European Diploma in Adapted Physical Activity, March 2020. 7 hour lecture in health promotion and adapted physical activity

1. UEF // University of Eastern Finland
Health promotion and adapted physical
activity
Kwok Ng, PhD
University of Eastern Finland, Finland
University of Limerick, Ireland
@kwokwng @eufapa @ifapanet

2. International Federation of Adapted Physical Activity
https://ifapa.net
European Federation of Adapted Physical Activity
https://eufapa.eu
5th March 2020 @kwokwng @eucapa @ifapanet 2

3. @kwokwng @eucapa @ifapanet 3
Adapted Physical Activity for Health
Elche (Spain), 21-23 October
https://jyu.fi/isapa2021
https://ifapa.net
https://eucapa2020.com
https://eufapa.eu
Volunteer opportunities
5th March 2020

4. 5th March 2020@kwokwng @eucapa @ifapanet 4

5. Content
Morning 10:00-12:00
• Introduction to Health
Promotion (HP)
• Competencies in HP
• Systems Approach for HP
Afternoon 13:00-16:00
• Adapted Physical Activity (APA)
models
• EUSAPA
• Systems Approach for HP and
APA
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6. UEF // University of Eastern Finland
Introduction to Health Promotion

7. Job Advertisement
Health Promotion and
Disease Prevention Officer
Purpose: …
Roles
Salary?
Responsibilities
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8. Health Promotion Advert
▪ Salary = 25-40,000€ → 35-50,000€ (NHS)
▪ The Health Promotion Officer works as part of the Health
Promotion Team, who, in partnership with the community and
relevant stakeholders will facilitate the provision, implementation
and evaluation of primary prevention programs for chronic
disease and injury prevention; contributing to improved health
outcomes the HP Team will build the capacity and skills of
others to attain environmental and behavioural changes. (NSW)
▪ US Bureau of Labor Statistics 2012 predicts jobs for Health
Services Managers will increase by 23% through 2022
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9. Health promotion =
health education × healthy public policy
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10. PRE-VENTING VS. PRO-MOTING
Meanings: to reach beforehand
to precede, anticipate, foresee
to go towards
to give impulse, purpose
Metaphor
suggested:
travelling on a motorway climbing up a mountain
path
Environment: known unknown
Timing: linear, rapid, direct irregular, irreversible
Attitude towards
obstacles:
avoiding embodying
Requested
virtue:
prevision experience and wisdom
Goal of journey: reaching destination
exploring
(Ingrosso 1993)5th March 2020 @kwokwng @eucapa @ifapanet 10

11. UEF // University of Eastern Finland
Nutbeam, 1985
”The process of enabling people to increase
control over the determinants of health and
thereby improve their health”

12. Social
Determinants of
Health
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13. Knowing in Part May Make a Fine
Tale, but Wisdom
Comes From Seeing the Whole

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15. Ottawa
Charter, 1986
• A Health Promotion Framework
for the promotion of “health for
all”.
• Public Health → Social Model of
Health
• Enable - Enables equity in health
• Mediate - Health promotion and
health care intersectoral collaboration
• Advocate - Important dimension of
Quality of Life)
• Action areas have strategies to
work towards the charter
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16. Health in All Policies
• “Health in all policies is an
approach to public policies
across sectors that
systematically takes into account
the health implication of
decisions, seeks synergies, and
avoid harmful health impacts in
order to improve population
health and health equity”,
Helsinki 2013
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17. UEF // University of Eastern Finland
Key skill areas for effective health promotion
1.Catalyzing change – Enabling change and empowering individuals
and communities to improve their health
2.Leadership – Providing strategic direction for developing healthy
public policy, mobilizing and managing resources for health promotion,
and building capacity.
3.Assessment – Conducting assessment of needs and assets in
communities and systems that leads to the identification and
analysis of the behavioral, cultural, social, environmental, and
organizational determinants that promote or compromise health

18. UEF // University of Eastern Finland
Key skill areas for effective health promotion
4.Planning – Developing measurable goals and objectives in response
to assessment of needs and assets, and identifying strategies that
are based on knowledge derived from theory, evidence, and practice.
5.Implementation – Carrying out effective and efficient, culturally sensitive,
and ethical strategies to ensure the greatest possible improvements
in health, including management of human and material resources.
6.Evaluation – Determining he effectiveness of health promotion programs
and policies. This includes utilizing appropriate evaluation and
research methods to support program improvements, sustainability,
and dissemination.

19. UEF // University of Eastern Finland
Key skill areas for effective health promotion
7. Advocacy – Advocating with and on behalf of individuals and
communities to improve their health and well-being and building
their capacity for undertaking actions that can both improve health
and strengthen community assets.
8. Partnerships – Working collaboratively across disciplines, sectors,
and partners to enhance the impact and sustainability of health
promotion programs and policies

20. UEF // University of Eastern Finland
Competencies in Health Promotion
5th March
2020
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21. UEF // University of Eastern Finland
•Core competencies are defined as a
combination of the essential
knowledge, abilities, skills and
values necessary for the practice of
health promotion.
•The minimum set of competences
in a framework for Health
Promotion roles.
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Developing Competencies and
Professional Standards for
Health Promotion Capacity
Building Europe, 2008

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Developing Competencies and Professional Standards
for Health Promotion Capacity Building Europe, 2008

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Developing Competencies and Professional Standards
for Health Promotion Capacity Building Europe, 2008

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Developing Competencies and Professional Standards
for Health Promotion Capacity Building Europe, 2008

25. Social
Ecological
Model
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26. PRECEDE-PROCEDE model
PRECEDE
PROCEED
Phase 5
Administrative and
policy diagnosis
Phase 4
Educational
and
organizational
diagnosis
Phase 3
Behavioral
and
environmental
diagnosis
Phase 2
Epidemiological
diagnosis
Phase 1
Social
diagnosis
Phase 6
Implementation
Phase 7
Process evaluation
Phase 8
Impact evaluation
Phase 9
Outcome evaluation
HEALTH
PROMOTION
Health
education
Policy
regulation
organization
Predisposing
factors
Reinforcing
factors
Enabling
factors
Behaviour
and lifestyle
Environment
Health
Quality
of life
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27. Transtheoretical Model Construct:
Stages of Change
Pre-contemplation Person is not planning a behavior change
within the next six months.
Contemplation Person begins to consider behavior
change and is intending to change within
six months.
Preparation Person is planning a behavior change
within the next month.
Action Person has initiated a behavior change
but has done so for six months or less.
Maintenance Person has maintained the behavior
change for at least six months but less
than five years.
(Prochaska et al. 1992)
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28. The range of interventions 1/3
• Instruction: teacher-based lessons (for example, lecture, discussion,
group work) and individual- based instruction (for example,
computer-assisted learning or written or audiovisual materials)
• Counseling: individual or group sessions, behavioral modification,
behavioral contracting
• Regulatory strategies: policy mandates, legislation, ordinances, rules,
regulations
Fertman &Allensworth 20105th March 2020 @kwokwng @eucapa @ifapanet 28

29. The range of interventions 2/3
• Environmental change: changes in the physical, social, or economic
environment that provide incentives or disincentives for behavior
change
• Social support: support buddy, support group, social networks
• Direct interventions: screening, referral, treatment, and follow-up to
stimulate needed changes
Fertman &Allensworth 20105th March 2020 @kwokwng @eucapa @ifapanet 29

30. The range of interventions 3/3
• Communication or media outreach: mass media, including radio, TV,
newspapers; personal media, including text messages; printed media,
including pamphlets, billboards, posters, direct mail, church bulletins
• Advocacy: organizing at the site, coalition building, community
development, social action
Fertman & Allensworth 20105th March 2020 @kwokwng @eucapa @ifapanet 30

31. UEF // University of Eastern Finland
Systems Approach for Health Promotion
5th March
2020
@kwokwng @eucapa @ifapanet 31

32. Coronay heart
disease
A reductionist assessment of need
High levels of
blood serum
cholesterol
Poor cardio-
vascular fitness
Poor diet
Low levels of
exercise
High prevalence
of smoking
Low income
Poor access to
cheap healthy
foods
Little
understanding of
’healthy’ diet
Few facilities for
exercise
Pro-smoking
community norms
Little
understanding of
risks of smoking
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33. ◼33
HOW DOES
PHYSICAL ACTIVITY
FIT IN A SYSTEM ?
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38. Whole Systems Approach
Implementation Process
Example: Obesity Prevention
Source: PHE, Whole systems approach to obesity,2019
Main Focus is
IMPLEMENTATION
[‘Action’]
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39. Rutter, Cavill, Bauman, Bull. Bull World Health Organization 2019;97:162–1655th March 2020 @kwokwng @eucapa @ifapanet 39

40. A ‘WHOLE
SYSTEMS’
APPROACH
TO PHYSICAL
ACTIVITY
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42. FOUR POLICY ACTION AREAS
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43. Create a paradigm shift in all of society by
enhancing knowledge and understanding of,
and appreciation for, the multiple benefits of
regular physical activity, according to ability
and at all ages.
RECOMMENDS
4 POLICY ACTIONS
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44. Create and maintain environments that
promote and safeguard the rights of all
people, of all ages, to have equitable access
to safe places and spaces, in their cities and
communities, in which to engage in regular
physical activity, according to ability.
RECOMMENDS
5 POLICY ACTIONS
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45. Create and promote access to
opportunities and programmes, across
multiple settings, to help people of all
ages and abilities to engage in regular
physical activity as individuals, families
and communities.
RECOMMENDS
6 POLICY ACTIONS
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46. Create and strengthen leadership,
governance, multisectoral
partnerships, workforce, advocacy,
research and information systems
across sectors to achieve excellence in
resource mobilization and implementation of
coordinated international, national and
subnational action
RECOMMENDS
5 POLICY ACTIONS
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47. A ‘WHOLE
SYSTEMS’
APPROACH
TO PHYSICAL
ACTIVITY
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48. Systems thinking and approaches
• A system has a set
of interrelated parts
that form a whole.
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A system is not the
sum of its parts, but
rather the product of
their interaction.

49. UEF // University of Eastern Finland
Adapted Physical Activity Models

50. UEF // University of Eastern Finland
ICF
Health Condition
(disorder or disease)
Body Function &
Structures
Activity Participation
Environmental
Factors
Personal Factors
5th March
2020
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51. UEF // University of Eastern Finland
F-Words
https://www.canchild.ca/en/research-in-practice/f-words-in-childhood-
disability

52. UEF // University of Eastern Finland
PAD model
Van der Ploeg, 2004. doi:10.2165/00007256-200434100-
00002

53. UEF // University of Eastern Finland
ICF
Health Condition
(disorder or disease)
Body Function &
Structures
Activity Participation
Environmental
Factors
Personal Factors
Kraus de Camargo, Simon, Ronen & Rosenbaum, 2018. ICF A hands on approach for clinicians and families
5th March
2020
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54. SEMA
Systematic Ecological Model Adapting PA

55. SEMA (Hutzler, 2007)
• SEMA takes its foundations from three important places.
– Action Systems Theory
– International Classification of Functioning, Disability and Health
– Adaptation Theory
• Use the following steps
1. Define your Task
2. Define successful performance criteria
3. Identify barriers and facilitators
4. Identify performance errors
5. Adaptation suggestions
http://www.adaptip.com/showArticle.asp?DynamicContentID=411&SubSectionID=92&LangCode=Eng

56. Adaptation Task
• Choose an activity and apply SEMA
• Focus on the function rather than the condition
• Discuss with others to give comments and share ideas
– What was the reason for using the strategy?
– What changes do you suggest?
– Which are the easiest to implement?
– Which are the hardest to implement?
– How ready would you be to carry it out?

57. UEF // University of Eastern Finland
European Standards in Adapted Physical Activity
5th March
2020
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58. UEF // University of Eastern Finland
EUSAPA outcomes
•Structured description of APA service delivery in partner countries (strengths
and weaknesses, conditions) in all three areas of APA and Functional map of
APA professional in three areas (Adapted Physical Education, Sport and
Recreation, Rehabilitation)
•The thoroughly designed and jointly accepted framework od STANDARDS
(subject specific competencies and learning outcomes) in three areas of APA
•A model curriculum structure for each area of APA 4) Examples of case studies
of good practice and innovations according to all free areas of APA
competencies

59. UEF // University of Eastern Finland
APE in schools and Health
Key area Key roles Key functions
D. Professional collaboration
to improve teaching quality
for students with SEN
D1. Collaborate with
professionals in APE
D1.2 Collaboration with
health and rehabilitation
professionals (e.g.
physiotherapist,
occupational therapist,
speech therapist,
psychologists)
SKILL: Ability to collaboration with other professionals

60. UEF // University of Eastern Finland
Rehabilitation and Health
Key area Key role Key functions
A. Planning A2. Assess the (dis)abilities,
risk factors, needs and
potential of the client
A2.1. Understand the condition of the clients and its
consequences in terms of function, disability and health
A2.4. Understand the clients’ response to physical activity;
identify and remediate potential contraindications, health
risks and risk factors
B. Education
and Training
B2. Educate clients about
their (dis)abilities and
potential through physical
activity
B1.1. Educate the client about his/her functional (dis)abilities,
response to exercise, potential health risks, risk factors and
contraindications with regards to physical activity.
B1.2. Educate the client about the recognition and
remediation of symptoms that potentially lead to health risks,
injuries, etc…
D.
Assessment
and
Evaluation
D1. Evaluate the effects of
the APA programme as part
of the rehabilitation and
post-rehabilitation process.
D1.1. Monitor the long term health related outcomes of the
APA programme.

61. UEF // University of Eastern Finland
Rating EUSAPA with HP core competencies
•For the following programs, rate on a scale
from 0 (low) – 10 (high) the Health
Promotion competencies
•APE teacher
•Rehabilitation and Health Professional
•Sport and recreation instructor
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2020
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1. Enable Change
2. Advocate for Health
3. Mediate through Partnership
4. Communication
5. Leadership
6. Assessment
7. Planning
8. Implementation
9. Evaluation and Research

62. UEF // University of Eastern Finland
Systems Approach to Health Promotion and APA
5th March
2020
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63. STRATEGIES OF HEALTH
PROMOTION, Beattie
Authoritative MODE OF INTERVENTION
Individual Collective
FOCUS OF
INTERVENTION
Negotiated
HEALTH PERSUASION
PERSONAL COUNSELLING COMMUNITY DEVELOPMENT
LEGISLATIVE ACTION
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65. A ‘WHOLE
SYSTEMS’
APPROACH
TO PHYSICAL
ACTIVITY
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66. UEF // University of Eastern Finland @kwokwng @eucapa @ifapanet 66
Elche (Spain), 21-23 October
Adapted Physical Activity for Health
https://jyu.fi/isapa2021
https://ifapa.net
https://eucapa2020.com
https://eufapa.eu
Volunteer opportunities
5th March 2020