Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain.
Sports' General Secretariat, Government of Catalonia, Barcelona, Spain.
BMC Public Health. 2018 Aug 3;18(1):968. doi: 10.1186/s12889-018-5773-2.
In adults, as little as 10 minutes of moderate physical activity (PA) three times a day can help prevent non-communicable diseases and prolong life expectancy. The aim of the study was to evaluate the process and impact of scaling up a complex intervention (PAFES) implemented in Catalonia, aimed to increase the proportion of adults complying with PA recommendations (especially those with cardiovascular risk factors).
The intervention, piloted in 2005, had three elements: 1) establishing clinical guidelines for PA; 2) identifying local PA resources; 3) PA screening and advice in primary health care (PHC) settings, based on stage of change. Central and local level implementation activities included training, support to municipalities, dissemination through a web page, and promotion of World Physical Activity Day (WPAD). Evaluation followed the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance), identifying 3-6 variables for annual evaluation of each dimension. These included coverage of PA screening and advice and individuals with access to a healthy exercise route (Reach), increased PA level between 2006 and 2010-15 (Effectiveness), PAFES adoption by PHC centres and municipalities (Adoption), process evaluation data (Implementation), and cost (Maintenance).
PHC screening coverage increased from 14.4% (2008) to 69.6% (2015) and advice coverage from 8.3% (2012) to 35.6% (2015). In 2015, 82.5% patients had access to a "healthy route" (Reach). The proportion of patients with at least one cardiovascular risk factor who were "sufficiently active" increased from 2006 to 2010-2013 (Effectiveness). By 2015, PAFES was applied by all PHC teams, 8.3% municipalities and 22.7% PHC centres had organized WPAD events (Adoption). The Plan showed good penetration in all health regions by 2013, with relatively low use of resources and estimated cost (Implementation). By 2013 the Plan was embedded within the health system (Maintenance).
In the first application of the RE-AIM framework to evaluate the scaling-up of a PA plan, PAFES showed good results for most RE-AIM indicators. Changes in priority and investment in health promotion programs affect reach, adoption, and effectiveness. It is important to maintain support until programs are strongly embedded into the health system.
在成年人中，每天进行三次、每次至少 10 分钟的中等强度身体活动（PA），有助于预防非传染性疾病并延长预期寿命。本研究的目的是评估在加泰罗尼亚实施的一项复杂干预措施（PAFES）的实施过程和影响，该措施旨在增加符合 PA 建议的成年人比例（尤其是具有心血管危险因素的成年人）。
该干预措施于 2005 年进行试点，包含三个元素：1）制定 PA 临床指南；2）确定当地 PA 资源；3）在初级保健（PHC）环境中进行 PA 筛查和建议，依据改变阶段进行。中央和地方层面的实施活动包括培训、对市政府的支持、通过网页传播以及推广世界身体活动日（WPAD）。评估遵循 RE-AIM 框架（范围、效果、采用、实施、维护），为每个维度的年度评估确定 3-6 个变量。这些变量包括 PA 筛查和建议的覆盖范围以及能够获得健康运动路径的个体数量（范围）、2006 年至 2010-2015 年期间 PA 水平的增加（效果）、PHC 中心和市政府对 PAFES 的采用（采用）、过程评估数据（实施）和成本（维护）。
PHC 筛查的覆盖范围从 2008 年的 14.4%增加到 2015 年的 69.6%，建议的覆盖范围从 2012 年的 8.3%增加到 2015 年的 35.6%。2015 年，82.5%的患者可以获得“健康路径”（范围）。至少有一个心血管危险因素的患者中“足够活跃”的比例从 2006 年增加到 2010-2013 年（效果）。到 2015 年，所有 PHC 团队、8.3%的市政府和 22.7%的 PHC 中心都采用了 PAFES（采用）。到 2013 年，该计划已在所有卫生区域得到很好的推广，资源使用相对较低，成本估计也较低（实施）。到 2013 年，该计划已嵌入卫生系统（维护）。
在首次应用 RE-AIM 框架评估 PA 计划的推广时，PAFES 在大多数 RE-AIM 指标上均取得了良好的结果。优先事项和健康促进计划投资的变化会影响范围、采用和效果。重要的是，在计划得到强有力的支持之前，需要保持支持，直到计划被深深地嵌入到卫生系统中。
