Körperliche Aktivität im höheren Lebensalter im Kontext sozialer Ungleichheiten. Ungleichheitseffekte von Public-Health-Interventionen zur Förderung körperlicher Aktivität

Abstract

Reducing health inequalities is a priority for public health. Social inequalities in physical activity are discussed to be an important determinant of health inequalities. Public health interventions to promote physical activity have the potential to reduce health inequalities, but may also unintentionally increase them. Therefore, there is a need for evaluating equity-specific effects of interventions, potentially arising during intervention uptake, acceptance, and efficacy. This cumulative dissertation examined whether and how potential equity-specific effects of public health interventions to promote physical activity among older adults are currently evaluated and what implications for research and practice can be derived. The applied methods comprised a quantitative data analysis, a systematic review, qualitative expert interviews, exploratory literature searches, a methodological workshop, and the establishment of an international cooperation for re-analyzing data of existing intervention studies. The results indicate that 1) changes in activity behavior among older men and women differ by socioeconomic characteristics, 2) studies of universal interventions to promote physical activity among older adults currently rarely consider equity-specific effects when evaluating the interventions' efficacy, 3) the use of logic models is a potential tool for planning, implementing, and interpreting the analysis of equity-specific intervention effects, and 4) developing a joint strategy for re-analyzing data of existing intervention studies regarding social inequalities in intervention acceptance and efficacy is feasible. Because equity-specific effects of interventions to promote physical activity among older adults are currently rarely evaluated, little is known about the impact of these interventions on health inequalities in the older population. In order to close this evidence gap, equity-specific effects of existing interventions should be evaluated through re-analyzing existing data. Moreover, equity-specific effects of new interventions should be evaluated by analyses specified a priori. Systematic reviews and meta-analyses should be conducted to systematically synthesize and appraise the results of these (re-)analyses. Based on this evidence, recommendations for future interventions should be derived. This would allow for the design of interventions most likely to reduce and not unintentionally increase social inequalities in physical activity among older adults.