ECRA Member Stefanie Do:

"My research goal is to develop a pan-European approach to assessing the impact of policies on health behaviour."

The research goal is to develop a pan-European approach to assessing the impact of policies on health behaviour, which requires the application of a consensus set of established, relevant indicators - including digital measurements where possible and/or appropriate.

In particular, we seek to identify key indicators of the impact of policies and the potential for their adoption by major EU monitoring systems. This requires an iterative three-step consultation process involving experts from research, policy and monitoring (e.g. STOP, CO-CREATE, HBSC, WHO COSI, EFSA, EHIS) and monitoring systems (e.g. OECD, EC DG SANTE, WHO, Eurostat) to select dietary and physical activity/sedentary behaviour (PA/SB) and health and inequality indicators. The key indicators will then be cross-checked against available European databases, followed by the identification of appropriate tools to measure the key indicators - preferably using objective and digital measurement tools that can complement existing survey questionnaires in subsamples.

BIPS will develop a protocol to realize the implementation of such a harmonized monitoring and surveillance system, which will facilitate the use of harmonized monitoring data from selected European databases. As complementary components, digital measurement tools can be used across existing monitoring systems to provide high quality data for policy impact assessment.

Planned research design

As part of the Joint Programming Initiative on a Healthy Diet for a Healthy Life (JPI HDHL), the Policy Evaluation Network (PEN) aims to establish a pan-European monitoring and surveillance system that will provide harmonized data on key indicators of dietary behaviour, PA and SB and their determinants at the individual, setting and population level to improve the assessment of the impact of policy interventions. This requires the development and application of universal indicators to collect necessary baseline information and monitor progress for a given policy area. Nevertheless, comparability of the prevalence of unhealthy behavior and health outcomes between countries is limited for both downward and upward factors. This is due to the lack of comparable indicators measured by the same standardized protocols using objective measurement tools, such as biosample collection or the use of digital tools.

First, a prioritization process was initiated in three rounds of consultation, resulting in a set of key indicators, which were confirmed by 40 EU experts. In a next step, all key indicators were matched with variables in existing pan-European monitoring and surveillance systems, including data currently available for policy evaluation. This so-called mapping process included an assessment of the suitability of the proposed variables for measuring selected indicators. The monitoring systems that provided relevant variables were then prioritized in terms of geographical coverage and frequency of data collection. Related indicators and their original databases resulted in a searchable catalog that allowed key stakeholders to consult the available EU indicators for the evaluation of health policies.

In addition to standardized questionnaires, objective measurement variables from digital instruments, such as fitness wristbands, can facilitate the harmonization of data in a possible add-on module. Their integration can contribute to a higher validity and quality of the data when assessing regional and temporal trends. Suitable instruments must meet the following criteria: (a) they must be valid and reliable for use in an intercultural context; (b) they should overlap as much as possible with methods and tools already used by current systems; (c) they must be easily applicable to provide robust estimates; and (d) they should be affordable. Validated examples suitable for monitoring purposes include accelerometers for SB (activPAL) and for PA (Actigraph). The latter is used in addition to the PA questionnaire in a sub-sample of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).

Our ultimate goal is to develop a protocol that includes (a) consensus among monitoring and surveillance initiatives and stakeholders on the common approach to be taken during the future harmonization process, (b) consultations on European data protection legislation, (c) clear recommendations on key indicators and tools for future use in surveillance systems, and (d) the development of a sustainable infrastructure for the future assessment of harmonized indicators. For optional use in add-on modules, objective measurement tools in existing monitoring systems will be further investigated on the basis of criteria such as feasibility.


Stefanie Do, M.Sc.
Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS 
Department of Epidemiological Methods and Etiology Research

Achterstraße 30
28359 Bremen, Deutschland
Telefon: +49 (0)421 218-56880
Websites: BIPS| Research Gate

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Professor Dr Hajo Zeeb
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Tel: +49 421 21856902
Fax: +49 421 21856941

Project Office

Dr. Moritz Jöst
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Rasmus Cloes
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Tel: +49 421 21856780
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