Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
Mulier Instituut, Herculesplein 269, 3584AA, Utrecht, The Netherlands.
Health Res Policy Syst. 2024 Sep 4;22(1):122. doi: 10.1186/s12961-024-01182-y.
Much remains unknown about how complex community-based programmes can successfully achieve long-term impact. More insight is needed to understand the key mechanisms through which these programmes work. Therefore, we conducted an in-depth study in five communities that implemented the Healthy Youth, Healthy Future (JOGG) approach, a Dutch community-based obesity prevention programme. We aimed to identify perceived outcomes and long-term impacts among local stakeholders and explore potential causal pathways and working mechanisms.
We used ripple effects mapping (REM), a qualitative participatory method to map outcomes and identify causal pathways, in five communities. We involved 26 stakeholders, professionals and policy-makers affiliated with the local JOGG approach, spread over eight REM sessions and conducted individual interviews with 24 additional stakeholders. To uncover working mechanisms, we compared outcomes and causal pathways across communities.
Over 5-9 years of implementation, participants perceived that JOGG had improved ownership of local stakeholders, health policies, intersectoral collaboration and social norms towards promoting healthy lifestyles. Causal pathways comprised small initial outcomes that created the preconditions to enable the achievement of long-term impact. Although exact JOGG actions varied widely between communities, we identified five common working mechanisms through which the JOGG approach contributed to causal pathways: (1) creating a positive connotation with JOGG, (2) mobilizing stakeholders to participate in the JOGG approach, (3) facilitating projects to promote knowledge and awareness among stakeholders while creating successful experiences with promoting healthy lifestyles, (4) connecting stakeholders, thereby stimulating intersectoral collaboration and (5) sharing stakeholder successes that promote healthy lifestyles, which gradually created a social norm of participation.
The JOGG approach seems to work through activating initial stakeholder participation and bolstering the process towards ownership, policy change, and intersectoral collaboration to promote healthy lifestyles. Key working mechanisms can inform further development of JOGG as well as other complex community-based prevention programmes.
对于复杂的基于社区的项目如何成功实现长期影响，我们仍知之甚少。为了深入了解这些项目的工作机制，我们需要更多的洞察力。因此，我们对五个实施荷兰基于社区的肥胖预防项目“健康青年，健康未来（JOGG）”的社区进行了深入研究。我们旨在确定当地利益相关者的感知结果和长期影响，并探讨潜在的因果途径和工作机制。
我们使用涟漪效应映射（REM），一种定性的参与式方法，在五个社区中映射结果并确定因果途径。我们涉及 26 名与当地 JOGG 方法相关的利益相关者、专业人员和政策制定者，分布在八个 REM 会议中，并对 24 名额外的利益相关者进行了个别访谈。为了揭示工作机制，我们比较了不同社区的结果和因果途径。
在实施的 5-9 年中，参与者认为 JOGG 提高了当地利益相关者、卫生政策、跨部门合作和促进健康生活方式的社会规范的所有权。因果途径包括小的初始结果，这些结果为实现长期影响创造了前提条件。尽管社区之间的 JOGG 具体行动差异很大，但我们确定了五个共同的工作机制，JOGG 方法通过这些机制促进了因果途径：（1）为 JOGG 创造积极的内涵；（2）动员利益相关者参与 JOGG 方法；（3）促进知识和意识项目，同时为利益相关者创造促进健康生活方式的成功经验；（4）连接利益相关者，从而促进跨部门合作；（5）分享促进健康生活方式的利益相关者成功案例，逐步形成参与的社会规范。
JOGG 方法似乎通过激活初始利益相关者的参与，并加强所有权、政策变革和促进健康生活方式的跨部门合作的进程来发挥作用。关键工作机制可以为 JOGG 以及其他复杂的基于社区的预防项目的进一步发展提供信息。
