With all, for all: From context-sensitive physical activity assessment to population-based physical activity promotion with a focus on health equity

Document Type
Doctoral Thesis
Granting Institution
Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Philosophische Fakultät und Fachbereich Theologie
Issue Date
Kohler, Simone

For decades, the epidemiology of physical activity (PA) and PA-related health promotion has been concerned with the problem of physical inactivity and has pursued a common goal: a healthier population through more PA. While epidemiology focuses on risk and protective factors for diseases, health promotion focuses on health promoting factors, health resources, and health equity. The latter is so important because non-communicable diseases (NCDs) follow a social gradient, affecting people with social disadvantages more than advantaged ones. One of the main risk factors for NCDs is physical inactivity. Between 2020 and 2030, nearly 500 million people will suffer from NCDs due to physical inactivity. Addressing this issue urgently remains a major challenge for all stakeholders involved in reducing health inequities through PArelated health promotion, whether they are researchers, policy-makers or local authorities.

The first part of this dissertation is located in the field of epidemiology of PA. The development and evaluation of a computer based PA recall (cpar24) for recording PA and its meaning for the epidemiology of physical activity, as well as the relevance of context-sensitive data, are the focus. The evaluation results of cpar24 showed that it is a user-friendly, practical, valid, and reliable method for assessing activity data of German adults. The cpar24 is not only suitable for monitoring PA but also for assessing contextual determinants (type and domain), which enables a better understanding of health effects. Furthermore, insights can be derived from the cpar24 data, which serve as a basis for the development of specific recommendations for promoting PA. If it is possible to measure the PA behavior of population groups with different social status in representative cohort studies, this can also provide urgently needed information for improving health equity.

The second part of this work deals with PA-related health promotion. One of the primary objectives was to create an umbrella review of successful population-based approaches to promoting PA, with a particular focus on health equity, to update the National Recommendations for PA and PA Promotion in Germany published in 2016. A total of six review articles were identified between January 2015 and December 2021, which represents an increase in scientific publications in this field compared to previous years, which included only two review articles. However, the state of research and thus the availability of scientific evidence on the effectiveness of population-based measures to promote PA with a focus on health equity is limited. In addition to the complexity of these approaches in complex systems such as communities, challenges for evaluation such as inadequate theoretical foundation and missing quality criteria are also discussed. In another study, the question of how to sustainably implement structure-building community-based PA-related health promotion with a focus on health equity in Germany was investigated. After several iterations and collaboration processes, a sixstage action model for successful and sustainable implementation of PA-related health promotion with a focus on health equity in the community was adopted in collaboration with stakeholders from science, politics, and local practice. Furthermore, this approach was systematically analyzed and theoretically reflected on the basis of a “conceptual model of the transdisciplinary research process”. Overall, it was confirmed that new knowledge could be generated for both practice and science by taking into account scientific and societal knowledge through several reflection loops.

The subtitle of this work, “with all, for all”, emphasizes with “for all” the need to reach all people in future public health efforts, especially those population groups whose chances are limited by social disadvantage. “With all” emphasizes that “all stakeholders”, i.e. from science (epidemiology together with health promotion), politics, and practice, must be involved and work together to achieve sustainable effects on public health.

In summary, the results presented here from two different research perspectives provide a deeper insight into existing challenges and show equitable solutions for reducing physical inactivity. The discussed interconnections between the epidemiology of PA and PA-related health promotion illustrate the importance of their collaboration, especially when epidemiological findings are (or can be) used in health promotion practice in such a way that sustainable interventions reach all population groups and contribute to improving the health of the population in an equitable manner.

Zugehörige ORCIDs