Youth sports clubs’ potential as health promoting setting

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Youth sports clubs’ potential as health promoting setting:

profiles, motives and barriers

Authors Jeroen Meganck1

Jeroen Scheerder²

Erik Thibaut²

Jan Seghers1

Affiliation 1KU Leuven – University of Leuven, Department of Kinesiology, Physical

Activity, Sports & Health Research Group, Leuven, Belgium

² KU Leuven – University of Leuven, Department of Kinesiology, Policy in

Sports & Physical Activity Research Group, Leuven, Belgium

Publication Health Education Journal

Online publication 23rd

of September 2014

DOI: 10.1177/0017896914549486

Youth sports clubs’ potential as health promoting setting

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Abstract

Setting & Objective. For decades the World Health Organization has promoted settings-based

health promotion but the applications in leisure settings are minimal. Focusing on organised

sports as an important leisure activity, this study had three goals: exploring the health

promotion profile of youth sports clubs; identifying objective club characteristics (e.g. size,

type of sport…) predicting the presence/absence of health promotion in youth sports clubs;

identifying perceived motives and barriers regarding health promotion in youth sports clubs,

thereby improving the basis for policy guidelines.

Method. Respondents were representatives from the board of 154 youth sports clubs

(completion rate 52%). Data were collected through an online survey including the health

promotion sports club index (HPSC-I). Linear regression and analysis of variance were used

to identify predictors and differences.

Results. Even though the motives were strongly supported, a majority of youth sports clubs

was rated as low health promoting on the HPSC-I (59%). Overall, linear regression indicated

that clubs founded more recently, offering multiple types of sports and offering both

recreation and competition scored higher on the health promotion indices. Health promotion

not being a priority of the board and lack of expertise were identified as the most important

barriers.

Conclusion. Much progress is needed before youth sports clubs can truly be considered health

promoting settings. Policy suggestions are made to address the barriers, e.g. financial

incentives to maximize efforts and establishing collaborations between sports clubs and health

promotion experts.

Keywords: Health promotion; health promoting sports club; settings-based health promotion;

motives/barriers for health promotion; child/adolescent health

Youth sports clubs’ potential as health promoting setting

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Introduction

For close to 30 years the World Health Organization (WHO) has advocated settings as

the basis for health promotion. Building on the Ottawa Charter (World Health Organization,

1986) a setting for health was later defined as the ‘…place or social context in which people

engage in daily activities in which environmental, organizational and personal factors interact

to affect health and well-being’ (World Health Organization, 1998, p19). While the goal

remains the optimization of the individual’s health behaviour, this approach proclaims this is

best effected through integrating ‘... a commitment to health within the cultures, structures,

processes and routine life of organizational and other settings’ (Dooris, 2004, p52). Even

though the WHO (2014) lists a variety of settings for health promotion (e.g. cities,

workplaces, hospitals, schools...) it is noteworthy that no leisure settings are mentioned. As

this is one of the main developmental contexts for children and youth, next to family and

school (Rutten, 2007), extending the settings-based approach to leisure settings may provide

additional benefits for adolescent health and well-being.

The sports setting then becomes of significant interest as club-organized sport is an

important leisure activity for youth (Dobbinson et al., 2006), with sports organizations

claiming the highest rate of membership among all youth oriented leisure organizations in

Flanders (the northern, Dutch speaking part of Belgium) (Smits, 2011) and over a third of

young people (35%) involved in sports clubs according to the Eurobarometer (European

Commission, 2013). As it has been argued that young people may be more receptive to health

information from other sources than school (Maro et al., 2009), sports clubs have the

additional benefit of operating outside of the formal education system, emphasizing the

voluntary nature of the collaboration of youth with adults (Kokko et al., 2006; Rutten et al.,

2007). Despite this voluntary aspect of sports participation the Flemish sports landscape is

structured so that sports clubs, mostly operating as independent non-profit organizations

Youth sports clubs’ potential as health promoting setting

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(91%), are usually embedded in both their sports federation (a sport governing body at

Flemish level, uniting all clubs offering that sports discipline and organising competition,

coaches’ education…) (82%) and in their local sports council (sport governing body at the

level of the municipality that units all sports clubs in that community regardless of sports

discipline, supporting local clubs by financial funding, providing sports accommodation…)

(90%) (Scheerder and Vos, 2010). Both these structures are well-established and can therefore

be used to inform and engage sports clubs at the grass-root level. The sports setting is of

additional interest to health promotion as sports club participation has been shown to have

psychological and psychosocial benefits going beyond physical health improvement,

emphasizing sports clubs’ potential to broach a variety of health issues (Geidne et al., 2013).

This is further supported by Eime et al. (2013) who found that these benefits are stronger for

sports participation as compared to other leisure-time physical activity (e.g. exercise, active

commuting...), hypothesizing that the positive involvement with peers and adults in sports

clubs may enhance the psychosocial health benefits.

Several studies have indeed explored the potential of sports organizations with regard

to health promotion. Both the negative influence of sports sponsors (e.g. Kelly et al., 2012 on

unhealthy food sponsorship; O'Brien and Kypri, 2008 on alcohol industry sponsorship) and

the potential of sponsorship aimed at promoting health (e.g. Corti et al., 1997; Lynch and

Dunn, 2003) have been documented. Sports venues have been studied with respect to their

health promoting policies and activities, such as food availability (Ireland and Watkins, 2009)

and implementation of tobacco policies (Pikora et al., 1999). The Healthy Stadia project has

even applied the settings-based approach to sports venues as a setting in their own right,

exploring the health promotion policies and activities in sports stadia in 10 European

countries and aiming to actualise the potential of sports venues through the European Healthy

Stadia Network (Drygas et al., 2013). The sports club itself has also been the focus of research

Youth sports clubs’ potential as health promoting setting

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(e.g. Dobbinson et al., 2006; Duff and Munro, 2007; Casey et al., 2009a), but it was the

concerted effort by Kokko and colleagues (2006) that lead to the concept of the sports club as

a health promoting setting. Using the Delphi method a consensus was reached between

experts in sports clubs and in health promotion on the fundamental characteristics of a health

promoting sports club, resulting in 22 standards considering the ways a sports club can

positively influence the health of club members. Organized in the health promoting sports

club index (HPSC-I), the validity and reliability of this instrument was confirmed in

subsequent research (Kokko et al., 2009). Developed in Finland, at present the use of the

HPSC-I has been documented in only one other country, utilising an adaptation of the

questionnaire with French coaches (Van Hoye et al., 2014).

As health experts are convinced that the responsibility for health promotion extends

beyond their own sector (e.g. Kickbusch, 2003; Kokko et al., 2006), it is promising that the

literature to date confirms the potential of the sports setting regarding health promotion. But

while there are indications that sports governing bodies at the national or state level are

starting to take on this responsibility (Casey et al, 2012), it remains paramount to ascertain to

which degree sports clubs at the grass-roots level are willing and able to take up this role. The

primary aim of this study, therefore, is to test the original HPSC-I with representatives of the

board of youth sports clubs as a tool to describe the current state of affairs in Flanders. The

second goal is to identify the objective club characteristics (e.g. club size, type of sport...)

predicting the presence of health promotion in youth sports clubs. Finally, this study aims to

extend previous research exploring the motives and barriers to integrate health promotion in

the policy and activities of youth sports clubs as perceived by the board. These results will

then guide the formulation of guidelines to optimize the health promoting role of youth sports

clubs.

Youth sports clubs’ potential as health promoting setting

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Method

Data collection and sample

The sample for this study, conducted in 2011, consisted of all 381 youth sports clubs

(having members <19 years old) of the Flemish Sports Club Panel, a representative sample of

sports clubs in Flanders (Scheerder and Vos, 2010), covering sports as diverse as, for

example, gymnastics, soccer, rope skipping and diving. All sports clubs were contacted via a

personalized e-mail introducing the study and asking a member of the board to fill out the

online survey. After two reminder e-mails non-responders were contacted by phone as a final

reminder.

Almost one in four clubs were removed from the list as they no longer had youth

members (n=70), ceased functioning (n=12) or could not be contacted (n=6). Of the

remaining 293 clubs, 200 respondents started the survey, of which 154 completed the HPSC-I

(52% completion rate). As the HPSC-I was essential to this study only the latter were

included.

Most youth sports clubs were represented by their president (40%) or secretary-general

(31%). Of the non-respondents, 15% could be contacted by telephone, of which 79%

indicated time constraints as the reason for not participating in the study.

On average, clubs were founded 32 years ago (ranging from 3 to 62 years old). Mean

size of the clubs was 160 members, with on average about half being youth members. Most of

the clubs offered training in only one sport, but one in eight were multi sports clubs offering

at least two sports (e.g. soccer and badminton). Forty percent of the clubs offered individual

sports (participation is possible without an opponent, e.g. track and field) with the remainder

divided about equally over duo (participation needs one opponent, e.g. tennis) and team sports

(participation usually happens in group, e.g. basketball). About one in ten of the clubs

reported to focus only on competition and almost one in three only on recreation, with the

Youth sports clubs’ potential as health promoting setting

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majority combining both. Almost all clubs were member of their sports federation and the

local sports council of their municipality. About two thirds of the clubs had a specific sport

policy regarding their youth members. (See Table 1 for a detailed overview of the sample

characteristics.)

Table 1. Sample characteristics

Nominal variables % N Continuous variables % N

Number of sports offered

Age of club (M=32.4, SD=16.78)b

one (1 sport) 87.5 133

founded after 2000 15.0 22

multi (>1 sport) 12.5 19

founded 1990-1999 12.9 19

Type of sporta

founded 1980-1989 19.7 29

individual 40.0 60

founded 1970-1979 23.8 35

duo 32.7 49

founded before 1970 28.6 42

team 27.3 41

Type of cluba

Club size (members) (M=159.7, SD=205.82)b,c

recreational only 31.6 48

small (<61 members) 35.7 55

recreational & competitive 57.2 87

medium (61-200 members) 42.2 65

competitive only 11.2 17

large (>200 members) 22.1 34

Member of sports federation

no 8.6 13

Percentage of youth members (M=57.7, SD=29.83)b

yes 91.4 91

<= 5% 7.1 11

Member of local sports council

<=25% 13.6 21

no 4.0 6

<=50% 19.5 30

yes 96.0 145

<=75% 28.6 44

Youth specific sport policy

>75% 31.2 48

no 36.4 56

yes 63.6 98 aRecoded into dummy variable for the regression analyses with first category as reference category.

bEntered as

continuous variable in the regression. cCut-off based on Van Lierde and Willems (2006).

Instrument

Health Promoting Sports Club Index. The HPSC-I (Kokko et al., 2009) was designed

to capture the health promotion activity level of sports clubs. It encompasses an overall index

and four sub-indices: i) policy (eight items), ii) ideology (two items), iii) practice (seven

Youth sports clubs’ potential as health promoting setting

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items), and iv) environment (five items). All 22 items were translated from the original

Finnish into Dutch in dialogue with the developer (Kokko, 2011, personal communication).

Respondents graded each item as to the extent it applied to their club on a Likert scale

anchored by “1 = does not describe the club at all” and “5 = describes the club very well”.

Index scores were then calculated as the average score of the items to compensate for the

different number of items included in each index. . These continuous index scores were used

for analyses specific to this study. The general HPSC-I as well as the policy, practice and

environment indices show a good to excellent internal consistency (ranging from .80 to .92),

with the ideology index, containing only two items, scoring lower (.43).

While the procedure described above maximises the available data and allows for easy

comparisons across indices, it precludes comparison with the original article in which a

different calculation was used. To make the international comparison possible this scoring

system is employed as well. First, all item scores are dichotomized into “0 = not in

accordance with the guideline (scores one through three)” or “1 = in accordance with the

guideline (scores four and five)”. Second, these dichotomous item scores are added to

calculate index-scores, but without averaging for the number of items. Finally, using the

original cut-off values (Kokko et al., 2009) the sports clubs are categorized as low, moderate

or high health promoting (HPSC-I: low<11 and high>14.99; policy: low<4.00 and high>5.49;

ideology: low<1.00 and high>1.49; practice: low<3.50 and high>4.49; environment: low<2.5

and high>3.49).

Perceived motives and barriers. Within health promotion there is a strong interest in

differentiating between intrinsic (e.g. focused on personal growth, community support...) and

extrinsic goals (e.g. focused on accumulating wealth, social recognition...), usually referred to

as motives (Teixeira et al., 2012). Adapting these to the sports setting resulted in four motives

to integrate health promotion in the youth sports club’s activities (Table 2), with two items

Youth sports clubs’ potential as health promoting setting

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focusing on the role of the club within the society (intrinsic, e.g. contributing to the health of

youth) and two on potential benefits to the club (extrinsic motives, e.g. getting better

competitive results). All items were scored on a five point Likert scale anchored by “1 = a

very weak motive” and “5 = a very strong motive”. As principal component analysis resulted

in one factor and Cronbach’s alpha was high (Table 2), item scores were averaged to compute

a single motives index.

Table 2. Principal component analyses and Cronbach's alphas of the motives and barriers

indices

Cronbach's

alpha

Factor loadings

Factor 1 Factor 2 Factor 3

Motives 0.84

Healthy athletes perform better

0.711 - -

Our club wants to profile itself as a healthy club

0.897 - -

Our club wants to contribute to the health of youth

0.888 - -

Our club wants to take up its responsibility in the community 0.811 - -

Barriersa

Factor 1: lack of internal support 0.89

Health promotion is not a priority in our club

0.748 -0.229 0.367

Lack of interest amongst parents

0.812 0.375 0.187

Lack of interest in the board

0.844 0.191 0.217

Lack of interest amongst youth members

0.884 0.269 0.159

Factor 2: lack of external support 0.91

Inadequate support with expertise from the federation

0.147 0.895 0.225

Inadequate support with expertise from the government

0.180 0.905 0.187

Factor 3: lack of resources 0.81

Lack of knowledge & expertise

0.340 0.390 0.645

Lack of money

0.140 0.325 0.773

Lack of time 0.273 0.040 0.877

aPrincipal component analysis with varimax rotation; 81% explained variance.

Analysing health promotion projects, Robinson et al. (2006) identified three main

barriers to health promotion practice: competing priorities and/or lack of interest, lack of

skilled and/or committed people and lack of funds and/or resources. Adapting these to the

Youth sports clubs’ potential as health promoting setting

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sports club setting resulted in a list of nine barriers to include health promotion in the club’s

policy and actions (Table 2). Respondents scored each item on a five point Likert scale,

anchored by “1 = totally disagree” and “5 = totally agree”. A principal component analysis

with varimax rotation identified three factors explaining 81% of the variance. Three barriers

indices (lack of internal support, lack of external support and lack of resources), all with high

to excellent internal consistency (Table 2), were calculated by averaging the respective item

scores. Finally, respondents were asked to identify the barrier they perceived as the most

important.

Statistical analyses

Linear regression was used to identify predictors for all indices, entering all club

characteristics (see Table 1) in one set. Nominal variables were recoded into dummy variables

when necessary, with the first category used as reference. Continuous variables were entered

in the regression as such, without categorization. Analyses of variance and post hoc LSD

analyses were used to identify differences for the perceived motives and barriers between

sports clubs with different level of health promotion classification. All statistical analyses

were performed using SPSS Statistics, version 20.0.

Results

Health Promoting Sports Club Index

Youth sports clubs in this study did not score particularly well on the HPSC-I (Table

3) with an average score just above the mid-point of the scale and three out of five clubs being

classified as low health promoting. Linear regression analysis (Table 4) found that 29% of the

variance in HPSC-I could be explained, with three predictors reaching significance: youth

sports clubs scored higher when they were founded more recently, were multi sports clubs and

had a dual focus on both recreation and competition.

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Table 3. Descriptives of HPSC-I

HPSC-I Policy Ideology Practice Environment

Number of items 22 8 2 7 5

Cronbach’s alpha / Spearman-Brown (Ideology) 0.92 0.82 0.43 0.86 0.80

Continuous score, averaged for number of items

M (maximal score = 5) 3.14 2.87 4.07 2.85 3.58

SD 0.726 0.771 0.833 0.911 0.885

Dichotomized score, not averaged

M (maximal score = number of items) 9.42 2.90 1.50 2.21 2.81

SD 5.344 2.035 0.597 2.029 1.742

Health promotion level classification (%)

low 59.1 62.3 5.2 75.3 37.7

moderate 22.7 26.6 39.6 10.4 20.8

high 18.2 11.0 55.2 14.3 41.6

Of the sub-indices the ideology index (Table 3) had the highest mean score, signifying

that respondents found their clubs to be fairly well in line with the items of this scale. This

was mirrored in their classification as over half of the clubs were deemed to be high health

promoting. As this index showed a low internal consistency, it should be noted that the

“everyone plays” ideology was supported more strongly (M=4.5, SD=0.849) than the “fair

play” ideology (M=3.7, SD=1.219). Linear regression analysis (Table 4) revealed that 19% of

the variance in the ideology index could be explained. Only two predictors were significant,

with higher scores for youth sports clubs that had been founded more recently and for clubs

that focused on both recreation and competition.

The environment index was the only other sub-index with an average score above the

midpoint of the scale, approaching a score of ‘describes our club well’, with less than 40% of

the clubs being classified as low health promoting (Table 3). Linear analysis (Table 4)

revealed that 27% of the variance could be explained for, with three predictors found to be

significant, indicating that youth sports clubs fared better if they had been founded more

recently, had a higher percentage of youth members or focused on both recreation and

competition.

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Table 4. Linear regression analyses for HPSC-I and motives index a

Dependent Explanatoryb Beta t p R²

F

(DF=11) p

HPSC-I age of club -0.211 -2.638 0.009 0.290 4.934 .000

number of sports in club 0.213 2.807 0.006

recreation & competitive levelc 0.331 3.404 0.001

Policy age of club -0.212 -2.562 0.012 0.235 3.709 .000

number of sports in club 0.251 3.179 0.002

recreation & competitive levelc 0.289 2.868 0.005

Ideology age of club -0.188 -2.201 0.029 0.189 2.817 .002

recreation & competitive levelc 0.232 2.230 0.027

Practice number of sports in club 0.188 2.431 0.016 0.260 4.253 .000

recreation & competitive levelc 0.326 3.290 0.001

Environment age of club -0.188 -2.314 0.022 0.267 4.395 .000

percentage youth members 0.285 3.325 0.001

recreation & competitive levelc 0.249 2.521 0.013

Motives total number of members 0.182 2.113 0.037 0.187 2.621 .005

number of sports in club 0.204 2.426 0.017 aAs the analyses of variance for all three barriers indices failed to reach significance and no

significant predictors could be identified, they are not included in this table. bNon-significant predictors (type of sport, member of sports federation, member of local sports council, youth specific

sport policy) are not shown. cReference category: recreational focus only.

With average scores just below the midpoint of the scale, respondents stated that their

club was only to some extent in accordance with the items presented in both the policy and

practice index, as further demonstrated by the majority of the clubs being classified as low

health promoting (Table 3). Linear regression analysis revealed that 24% of the variance in

the policy index could be explained, with three significant predictors, indicating that youth

sports clubs scored higher when they had been founded more recently, were multi sports

clubs, and focused on both recreation and competition (Table 4). Regarding the practice

index, 26% of the variance could be explained by the regression analysis, but only multi

sports clubs and a focus on both recreation and competition were significant predictors (Table

4) for higher scores.

Youth sports clubs’ potential as health promoting setting

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Motives and barriers

With an average score of ‘rather strong’ on the motives index (Table 5), respondents

recognized different advantages of including health promotion in their youth sports club’s

policy and actions. Further analysis indicated that the motives were supported more strongly

by youth sports clubs with a moderate or high health promoting classification in comparison

with clubs with a low classification. Linear regression (Table 4) indicated that 19% of the

variance in the motives index could be explained by club characteristics. However, only two

predictors reached significance, with larger clubs and multi sports clubs scoring higher.

Table 5. Motives and barriers indices for health promotion: descriptives and analyses of

variance

Complete

sample

(range 1-5)

ANOVA for level of health promotion classification

low moderate high statistics

M SD M SD M SD M SD F p

Motives 4.01 0.739

3.72 0.683 4.40 0.592 4.60 0.538 23.714a .000

Barriers

Lack of internal support 2.63 1.012

2.79 1.022 2.45 0.941 2.19 0.964 3.306b .040

Lack of external support 2.95 1.081

3.07 1.090 2.81 1.110 2.65 0.915 1.541 .218

Lack of resources 2.87 1.048

3.01 1.056 2.80 1.016 2.28 0.892 3.788 b .025

Post hoc analyses (LSD) indicated significant differences: athe low category differs from the moderate and high

categories, which do not differ from each other; bthe low category differs only from the high category.

With average scores just below neutral on all barriers indices (Table 5), respondents

indicated that none of the potential barriers were important as reasons not to integrate health

promotion in their club’s policy and practices. Analyses of variance found significant

differences between levels of health promoting classification for lack of internal support and

lack of resources but not for lack of external resources. Post hoc analyses revealed that the

clubs classified as low health promoting endorsed the former indices to a greater extent than

clubs with a high classification, with no significant differences found with the moderate

Youth sports clubs’ potential as health promoting setting

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classification. Linear regressions found none of the club characteristics to be a significant

predictor for any of the barriers indices.

Asked to identify the most important barrier, 33% of the respondents submitted that

health promotion was not a priority in their club. The top five was completed by lack of

knowledge/expertise (18%), lack of time (16%), inadequate support from the government

(12%) and lack of money (7%).

Discussion

With 52% of adolescents (12 to 18 years old) in Flanders being a member of a sports

club (Scheerder et al., 2013), youth sports clubs are a promising setting to reach a large

number of this population. However, with not even one in five sports clubs classified as high

health promoting on the HPSC-I, it is clear that these clubs have a way to go before living up

to their potential as a health promoting setting. Even though the scores on the ideology index

give a more positive impression, some restraint is in order as it is easy for respondents to state

they support an ideology. In that respect it may even be surprising that 40% stated their club

did not subscribe to the ‘fair play’ ideology. If this interpersonal value is to be taught in and

through participation in youth sports club’s activities, additional efforts seem appropriate. As

such, fair play is one of the central themes promoted in the Flemish governmental campaign

for ethically responsible sports (Vlaamse regering, 2012), which was launched shortly after

the data for this study was collected. While the results on the environment index are also

somewhat encouraging they stand in contrast to the policy and practice index, on which only a

minority of clubs attains a high health promoting categorization. This may be due to many

clubs not possessing such formalized documents (e.g. written regulations) and procedures as

are proposed in the items within these indices. Also, these latter indices encompass more

specific health promotion items which may not yet be part of a club’s routine activities,

Youth sports clubs’ potential as health promoting setting

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whereas the ideology and environment index are much more in line with a sports club’s core

business (Kokko et al., 2009).

Comparing the results from members of the board of sports clubs internationally is

currently only possible with Finnish data (Kokko et al., 2009), indicating that the percentages

of high classification on the general HPSC-I are similar; however twice as many Finnish

sports clubs gained a moderate classification and only about half as many were classified as

low health promoting. Finnish youth sports club outperform their Flemish counterparts on the

ideology, practice and policy index. The only exception is the environment index on which

Flemish clubs are classified as high health promoting almost four times as often as the Finnish

clubs, which may be the result of a longstanding focus on safe and healthy sports participation

in Flemish sports. Still, the overall conclusion that much progress still needs to be made in

Finland clearly applies to the Flemish situation to an even greater extent.

In line with the Finnish results (Kokko et al., 2006) no association was found between

the indices and the size of the club or the type of sport practiced. In contrast, the present study

did find that multi sports clubs do better than clubs focusing on one sport only. Furthermore,

two variables not included in the Finnish study were also found to be significant predictors for

at least four of the five indices. Clubs that were founded more recently tended to score better

than their older counterparts, potentially paralleling a trend in society towards an increased

emphasis on health. Clubs that focused on both recreation and competition also tended to be

better off compared to clubs focusing on only one of these. It could be argued that these clubs

have a broader perspective and are therefore able to embrace health promotion more easily.

Motives, barriers and practical implications

Concerning the future of the health promoting sports club ideal, it is encouraging that

the respondents supported the different motives to include health promotion in their sports

club’s activities. While this result seems to coincide with relatively lower support for the

Youth sports clubs’ potential as health promoting setting

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barriers, there are still hurdles to overcome. To improve the health promotion profile of sports

clubs will require a shared effort. While the boards and coaches of the sports clubs need to be

involved at grass-root level where policy and action meet the athletes, these clubs can and

should be encouraged and supported to do so by health promotion experts, their sports

federation and the local government. Based on the barriers as perceived by the respondents in

this study, the following guidelines are proposed to increase the viability of the health

promoting sports club concept.

In line with previous studies (Dobbinson et al., 2006; Robinson et al., 2006), one third

of the respondents indicated that health promotion is not a priority in their club, making it the

primary barrier. While these other priorities were not specified, other studies have pointed out

that the core business for sports clubs is not health but to provide a high quality sports

experience and/or increasing membership (e.g. Casey et al., 2009a; Casey et al., 2012;

Seghers et al., 2012). The counterargument can be made, however, that sports clubs with other

priorities may still promote or at least influence their members’ health behaviour as part of

their day to day activities, intentionally so or not. Opportunities should therefore be explored

to get these clubs involved as well. Even though lack of financial resources was not put forth

as an important barrier, financial rewards, e.g. by way of increased funding from local

municipality or sponsorship by health promotion organisations (e.g. Kelly et al., 2014), could

still be efficient incentives. Non-monetary recognition such as a ‘healthy sports club’ quality

label accorded by, for example, the sports federation could also be of interest to clubs to

improve their public image and thereby attract new members. Even for clubs that hold health

promotion as a priority, these incentives could help to increase the percentage that has a

written policy regarding health and health promotion that could then be translated into

specific actions (Dobbinson et al., 2006).

Youth sports clubs’ potential as health promoting setting

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The second to fourth most important barriers could arguably be related to each other. It

seems plausible, for instance, that the argument of insufficient time may stem from a lack of

know-how regarding the opportunities for health promotion in a sports club. This lack of

expertise may then elicit the complaint of insufficient support from the government. One

strategy to overcome these barriers could be to include health promotion as an integral part of

the formal education of club officials and coaches as organised by the sports federation. While

this capacity building may be the optimal solution for the long term, it may not lead to short

term changes. Furthermore, care should be taken not to unduly increase the demands placed

on the clubs thereby endangering the clubs’ primary aim of providing opportunities for sports

participation. An alternative strategy could be to create collaborations between sports

representatives and health promotion experts (Casey et al., 2009b), thereby offering sports

clubs the necessary technical support (Kelly et al., 2014). At the local level, this could be

instigated by the sports functionary of the municipality (the person in charge of sports within

the local government), helping sports clubs network directly with either the health department

of the municipality or non-governmental health promotion experts in the community. At the

level of the sports federations, collaborations with larger health promotion organisations is

feasible as well (Casey et al., 2012), creating and disseminating ready-made, preferably free

of charge, health promotion ‘packages’ that club officials and coaches can apply directly in

their own club and training (e.g. good practices for activities, examples of sports club policies

on alcohol, tobacco, unhealthy foods...). Alternatively, a health professional could be invited

to ‘join the team’, for example to guide a sports federation or club’s health committee. In the

latter scenario it is advisable for health promotion experts to take a proactive approach

towards the sports settings and demonstrate a willingness to translate their expertise into the

language of this setting (Leow et al., 2012), while respecting that sports clubs have a primary

focus on providing their members with a high quality sports experience. Providing sports

Youth sports clubs’ potential as health promoting setting

18

clubs with access to this health promotion expertise would probably be even more

advantageous than providing funding as insufficient financial resources are mentioned by only

a minority as the primary barrier.

As these suggestions illustrate, both the local government and the sports federation can

take on a supportive role, either directly or by establishing networks. In contrast with other

studies (e.g. Eime et al., 2008) current results indicate that the lack of support from the sports

federation is a much less important barrier than the lack of support from the local government.

This may be due to different expectations. It seems reasonable that the primary reason for

sports clubs to contact their sports federation is related to the core business of sports (e.g.

offering opportunities for sport, competition…). The local government has a much broader

scope and could therefore be expected to take the initiative regarding subjects like health

promotion.

No matter which strategies are chosen, care must be taken that health promoting programs are

sustainable (Casey et al., 2009c) even if funding and/or support from external experts ends. In

that respect, Dooris (2004) pointed out that strategies to integrate health promotion in a

setting’s policy and activities stand a better chance of success if they help that setting achieve

its core objectives as well (in the case of sports clubs: high quality training, running the club

smoothly, optimal performance of the athletes…). This long term embedding may be further

enhanced through continued advocacy by the sports federation and the sports functionary of

the local municipality to keep health promotion on the agenda of the local sports council and

its sports clubs. Research from the school setting (e.g. Inchley et al., 2007; MacLellan et al.,

2009) indicates that this should be complemented by the installation of an ‘advocate of health’

within the club’s structure, for example by appointing a board member as responsible for

health promotion.

Youth sports clubs’ potential as health promoting setting

19

Strengths and limitations

With the health promoting sports club concept still in its infancy, this study provided

an important addition to the research base, reporting the first use of the HPSC-I in another

country. The high internal consistency of the indices and the relative order of the index-scores

are both comparable to the original study, indicating the robustness of the instrument in cross-

cultural applications.

This study also contributed to the extension of this field of research by exploring the

perceived motives and barriers for including health promotion in a sports club’s policies and

activities. These will need to be considered when developing interventions or suggesting

policy changes geared towards getting sports clubs actively involved in health promotion.

Even though the sample in this study was representative for Flemish youth sports,

these results may not be generalized to sports clubs whose membership consists only of

adults. Additionally, future studies should try to increase the number of respondents per club

to investigate the inter-rater reliability: Kokko et al. (2009) found only a low correlation

between HPSC-I scores of two representatives of the board, indicating that responses may be

biased by the person’s individual opinions and perceptions. This is especially of concern as

the HPSC-I is as vulnerable to socially desirable answers as other self-reported measure.

Ideally, information should therefore be collected from other sources (e.g. coaches, members,

documents…) as well to offset information provided by the board. While not feasible within

this study, it would be of benefit to gain additional support for the HPSC-I by analysing its

test-retest reliability, while the construct validity in international context could be reviewed by

a panel of local experts in sports and in health promotion.

Research recommendations

As the sports clubs’ characteristics included in this study accounted for only 19% to

29% of the variance in the index-scores, additional research is necessary to identify the

Youth sports clubs’ potential as health promoting setting

20

predictors of the health promoting activity in youth sports clubs. Special attention should be

given to variables that can be influenced (e.g. collaboration with external experts, education

level of representatives and staff…) so that the policy guidelines can be expanded to take

these into account. In addition, an in-depth exploration of the health promoting activities

currently being undertaken by youth sports clubs could result in good practices, allowing

other clubs to benefit from available expertise. Furthermore, there is a need to evaluate the

impact of a club’s health promoting classification on the health status and behaviour of their

youth members. Finally, strategies to help sports clubs integrate health promotion in their

policies and activities have to be developed and tested, up to and including monitoring the

long-term effect on their members’ health.

Funding

This work was supported by the Flemish Government through the Policy Research Centre for

Culture, Youth & Sport, Leuven, Belgium

Youth sports clubs’ potential as health promoting setting

21

References

Casey M, Payne W, Brown S, et al. (2009a) Engaging community sport and recreation

organizations in population health interventions: factors affecting the formation,

implementation, and institutionalization of partnerships efforts. Annals of Leisure

Research 12: 129-147.

Casey M, Payne W and Eime R (2009b) Building the health promotion capacity of sport and

recreational organizations: a case study of regional sports assemblies. Managing

Leisure 14: 112-124.

Casey M, Payne W and Eime R (2012). Organisational readiness and capacity building

strategies of sporting organisations to promote health. Sport Management Review 15:

109-124.

Casey M, Payne W, Eime R, et al. (2009c) Sustaining health promotion programs within sport

and recreation organisations. Journal of Science and Medicine in Sport 12: 113-118.

Corti B, Donovan R, Holman C, et al. (1997) Using sponsorship to promote health messages

to children. Health Education & Behavior 24: 276-286.

Dobbinson S, Hayman J and Livingston P (2006) Prevalence of health promotion policies in

sports clubs in Victoria, Australia. Health Promotion International 21: 121-129.

Dooris M. (2004) Joining up settings for health: a valuable investment for strategic

partnerships? Critical Public Health 14: 37-49.

Drygas W, Ruszkowska J, Philpott M, et al. (2013) Good practices and health policy analysis

in European sports stadia: results from the 'Healthy Stadia' project. Health Promotion

International 28: 157-165.

Duff C and Munro G (2007) Preventing alcohol-related problems in community sports clubs:

The Good Sports program. Substance Use & Misuse 42: 1991-2001.

Youth sports clubs’ potential as health promoting setting

22

Eime R, Payne W and Harvey J (2008) Making sporting clubs healthy and welcoming

environments: a strategy to increase participation. Journal of Science and Medicine in

Sport 11: 146-154.

Eime R, Young J, Harvey J, et al. (2013). A systematic review of the psychological and social

benefits of participation in sport for children and adolescents: informing development

of a conceptual model of health through sport. International Journal of Behavioral

Nutrition and Physical Activity 10:98.

European Commission (2013). European Youth: participation in democratic life. Flash

Eurobarometer 375. May, Brussels: Directorate-general Education and Culture.

Geidne S, Quennerstedt M and Eriksson C (2013) The youth sports club as a health-

promoting setting: An integrative review of research. Scandinavian Journal of Public

Health 41: 269-283.

Inchley J, Muldoon J and Currie C (2007) Becoming a health promoting school: evaluating

the process of effective implementation in Scotland. Health Promotion International

22: 65-71.

Ireland R and Watkins F (2010) Football fans and food: a case study of a football club in

English premier league. Public Health Nutrition 13: 682-687.

Kelly B, Baur L, Bauman A, et al. (2012) Restricting unhealthy food sponsorship: Attitudes

of the sporting community. Health Policy 104: 288-295.

Kelly, B, King L, Bauman A, et al. (2014). Identifying important and feasible policies and

actions for health at community sports clubs: A consensus-generating approach.

Journal of Science and Medicine in Sport 17: 61-66.

Kickbusch I (2003) The contribution of the World Health Organization to a new public health

and health promotion. American Journal of Public Health 93: 383-388.

Youth sports clubs’ potential as health promoting setting

23

Kokko S, Kannas L and Villberg J (2006) The health promoting sports club in Finland - a

challenge for the settings-based approach. Health Promotion International 21: 219-

229.

Kokko S, Kannas L and Villberg J (2009) Health promotion profile of youth sports clubs in

Finland: club officials' and coaches' perceptions. Health Promotion International 24:

26-35.

Leow A, MacDonald D, Hay P, et al. (2012) Health-education policy interface: the

implementation of the Eat Well Be Active policies in schools. Sport, Education and

Society. Epub ahead of print 06 November. DOI: 10.1080/13573322.2012.737777.

Lynch B and Dunn J (2003) Scoreboard advertising at sporting events as a health promotion

medium. Health Education Research 18: 488-492.

MacLellan D, Taylor J and Freeze C (2009) Developing School Nutrition Policies: Enabling

and Barrier Factors. Canadian Journal of Dietetic Practice and Research 70: 166-171.

Maro C, Roberts G and Sorensen M (2009) Using sport to promote HIV/AIDS education for

at-risk youths: an intervention using peer coaches in football. Scandinavian Journal of

Medicine & Science in Sports 19: 129-141.

O'Brien K and Kypri K (2008) Alcohol industry sponsorship and hazardous drinking among

sportspeople. Addiction 103: 1961-1966.

Pikora T, Phang J, Karro J, et al. (1999) Are smoke-free policies implemented and adhered to

at sporting venues? Australian and New Zealand Journal of Public Health 23: 407-

409.

Robinson K, Driedger M, Elliott S, et al. (2006) Understanding facilitators of and barriers to

health promotion practice. Health Promotion Practice 7: 467-476.

Rutten E (2007) Education through organized youth sport. The Netherlands: Universiteit

Utrecht.

Youth sports clubs’ potential as health promoting setting

24

Rutten E, Stams G, Biesta G, et al. (2007) The contribution of organized youth sport to

antisocial and prosocial behavior in adolescent athletes. Journal of Youth and

Adolescence 36: 255-264.

Scheerder J, Vandermeerschen H, Borgers J, et al. (2013) Vlaanderen sport - vier decennia

sportbeleid en sportparticipatie [Sport in Flanders - four decades of sport policy and

sport participation.], Ghent: Academia Press.

Scheerder J and Vos S (2010) Sportclubs in beeld. Basisrapportering over het Vlaamse

Sportclub Panel 2009 (Beleid & Management in Sport 4) [Sports clubs described.

Basic results of the Flemish sports clubs panel 2009 (Sport Policy & Management 4)].

Leuven: KU Leuven / Department of Social Kinesiology and Sport Management.

Seghers J, Scheerder J, Boen F, et al. (2012) Medisch en ethisch verantwoord sporten. Het

promoten van fysiek, psychisch en sociaal welbevinden van jongeren in Vlaamse

jeugdsportclubs (Beleid & Management in Sport 12) [Medically and ethically

responsible sports participation. Promoting physical, psychological and social well-

being for youth in Flemish youth sports clubs (Sport Policy & Management 12)].

Leuven: KU Leuven / Department of Kinesiology.

Smits W (2011) Join the club. Een profiel van leden van verenigingen en vrijwilligers [Join

the club. A profile of members of societies and volunteers]. In: Lievens J and Waege

H (eds) Participatie in Vlaanderen 2. Eerste analyses van de participatiesurvey 2009

[Participation in Flanders 2. First analyses of the participation survey 2009]. Leuven:

Acco, 83-119.

Teixeira P, Carraçca E, Markland D, et al. (2012). Exercise, physical activity, and self-

dertermination theory: a systematic review. International Journal of Behavioral

Nutrition and Physical Activity 9:78.

Youth sports clubs’ potential as health promoting setting

25

Van Hoye A, Sarrazin P, Heuzé J, et al (2014). Coaches’ perceptions of French sports clubs:

Health promotion activities, aims and coach motivation. Health Education Journal,

published online May 5. DOI: 10.1177/0017896914531510.

Van Lierde A and Willems T (2006) Hoe goed zit het met de Vlaamse sportclubs? [How well

do Flemish sports clubs fare?]. In: De Knop P, Scheerder J and Ponnet H (eds)

Sportbeleid in Vlaanderen. Studies (Volume 2) [Sport policy in Flanders. Studies

(Volume 2)]. Brussels: BLOSO, 127-135.

Vlaamse Regering (2012). Besluit van de Vlaamse Regering tot uitvaardiging van de thema’s

en de richtsnoeren betreffende ethisch verantwoord sporten voor de Olympiade 2013-

2016 [Decision of the Flemish government to promulgate themes and guidelines for

ethically responsible sports participation for the Olympiad 2013-2016]. Staatsblad, 21

December. Available at :

http://www.codex.vlaanderen.be/Portals/Codex/documenten/1022640.html.

World Health Organization. (1986) Ottawa charter for health promotion. Geneva: World

Health Organization.

World Health Organization. (1998) Health promotion glossary. Geneva: World Health

Organization.

World Health Organization. (2014) Types of Healthy Settings. Available at:

http://www.who.int/healthy_settings/types/en/. (accessed 7 April 2014)