventions in sports organizations (4). Furthermore, a systematic mapping review revealed that the settings-based approach was poorly applied in sports clubs (5). To enhance the implementation and evaluation of health promotion interventions in sport settings, the health promoting sports club (HPSC) approach was developed. It includes a model showing internal (Individual, Micro, Meso, Macro) and external (Sports Federations, Second Line Actors) sports club levels with four health determinants: economic, environmental, organizational and social (6). The model highlights how the levels interact to influence the health determinants of stakeholders involved in sports clubs. Further research developed an HPSC intervention framework to aid sports club stakeholders to plan and implement health promotion actions targeting different levels and health determinants within their club. This HPSC framework incorporates 14 broad strategies for intervention development: Communication, Dynamic, Education, Experience, Feasibility, Goals, Mobilization, Monitoring, Motiv-ation, Participative Approach, Partners, Planning, Policies and Resources. Through stakeholder work-shops, specific intervention components were identified within each strategy and labelled using the first three or four letters of the strategy they represent and then numbered. For example, the first intervention component in the communication strategy is labelled COM1 and the fifth intervention component in the feasibility strategy is labelled FEAS5. The numbering system has no relation to temporal implementation nor importance to health promotion. Once defined and labelled, intervention components were classified into the sports club level and health determinant that they best target through group consensus (6). The HPSC framework can be used by sports club stakeholders and public health practitioners to develop, plan and implement health promotion interventions specific to the sports club’s goals.

Solely based on evidence-driven strategies, the original HPSC framework needed to be enriched with perspectives directly from sports club stakeholders (e.g. managers and coaches). Therefore, a concept mapping study was undertaken to identify stakeholders’ needs when implementing health promotion interventions (7). Through this process, stakeholders from sports organizations identified 35 statements that they determined to be both important and feasible in supporting their needs when developing health promotion in sports clubs (7). This commentary outlines how these statements have been integrated into the original HPSC framework to generate a revised HPSC model and intervention framework.

Updating the HPSC model

To update the original HPSC model, previously undefined levels (Individuals, Sports Federations and Second Line Actors) (6) and coordinating health determinants were defined in line with the original HPSC model definitions. To clearly define the Second Line Actors’ level, sports club stakeholders suggested splitting it into ‘Government Authorities’ and ‘Public Health Actors’. The updated HPSC model now consists of seven (four internal and three external) sports club levels (Figure 1).

Figure 1.

The updated health promoting sports club framework.

Formulating strategies and intervention components

Statements from the concept mapping study (7) were analysed and then compared with the strategies and intervention components from the original framework (6). In response, two strategies and nine intervention components were modified. The ‘Policies’ strategy was removed owing to the focus on policy planning rather than drafting (6); corresponding intervention components were incorporated into the ‘Planning’ strategy and relabelled accordingly. While no new strategies emerged, 14 new intervention components were formulated and labelled, predominantly within the Education, Experience, Mobilization, Participative Approach and Resources strategies (Table 1).

Table 1.

Health promoting sports club strategies and intervention components.

Communication: develop and implement communication to raise awareness of the actions taken to promote health within the sports club
COM1	Develop a communication plan
COM2	Communicate with one message, a slogan (clear, explicit and visible)
COM3	Ensure internal club communication
COM4	Ensure the club communicates with the external community
COM5	Ensure the club communicates with all partners
COM6a,b	Communicate the benefits of health promotion activities
Dynamic: create strategies to improve all stakeholders’ sense of belonging to the club and take into account the individual and their environment (socio-ecological approach) in order to define the most relevant health promotion goals
DYN1	Take the feeling of belonging to the club into account when defining the goals
DYN2	Take into account interactions between the individual and their environment, while defining health promotion goals
Education: support the sports club, management and coaches by varying the type of education they receive and take into account differences in the sports participants they coach
EDU1	Support the managers and coaches to actively engage in gaining knowledge and skills to promote health
EDU2	Tailor the support to the managers and coaches individually in relation to the sports participants they coach (mentoring, courses, online tools)
EDU3	Encourage the managers and coaches to support each other to promote health
EDU4 b	Propose a variety of ways for the sports clubs to raise awareness about health promotion
EDU5 b	Create tools and training courses to support health promotion in sports clubs
Experience: identify past club experiences, organizational readiness and the reasons and quality of the club’s commitment to promote health
EXP1	Identify previous club experiences to promote health
EXP2	Identify the organizational readiness to promote health
EXP3	Identify reasons for commitment to promote health
EXP4	Identify the degree of commitment to promote health
EXP5 b	Rely on existing, evidence-based health promotion tools
EXP6 b	Rely on a diagnosis to assess needs and expectations in order to implement health promotion actions
EXP7 b	Rely on other clubs’ experiences when developing health promotion actions
Feasibility: regularly review the capacity of the sports club to achieve its health promotion goals
FEAS1	Regularly review the financial resources being used
FEAS2	Regularly review the human resources being used
FEAS3	Regularly review the club’s capacity to undertake the actions required to achieve the goals
FEAS4	Regularly review the time dedicated to achieving the goals
Goals: write down the sports club’s health promotion goals, using positive messages, adapted to sports language, culture and the placement of health promotion within the club, taking into account the social inequalities of health
GLS1	Define the goals of health promotion
GLS2	Health promotion goals are formally written and documented
GLS3	Write goals in a positive sporting language based on the club’s culture
GLS4	Take into account inclusivity (i.e. how people experience health differently) when defining the goals
Mobilization: mobilize people to manage the development of health promotion
MOB1	Mobilize sports champions to support the development of health promotion within your club
MOB2	Mobilize experts in health promotion
MOB3	Identify and mobilize one or several internal health promotion representatives
MOB4 b	Mobilize parents (and other family members) to support health promotion actions
MOB5 b	Mobilize local decision-makers and elected officials to promote health within the sports club
MOB6	Advocate with sports federations to support the clubs on health promotion actions
Monitoring: monitor health promotion activities in daily practice using a ‘small steps’ philosophy and review any changes
MON1	Review small improvements towards achieving health promotion goals
MON2	Review all the health promotion activities undertaken in the club
MON3	Review the short term effects of the actions (changes within one sports season)
MON4	Review the long term effects of the actions (changes beyond one sports season)
MON5	Review the health promotion policies of the sport clubs
Motivation: understand what motivates coaches to implement health promotion and empower them in this undertaking
MOT1	Foster positive interpersonal relationships
MOT2	Take coaches’ skills to manage situations into account
MOT3	Take coaches’ motivation for coaching and their future expectations into account
MOT4	Strengthen coaches’ autonomy to promote health
MOT5	Strengthen coaches’ sense of ownership of the club
Participative approach: value a ‘participative approach’ to promote health throughout the club and beyond
PAP1	Identify and call attention to health promotion actions of individuals
PAP2	Identify and call attention to coaches’ health promotion actions
PAP3	Identify and call attention to management health promotion actions
PAP4	Identify and call attention to every health promotion action
PAP5	Include the managers, coaches and sports participants in the decision making process
PAP6 b	Involve parents (and other family members and friends) in health promotion efforts
Partners: partner with other organizations to create a common culture and collaborative process to promote health
PART1	Identify partners for health promotion (clubs, agencies, regional authorities, health professionals)
PART2	Define how to collaborate with existing and future partners (define roles, share experiences, contract terms, evaluation of results, equal partner power)
PART3	Create a common culture with existing and future partners (trust, recognition, shared time)
Planning: create an implementation plan to achieve the written health promotion goals
PLAN1	Include the core goals in the plan
PLAN2	Include the target population in the implementation plan
PLAN3	Include the funding sources in the implementation plan
PLAN4	Include the responsible persons in the implementation plan
PLAN5	Include key steps in the implementation plan
PLAN6	Encourage sustainable health promotion actions
PLAN7 a	Base future plans and policies on current health promotion actions
PLAN8 a	Plan future actions based on the evaluation of current actions
Resources: identify, develop or review financial, human, material and capacity building resources available to invest in health promotion
RES1	Review available financial resources (subsidies, sponsors) to invest in health promotion
RES2	Review available human resources (dedicated volunteer time, staff turnover) to invest in health promotion
RES3	Review current skills and knowledge available to promote health
RES4 b	Identify and mobilize tools for health promotion development within sports clubs
RES5 b	Identify the funding that can be used for health promotion actions
RES6 b	Establish a national resource site for health promotion within sports clubs
RES7 b	Establish a national spokesperson for health promotion within sports clubs
RES8 b	Create and host a regional and local network of health promotion mentors within sports clubs (share practices)

Table modified from Van Hoye et al. (6).

Italics represent changes to original strategies or intervention components.

a

Intervention components which were moved from another strategy, modified and renamed.

b

New intervention components.

Framework revision

To integrate these new intervention components into the original HPSC framework, a qualitative one-day seminar with French sports federations (2), public health experts (2) and academics (3) was conducted.

The seminar participants classified 45 intervention components into the HPSC model. This included three intervention components created during the original workshops (GLS1, MOB3, MOT3), four intervention components not meeting original consensus (DYN2, EDU3, FEAS4, RES3) and four modified intervention components requiring reconsideration (COM3–5 and MON5) (6). Additionally, 14 intervention components from the concept mapping study were integrated (EDU4–5, EXP5–7, MOB4–6, PAP6, RES4–8). Finally, 20 intervention components originally classified into the undefined levels were re-classified into the updated levels (EDU1–2, EXP3, DYN2, FEAS3, GLS4, MOB1, MON3–4, MOT3–4, PAP1,3–5, PART1, PLAN6–8, RES3) (Supplemental material File 1 online). This updated HPSC intervention framework now includes 13 strategies with 69 intervention components derived from combining the outcomes of top-down and bottom-up approaches (Figure 1).

Implications for the HPSC framework

When creating health promotion interventions, a participative approach is critical, as it combines stakeholder needs and experiences with scientific evidence to add credibility, feasibility and applicability (3). The revised HPSC model now represents all potential levels impacting sports club stakeholders and provides an improved definition of external actors’ investment and leverage for sports clubs. The additional intervention components included in the updated HPSC framework offer sports clubs more options for advocating and seeking external support when planning health promotion interventions. Previous research supported the inclusion of a Sports Federation and Governmental Authorities level by demonstrating that support from sport federations and state sporting organizations can influence members’ perceptions of health promotion within their club, as well as assisting sports clubs to build organizational capacity for health promotion (8), by providing resources such as funding and education. In addition to the external levels, the updated HPSC model defines how individuals are part of and impacted by the sports club, managers and coaches (9). This commentary describes how top-down and bottom-up approaches have been integrated to provide sports clubs with context-specific and evidence-informed strategies for health promotion intervention planning. Integrating evidence and stakeholder perspectives strengthens the applicability of the HPSC model and intervention framework when planning and implementing interventions targeting multiple levels and health determinants in the sports club setting.

Supplemental Material

sj-xlsx-1-ped-10.1177_17579759231195562 – Supplemental material for A health promoting sports club framework: strategies from the field

Supplemental material, sj-xlsx-1-ped-10.1177_17579759231195562 for A health promoting sports club framework: strategies from the field by Stacey Johnson, Aurélie Van Hoye, Susanna Geidne, Alex Donaldson, Florence Rostan, Fabienne Lemonnier, Benjamin Tezier and Anne Vuillemin in Global Health Promotion