Xuxi Zhang

Figure 1.1.2 Public health framework: the steps of public health approach * * This is an adaptation of an original work “The public health approach. Geneva: World Health Organization  (WHO); 2010. Licence: CC BY‐NC‐SA 3.0 IGO”. This adaptation was not created by WHO. WHO is not responsible  for the content or accuracy of this adaptation. The original edition shall be the binding and authentic edition.  1.2 THIS THESIS  Research questions  In this thesis, the aim is to investigate frailty and chronic conditions from the public health  perspective. The study questions are:  Health promotion for people with frailty  1. What are the associations between physical, psychological and social frailty and  health‐related quality of life (HRQoL) among community‐dwelling older adults?  (Step  1 of Public Health Framework)  2. What are the longitudinal associations between physical activity (PA) and frailty as  well as the association between a 12‐month change in physical activity and frailty  among community‐dwelling older adults?  (Step 2 of Public Health Framework) 3. What are the reliability and validity of the Tilburg Frailty Indicator (TFI) in 5 European  countries?  (Step 3 of Public Health Framework) 4. How does the Urban Health Centres Europe (UHCE) approach perform in terms of  specific process components? (Step 3 of Public Health Framework) What is the problem? What are the causes? What works? Scaling‐up effective and  promising interventions and  evaluate their impact 1. Surveillance 2. Identify potential risk  and protective factors 3. Develop and evaluate  interventions 4. Implementation e.g.  ‐ Impact of frailty on  health‐related quality of  life ‐ Chronic conditions e.g.  ‐ Risk factors of frailty ‐ Lack of effective  interventions on chronic  conditions e.g.  ‐ Frailty identification/  interventions ‐ Effective ways to manage  chronic conditions e.g.  ‐ Implementation of  interventions to improve  self‐management of  chronic conditions  1 17 General introduction