Connecting primary care, sport and physical activity. Evaluation of the role of Care Sport Connectors in connecting primary care, sport, and physical activity and residents* participation.

In 2012, the Dutch Ministry of Health, Welfare, and Sport introduced Care Sport
Connectors (CSCs), to whom the broker role has been ascribed. These CSCs are
40% funded by the state; the remaining 60% is funded by the municipality or
other local organisations. The defined outcome of CSCs is an increased number
of residents participating in local sports facilities and being physically
active in their own neighbourhood. Therefore, CSCs are employed to connect
primary care, sport, and physical activity and to guide primary care patients
on lifestyle programmes towards local physical activity facilities. The CSC
function is new. In 2013, 90% of Dutch municipalities had appointed CSCs.
However, neither the CSCs* job description and competencies, nor how they can
be embedded in their context, are yet clear. It is accepted that CSCs will
operate differently because of their different backgrounds and contexts.

The reason for this is that in the Netherlands, 25% of the total population is
diagnosed with a chronic disease. The expectation is that this number will
increase in the next 20 years. The increase in chronic diseases is alarming
considering that chronic diseases are highly preventable. Chronic disease risk
factors relate to individual behaviour and lifestyle, the social and physical
environment in which people live, and the healthcare system. There is an
increased need to join forces both within the healthcare sector and between the
health and other societal sectors, because no organisation has the resources,
access, and trust relationship to address the wide range of community
determinants of public health problems alone. Working in alliances between
health and other societal sectors is challenging, because it means working in a
new area or setting, with new people, with different backgrounds, interests,
and perspectives. For example, a study on alliances in the Dutch BeweegKuur
showed that it was difficult to create the connection between care and sport
because of the different culture and target groups of the care and sport
sectors. A health broker role seems to offer the promise of improving
intersectoral collaboration.

Adequate scientific research is needed to assess CSCs impact in: 1) connecting
primary care, sport en physical activity and 2) promoting the health of primary
care patients. Therefore, the research project consists of two studies.

Study I focuses on the intermediary target groups; CSCs and professionals in
primary care, sport and physical activity who implement lifestyle programs.
CSCs are expected to form alliances for health by connecting professionals from
different sectors, to achieve and sustain collaboration in these alliances.
Consequently the following research questions will be examined:
a. What are the processes that contribute to the connection between primary
care, sport and physical activity?
b. What are the conditions at national and local level that facilitate or
hinder CSCs in connecting primary care, sport and physical activity?
c. Which impacts are mediated by CSCs and what are the perceived societal
benefits for the municipality, neighborhood and local residents?

Study II concentrates on health and physical activity behavior changes of
primary care patients who participate in lifestyle programs. Center of
attention is the target group, adults from the neighborhood who participate in
lifestyle programs organized by professionals from the alliances of study I.
Following research questions will be addressed:
a. Which lifestyle programs are implemented and which target groups are reached?
b. What are effective principles to enlarge participation, self management and
hand over primary care patients and which preconditions
are essential to accomplish this?
c. What is the effect in terms of physical activity behavior and maintenance,
their self- reliance, quality of life, experienced health and
health gains? For this part of the review of the METC is
required.

Only traject 2c is described because this is the part which is relevant for the
review of the METC .

The physical fitness scan is used three times to measure of physical actvities
or a combined lifestyle interventions contributes to health benefits .
Participants who enroll, on referral from a health care professional, in an
exercise program or combined lifestyle intervention are measured at the moment
of entry, after six months and one year.
Elements of the test are:
- Blood Pressure
- Resting Heart Rate
- Height
- Weight
- Waist circumference
- Body fat percentage
- Cholesterol
- Blood glucose
- Arm curl
- 30 second chair stand
- Grip strength
- 3 meter up and go
- Straight leg raise
- Modified Schober test
- Back Scratch
- Astrand endurance test

In addition, after the physical fitness scan the participants fill in a
questionnaire about the topics : physical activity, perceived health,
motivation, illness and care, self-efficacy, perceived importance, behaviour
change, social support, self- monitoring and exercise goals .

The risks for participation in the study are minimal. There are no reserved
operations included.The subtests of the fittest are performed regularly in
practice and unproblematic.
It's fair to carry out this research because the load is not too high (3x 1.5
hours), and the risk is minimal. In addition, most exercise programs or
combined lifestyle interventions already contain a physical fitness scan. Many
people also find it helpful to have insight in their physical health. Through
this study, the effects of the combined lifestyle intervention or physical
activity can be demonstrated. In this way it can be shown whether policy
pretensions around the Care Sport Connector are realized. RCT studies showed
that physical activity is helpful, but it is relevant to show whether this
intended effect is also achieved in practice through community based
interventions, which involves many more factors than just physical activity .