Determinants influencing municipal decision-makers in Germany regarding community health promotion

Abstract Background Community health promotion should be based on theoretical behavioural and environmental approaches. Especially changes in the physical environment require administrative and political decisions. This study aims to identify determinants that influence decision-makers from local politics and administrations on decisions so that health promotion can be placed on the agenda of communities as a prerequisite of intervention implementation. Methods We used the methods of qualitative guided interviews and a quantitative survey. First, decision-makers from local politics and administrations in both urban and rural areas in Germany were interviewed in the period from July to November 2020. The interviews were analysed using qualitative content analysis according to Kuckartz and MAXQDA. Second, a nationwide online survey was conducted using Limesurvey. We used descriptive analyses. In both surveys, decision-makers reported the determinants for decision-making processes and their decision-making behaviour. Results 22 interviews were conducted (women n = 7), and 415 participants (women n = 118) responded to the online survey. The decision-making behaviour of local decision-makers can be differentiated on different levels, following socio-ecological models: individual, socio-cultural, institutional, municipal and political. Each of these levels comprises a multitude of determinants that are essential for successful persuasion toward community health promotion. At the individual level, we identified determinants like attitudes, outcome expectations or emotions towards a topic. Conclusions The identification and understanding of determinants for local decision-making are essential for a tailored and theory-based intervention approach to place health promotion on the agenda of communities and to implement interventions. Further research is needed to replicate the importance of potential determinants and to develop effective intervention methods and techniques. Key messages Regarding to a theory-based implementation of community health, determinants of local decision-makers should be taken into account. The determinants are nested on different levels (e.g. individual, socio-cultural, institutional) of a socio-ecological approach.


Background:
The political context is an important determinant of health. Politicians in municipalities and regions in Sweden are responsible for many of the determinants of health, and their role is therefore important when considering health promotion. The aim of the study was to explore how politicians describe their role in health promotion.

Methods:
An electronic questionnaire focused on politicians' role, responsibility, and possibility to promote health was sent to all politicians in municipalities and regions in the north of Sweden. A total of 667 politicians answered the questionnaire, and out of them, 361 politicians answered the free text question ''as a politician I consider my role in health promotion to be ...''. The answers were analyzed using thematic analysis. The four themes discovered were used to sort politicians into groups. All politicians were sorted into the group that was most similar to their answer. Group sizes were shown in percentage of how large part of the politicians belonged to the respective groups.

Results:
Preliminary results show that the politicians could be divided into four different groups: 1) No political role, only personal aspects described (such as being a good role model) (25,3%), 2) Promote individuals to take care of their health (for example through information) (19,5%), 3) Support other parts of the organization (municipality or region) to promote health, mainly through financial support and agenda-setting (29,8%), 4) Most (if not all) political decision-making affect health (25,4%).

Conclusions:
There is a large variety in how politicians describe their role in promoting health. Only approximately half of the politicians see that their political decision-making can directly affect the health of the population. With the political context being an important determinant of health, this could be considered a missed opportunity for structural health promotion work.

Key messages:
Approximately half of the politicians did not describe political means of affecting population health. Not recognizing the political determinants of health risk making politicians miss the opportunity for structural health promotion work.

Background:
How healthcare systems should respond to health and psychosocial needs in the population after terrorism is debated. Still, there has been recent interest for more coordinated health threat governance in Europe. Studies comparing approaches to health emergency contingency in different countries are thus needed. This poster will present a comparative study of how France and Norway planned for disaster follow-up prior to four major terrorist attacks, and how differences in the approaches can be understood.

Methods:
National plans and guidelines from France and Norway, planning the response to mass casualty incidents relevant to four terrorist attacks in 2011, 2015 and 2016 were analyzed, by document analysis. Walt and Gilson's health policy model, focused on context, process, content and actors guided the analysis.

Results:
The countries' approaches were similar regarding identified target groups of prescribed measures and contents of some measures, however historical and systemic differences shaped approaches to post-terror needs. The countries deviated particularly on who the actors responsible for providing care were, and also the content of some measures. For instance, in iii402 European Journal of Public Health, Volume 32 Supplement 3, 2022