Contexts, Mechanisms, and Outcomes That Matter in Dutch Community-Based Physical Activity Programs Targeting Socially Vulnerable Groups

This article presents a practitioner-based approach to identify key combinations
of contextual factors (C) and mechanisms (M) that trigger outcomes
(O) in Dutch community-based health-enhancing physical activity
(CBHEPA) programs targeting socially vulnerable groups. Data were collected
in six programs using semi-structured interviews and focus groups
using a timeline technique. Sessions were recorded, anonymized, and transcribed. A realist synthesis protocol was used for data-driven and
thematic analysis of CMO configurations. CMO configurations related to
community outreach, program sustainability, intersectoral collaboration,
and enhancing participants’ active lifestyles. We have refined the CBHEPA
program theory by showing that actors’ passion for, and past experiences
with, physical activity programs trigger outcomes, alongside their commitment
to socially vulnerable target groups. Project discontinuity, limited
access to resources, and a trainer’s stand-alone position were negative
configurations. The authors conclude that local governance structures
appear often to lack adaptive capacity to accommodate multilevel processes
to sustain programs.