Health and Local Community

Community mobilisation and integrated interventions for sustainable impact in health promotion.

Aim and purpose
Project "Sundhed og Lokalsamfund" (SoL) is a research-based intervention project implemented in response to the growing challenge of non-communicable diseases, including type 2 diabetes, in Denmark, Europe and most other parts of  the world. The project applies a community perspective with emphasis on influencing people's lifestyle habits through a multi-dimensional approach. It also applies a broad understanding of the concept of health and healthy living, which includes food choices and physical movement as well as joy, play, social interaction, wellbeing, meaningfulness, self-determination and action competence.

Project SoL aims to promote the health and wellbeing of families with small children aged 3-8 years living in selected communities on the Danish island of Bornholm. This aim is achieved by mobilising local community resources, strengthening social networks and promoting healthier food choices and more physical movement. The project applies structural, social and pedagogic interventions in multiple settings such as primary schools, after-school centres, childcare centres, sport centres, supermarkets, market places and local media.

Project SoL adheres to the values and principles of the "supersetting approach". This is an intervention strategy whereby coordinated activities targeting a common overall goal such as improved health in a population group are carried out in a variety of different settings and involving a variety of different stakeholders within a local community. A supersetting initiative builds on the optimised use of diverse and valuable resources embedded in local community settings and on the strengths of social interaction and local ownership as drivers of change processes.

Project SoL has an intervention arm and a research arm
In relation to the intervention arm, the project is designed to be: 1) participatory and inclusive, 2) integrated and intersectoral, 3) context-sensitive, 4) empowering and action-competence building, 5) social network strengthening, and 6) relatively long-term. Interventions are not pre-determined but developed and implemented jointly by researchers, local partners and beneficiaries (including children and parents) in respectful dialogues that are responsive to every-day life challenges and needs; to planning cycles, action plans and resources of local stakeholder institutions; and to scientific knowledge about what has been shown to work (or not work) elsewhere.

In relation to the research arm, the project is designed as a controlled interdisciplinary intervention study. It applies action research to actively involve children, parents and professionals in identifying visions for a healthier and socially coherent local community and in transforming these visions into realistic activities that are subsequently implemented using local human and material resources. Actions are iteratively evaluated and adjusted by participants during the course of implementation. This approach strives to strengthen participants’ competences to take action on the needs of their local community. Project SoL also applies a pre- and post-intervention design whereby the effects of interventions on participants’ knowledge, attitudes and practices regarding a wide range of health and social issues are determined by comparing questionnaire responses obtained from the prime target group of parents and children before and after implementation of interventions.

Target groups
The primary target group is families with children aged 3 to 8 years who are enrolled in childcare centre and primary schools in three selected communities (Allinge/Sandvig, Hasle and Nexø) on the Danish island of Bornholm. This includes children, parents and grandparents, guardians and other close family members. Equivalent families with children aged 3 to 8 years who are enrolled in childcare centre and primary schools in three selected communities (Asnæs, Egebjerg and Højby) in the Danish municipality of Odsherred act as a reference group.

Secondary target groups are other stakeholders who influence children’s health and wellbeing most notably professionals within primary schools, after-school centres, childcare centres, supermarkets, media, the administration and policy makers of the local government and a number of civil society organisations and resource persons with expertise in nutrition, cooking, recreation and physical movement.

Expected outcome
The outcomes of Project SoL relate to: a) qualitatively determined perceptions, attitudes and motivations regarding healthy living, b) quantitatively determined behaviours and practices related to physical movement, sedentary behaviour and intake of healthy and unhealthy food products, c) procurement and sales of healthy and unhealthy commodities in supermarkets, and d) physical and biological measures such as Body Mass Index (BMI) for overweight and obesity.

From commencement of interventions in September 2012 to end of interventions in May 2014 the following quantitative targets are set:
• Increased sales of fruits, vegetables and whole grain products and reduced sales of sweets and soft drinks by 15% in supermarkets located in intervention communities compared to control communities.
• Increased intake of fruits, vegetables and whole grain products and reduced intake of sweets and soft drinks by 25% among children in intervention families compared to control families.
• Reduced use of TV by ½ hour per day among children in intervention families compared to control families.
 
In addition, Project SoL documents the qualities of a new intervention paradigm based on the "supersetting approach" and its values and principles for integrated interventions implemented in a complex local community setup. This documentation is qualitative and includes political, strategic, organisational, inter-personal and cultural dimensions.     

Funding and collaborators

Project SoL is financially supported by the Nordea-Foundation.

Project SoL involves the Regional Municipality of Bornholm, the Municipality of Odsherred, a variety of local community organizations, and three Danish research institutions, namely the Steno Health Promotion Center at the Steno Diabetes Center, the research group Meal Science and Public Health Nutrition (MENU) at the University of Aalborg, and the Research Centre for Prevention and Health at the Capital Region of Denmark.

Project SoL is funded for a four-year period (2012-2015) but recognises the need for more time to consolidate local trust-relations, and to safeguard organisational integration and sustainable actions; it is therefore intended to keep the initiative alive as a coherent entity beyond the first four years. Best practices are transferred to reference communities in Odsherred and evaluated by the research group during 2014-2015.


Publication
Paul Bloch1, Ulla Toft, Helene Christine Reinbach,  Laura Tolnov Clausen1, Bent Egberg Mikkelsen, Kjeld Poulsen and Bjarne Bruun Jensen: Revitalizing the setting approach – supersettings for sustainable impact in community health promotion, International Journal of Behavioral Nutrition and Physical Activity 2014, 11:118  doi:10.1186/s12966-014-0118-8

Learn more
Download the report (in Danish), published in 2016

Media coverage (in Danish)
FAKTA: Ny metoder hjælper til sund livsstil
TV-ØST: Øboere vinder kampen om et sundere liv
Politiken; Forskningsprojekt har lært bornholmerne at spise sundere


Sidst opdateret 20-09-2016

Paul Bloch
Senior researcher
Prevention Research

Projekt SoL var et udviklingsprojekt gennemført i udvalgte lokalsamfund på Bornholm og i Odsherred i perioden 2012-2015. Rapporten beskriver bl.a. evaluering, resultater og lokal forankring. Læs rapporten