The social return on investment of physical activity and nutrition interventions—a scoping review

Introduction Scarcity of resources and mounting pressures on health systems make it critical to evaluate new and existing public health interventions related to physical activity and nutrition. The Social Return on Investment (SROI) framework has gained prominence for capturing traditional variables such as economic costs and returns, as well as wider beneficial social and environmental outcomes. A scoping review was conducted to present the existing evidence on the SROI of physical activity and nutrition interventions, demonstrating the wider benefits of these interventions. Methodology Existing peer-reviewed evidence and grey literature was collated to identify physical activity and nutrition interventions that were evaluated using the SROI framework between January 1996 up until February 2022. Only literature published in the English language, interventions that were conducted in high-income countries were considered for inclusion. Study information and economic data was entered into a pre-prepared data extraction sheet and eligible studies were quality assessed using a 12-point quality assessment framework for SROI studies. Results This review identified a total of 21 SROI studies, with only four deriving from peer-reviewed literature sources. In total, 18 studies evaluated physical activity interventions, one study was purely focused on nutrition, whereas the two remaining studies presented a mix of physical activity and nutrition. The majority of studies derived from the United Kingdom (n = 16) with very few of the studies published prior to 2010 (n = 1). In total, four studies were classified as low quality based on the 12-point quality assessment framework used for this review. Outcomes of the relevant studies show that the benefits of these interventions have added value to families, communities and the wider environments of the target groups. Conclusion This scoping review is adding to research conducted to understand the wider value of public health interventions such as physical activity and nutrition interventions using the SROI framework. This is important so that the development and implementation of public health interventions have the greatest value to people and society, which also benefits decision-makers to effectively and sustainably allocate scarce resources.

Table 3. 12-point quality assessment framework for SROI studies2 Dimension Criterion I Transparency about why SROI was chosen ("referring to how strong the study relates to the broader impact discourse and how much background information it gives on the method -is fairly well advanced") • Linked to context discussion?II Documentation of the analysis (published full and summary report available to get an insight of the comprehensive analysis to avoid misinterpretation and establish legitimacy of the method) • Analysis well documented?
• Impact map used?
III Study design (approximation of 'dead-weight') (elements of ex-ante and ex-post observations included) • Control group setup applied?
• Ex ante-ex post observations performed?Precision of the analysis • Indicators valid and comprehensive?
IV (capture of social effects, which is needed to be enhanced in both quantitative and qualitative ways) • Proxies valid and comprehensive?
• Sensitivity analysis performed?One point is given to each criterion "present" in the study and 0 if the item was "missing" or "could not be ascertained".According to the framework Krlev et al. describe 70% as a "good score", classifying papers into high quality, if the study scored ≥ 70 % and low quality, if the study scored < 70 %.-Improved health (e.g.CHS & stroke, cancer, type 2 diabetes) -Reduced crime (criminal incidences) -Improved educational performance (educational attainment) -Enhanced human capital -Improved subjective well-being (life satisfaction) -Enhanced human resources (non-market benefits) *(Eleven social outcomes were identified, which were empirically linked with participation and volunteering in sport.There were six health-related outcomes; two education-related outcomes; and three others related to subjective well-being, crime and the human resource benefits to sports organisations utilising volunteers).KPMG Sustainability Consulting Co. (2021).L., Loughren, E.A. and Crone, D., 2017. [43] Community connections and resources (Ensuring a stronger future by attracting new members and funding; A greater sense of independence for people of all ages, and better connected people building stronger, safer and more cohesive communities with a clearer sense of community spirit) -Improved well-being through development of cultural, recreational and sports facilities -Improved access to community resources -Greater integration of social, sport and special interest groups  -Walkers are able to interact with others from different cultural and social backgrounds and to gain a better understanding of ethnicity and disability -Walkers are fitter and have improved physical health as a result of becoming more regularly physically active -Walkers have more social contacts and are now more confident, experience less isolation and take part in new experiences -Walkers are able to be participate in a supported programme that encourages them to progress and achieve a greater sense of personal satisfaction -Walkers form close relationships with friends made on walks after experiencing social isolation after losing partners, retiring or moving into the area -Walkers feel safe and comfortable and are able to take part in outdoor physical activity in their local green space by being part of a supported group -Walkers know more about their local area and find new places to visit which increases the sense of satisfaction and enjoyment they derive from the place in which they live Walkers in closed Walks: -Walkers are fitter and have improved physical health as a result of becoming more regularly physically active -Walkers who are extremely socially isolated and excluded are able to meet people and form new independent friendships -Walkers are able to be participate in a supported programme that encourages them to a progress and achieve a greater sense of personal satisfaction -Walkers are more relaxed and calm and have improved relationships and off-site training CTBC Bank -Enhance the image and value of the organization -Improve communication and coordination skills -Increase senses of satisfaction and achievement -Improved interpersonal skills Get win Advertising -Increased identification with the organization -Improved communication and coordination skills -Increased sense of satisfaction and achievement -Improved interpersonal skills High School (coaches) -Increased identification with the organization -Improved communication and coordination skills -Increased sense of satisfaction and achievement -Improved interpersonal skills -Improved skills and abilities to teach basketball High School -Increased senses of satisfaction and achievement Students -Increased a sense of belonging to the team and the school -Boostered self confidence -Improved discipline and competence -Improved interpersonal skills -Learned baseball knowledge and improve baseball skills -Increased frequency of daily exercise and improve health conditions Competing teams -Finance the school's image and popularity -Increased school cohesion -Increased identification with the organization -Increased senses of satisfaction and achievement -Improved interpersonal skills -Improved skills and abilities to teach baseball -Increased a sense of belonging to the team and the school -Boosted self-confidence -Improved discipline and competence -Developed an interest in baseball and enjoy the happiness it brought -Learned baseball knowledge and improve baseball skills Fans (family, friends and classmates of players) -Strengthened the relationships with family members and friends -Developed an interest in baseball and enjoy the happiness it brought -Learned baseball knowledge and improve baseball skills Whitebarn Consulting (2019).[42] -Improved health -Friendships -Sense of belonging -Relative satisfaction with volunteering for club -Improved skills -Sense of being good parent -Relative satisfaction with having club in local area -Increased profit -Satisfaction with club's contribution -Successful events -Gaelic games and culture are preserved and grown Baker, C., Courtney, P., Kubinakova, K., Ellis, (better social circle) -More active in locally based positive activities/ keeping out of trouble -Improved skills and employability -Improved sense of personal well-being Wider community -Improved and safer living environment for my children Partner agencies -Savings as a result of resources not required -Savings as a result of partners working together and not duplicating resources -Other young people services better informed and improving own practice as a result of partnership working -Expertise from ACN -ability to pull in additional funding that would not have happened without the partnership State agencies -Police service (cost savings from reduced numbers of young people involved in crimes) -Judicial system (reduced cases being tracked through the court system) -National Health Service (cost savings from the improved health and fitness of young -People Reaching recognised fitness levels through sport) -Department of work and pension (reduced job seekers allowance claims) -Social services (reduced deployment social worker time; family services) ICF GHK Consulting (2012).[48] -Increased participation in sport 3 months after project completed (sustained) -Improved fitness and physical health -Increased self-esteem / confidence -Decreased anti-social behaviour -Improved qualifications and opportunities for coaches -Increased use of leisure facilities -Increased sports club membership -Increased capacity for project deliverers to work with commissioning agendas and Ireland N. (2012).[51] Service user A (significant improvement in independence and mental health) -Improved confidence, self-esteem, sleep patterns, activity levels, reduced stress -Increasing social activity with Gardening in Mind and then elsewhere -Change in physical activity -Eating more healthily -More active -More knowledgeable -Giving something back to the community -Economic activity Service user B (managing and improving mental health) -Improvements in confidence and self-esteem -Increasing social activity within Gardening in Mind and elsewhere -Eating more healthily -More active Service user C (high risk of substantial relapse/ deterioration without project) -Improvements in confidence and self esteem -Increasing social activity within Gardening in Mind and elsewhere -More active Service user D (little sustained impact/ relapse) -Social activity Families of service users -Respite for family of service user Coventry and Warwickshire Mind -Additional monitoring and care of clients NHS community mental health services -Reduction in GP visits -Reduced visits to hospital/ consultant -Reduced medication -Reduction support workers times -Reduced requirement for care packages -Reduction in crisis intervention -Reduction in days respite care to allow families time off Benefits provider -Saving in benefits costs as Service User became named carer for might be anticipated from the Greenlink project, based on the available information, are: • Reduced obesity from exercise and healthy eating • Reductions in cancers from reduced obesity and healthy eating • Reduced CVD, stroke and hypertension from reduced obesity and healthy eating-Regular volunteers: -Giving something back to the community -Learning new environmental skills -Increased physical health/ stamina -Improved well-being and positive thinking from being outdoors -Making new friends -Meeting new people from the community -Gaining more confidence -Better tolerance of children and young people Volunteers on formal training programmes: -Getting a job -More likely to get a job in the future Volunteers with learning difficulties -Maintaining skills by having something to to the NHS arising as a result of 37 individuals taking part in the programme on a regular basis reducing their blood pressure and requiring less drug therapies -Cost savings to the NHS arising as a result of 60 individuals with clinically diagnosed mental health conditions taking part in the programme on a regular basis and requiring less drug therapies Glasgow City Council: -Value in reduced demand for home care as walkers have better mobility, and fewer falls due to increased agility and movement Paths for All -Cost savings/As a result of the walks PfA can recruit, train and retain volunteer walk leaders who provide services that would otherwise have to be provided by paid staff.-Volunteers acquire the requisite experience by participating in the walk and this allows PFA to expand the scope of the programme as it is possible to use savings to provide more walking opportunities Leaders: -Walk leaders have more social contacts and are now more confident, experience less isolation and take part in new experiences -Walk leaders are much fitter and have improved health as a result of becoming more regularly physically active -Walk leaders have improved self-esteem and a sense of worth as they feel valued by the community -Walk leaders have undertaken and achieved Walk Leader and First Aid certificates.This has increased their levels of confidence and given them practical skills (administration, planning, team working, first aid etc.) to enhance employability or volunteering prospects Walkers and Walk Leaders: -Walkers who have experienced mental health problems are able to engage in physical activity and feel happier and positive -Walker with diagnosed physical medical conditions are able to engage in physical activity and as a result feel fitter and become healthier Walkers in open walks: with staff who are able to offer better care and support Davies L (2018).[55] Health outcomes -Reduced risk of: CHD and stroke, type 2 diabetes, breast cancer, colon cancer, dementia, clinical depression, good health Subjective well-being -Improved subjective well-being for participants and volunteers Social capital -Improved social capital for communities Education -Improved educational attainment and enhanced human capital Crime -Reduced criminal incidences Non-market benefits acquired by sports organisations utilising volunteers Parker KR (2019).[56] -Improvement in physical health -More energy -Made friends -Have less illness (reduction in medication and use less health services including GP) -Positive effect on mental health Economizing on breakfast costs -Relieving parental stress Teachers -Reducing work-related stress in teachers

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Improved social capital, community ties and strengthened civic engagement Education and skills (More people leading healthier lives and learning new skills; Creating sustainable and innovative ways of doing things in order to achieve greater success)