The Physical Activity Environment Policy Index for monitoring government policies and actions to improve physical activity

Physical activity policies in the six Gulf Cooperation Council countries: a qualitative study with document analysis

BACKGROUND

The Gulf states have some of the lowest physical activity levels and some of the highest obesity rates globally. Understanding physical activity policies is important but under-researched in this region.

PURPOSE

To analyse physical activity policies in terms of structures, formulation, implementation and evaluation in the six Gulf Cooperation Council (GCC) member countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and United Arab Emirates (UAE)).

METHODS

We systematically searched the websites of the Ministries of Health, Education, Sport, Transport, Tourism and Municipal Affairs of the GCC countries between March 2023 and February 2024 for documents related to physical activity policy. Experts from Saudi Arabia, Oman and Bahrain were consulted to identify unpublished documents. Desk research questions from the Health-Enhancing Physical Activity Policy Audit Tool were used to evaluate the content of these documents in terms of the policy cycle model.

RESULTS

We identified 39 policy documents from the six countries. Comparative analysis revealed centralised governance across GCC nations, except for the UAE's federal monarchy system. Policy formulation typically involves collaboration among health, sports and education ministries, although responsibilities vary. There were no sedentary behaviour reduction policies. Policy implementation lacks funding, especially for marginalised groups such as individuals with disabilities and immigrants. Evaluation lacks economic assessment.

CONCLUSIONS

Our study revealed a lack of implementation of physical activity policies and a general dearth of policies aimed at reducing sedentary behaviour within the GCC. Enhancing transparency, inclusion and evaluation mechanisms are essential for fostering effective physical activity policies in GCC countries.

PRACTICAL IMPLICATIONS

Our study provides impetus for policy-makers in the Gulf region to develop policies addressing sedentary behaviour and improving the evaluation framework. Additionally, it serves as a foundation for researchers to identify and address gaps in future policy analysis, contributing to the advancement of effective strategies for promoting physical activity.

'It's about collaboration': a whole-systems approach to understanding and promoting movement in Suffolk

BACKGROUND

Population-levels of physical activity have remained stagnant for years. Previous approaches to modify behaviour have broadly neglected the importance of whole-systems approaches. Our research aimed to (i) understand, (ii) map, (iii) identify the leverage points, and (iv) develop solutions surrounding participation in physical activity across an English rural county.

METHODS

A systems-consortium of partners from regional and local government, charities, providers, deliverers, advocacy groups, and health and social care, and public health engaged in our research, which consisted of two-phases. Within Phase 1, we used secondary data, insight-work, a narrative review, participatory workshops, and interviews in a pluralistic style to map the system-representing physical activity. Phase 2 began with an initial analysis using markers from social network analysis and the Action Scales Model. This analysis informed a participatory workshop, to identify leverage points, and develop solutions for change within the county.

RESULTS

The systems-map is constructed from biological, financial, and psychological individual factors, interpersonal factors, systems partners, built, natural and social environmental factors, and policy and structural factors. Our initial analysis found 13 leverage points to review within our participatory workshop. When appraised by the group, (i) local governing policies, (ii) shared policies, strategies, vision, and working relationships, (iii) shared facilities (school, sport, community, recreation), and (iv) funding were deemed most important to change. Within group discussions, participants stressed the importance and challenges associated with shared working relationships, a collective vision, and strategy, the role of funding, and management of resources. Actions to leverage change included raising awareness with partners beyond the system, sharing policies, resources, insight, evidence, and capacity, and collaborating to co-produce a collective vision and strategy.

CONCLUSIONS

Our findings highlight the importance and provide insight into the early phase of a whole-systems approach to promoting physical activity. Our whole-systems approach within Suffolk needs to consider methods to (i) grow and maintain the systems-consortium, (ii) create a sustainable means to map the system and identify leverage points within it, and (iii) monitor and evaluate change.

Taking a partnership approach to embed physical activity in local policy and practice: a Bradford District case study

BACKGROUND

Supportive policy is an important component of a whole-systems approach to increasing physical activity and reducing inequalities. There is a growing body of literature surrounding the design and effectiveness of national policy approaches to physical activity, but evidence related to local-level approaches is lacking. The aim of this study was to examine 'what works', and identify factors underpinning change, focused on work to embed physical activity in local policy and practice in Bradford, UK.

METHODS

A mixed-methods case study approach involved collecting data from cross-sectoral stakeholders directly or indirectly engaged in the physical activity agenda in Bradford over a period of three years (2021-2024). Data collection included focus groups, semi-structured interviews, researcher observations of key workshops and meetings, and surveys at two time-points (December 2021 and January 2024). Qualitative data were analysed using reflexive thematic analysis. Quantitative data were analysed using descriptive and inferential statistics.

RESULTS

Four themes were identified which embody conditions that appear to be critical for working towards physical activity being embedded in local policy & practice within the Bradford District. These included: collaboration and sector integration, co-productive working, governance and leadership, and cultivating a learning culture. The process of co-producing a district-wide strategy for physical activity was key to facilitating shared ownership of the physical activity agenda across different levels of the system, and for supporting and maintaining cross-sectoral collaboration. On average, survey respondents connected with four more local organisations in relation to the physical activity agenda in January 2024 than in December 2021.

CONCLUSION

Taking a partnership approach, and fostering a culture of evidence-informed decision making, is key to embedding physical activity into policy and practice at a local level. Investing time to understand the aims and values of each partner, and potential synergies and tensions between them, can support the development of a positive and productive collaboration and, subsequently, more effective whole-system delivery and population-level increases in physical activity.

DE-PASS best evidence statement (BESt): determinants of adolescents' device-based physical activity and sedentary behaviour in settings: a systematic review and meta-analysis

BACKGROUND

Although physical activity (PA) is associated with significant health benefits, only a small percentage of adolescents meet recommended PA levels. This systematic review with meta-analysis explored the modifiable determinants of adolescents' device-based PA and/or sedentary behaviour (SB), evaluated in previous interventions and examined the associations between PA/SB and these determinants in settings.

METHODS

A search was conducted on five electronic databases, including papers published from January 2010 to July 2023. Randomized Controlled Trials (RCTs) or Controlled Trials (CTs) measuring adolescents' device-based PA/SB and their modifiable determinants at least at two time points: pre- and post-intervention were considered eligible. PA/SB and determinants were the main outcomes. Modifiable determinants were classified after data extraction adopting the social-ecological perspective. Robust Bayesian meta-analyses (RoBMA) were performed per each study setting. Outcomes identified in only one study were presented narratively. The risk of bias for each study and the certainty of the evidence for each meta-analysis were evaluated. The publication bias was also checked.

PROSPERO ID

CRD42021282874.

RESULTS

Fourteen RCTs (eight in school, three in school and family, and one in the family setting) and one CT (in the school setting) were included. Fifty-four modifiable determinants were identified and were combined into 33 broader determinants (21 individual-psychological, four individual-behavioural, seven interpersonal, and one institutional). RoBMAs revealed none or negligible pooled intervention effects on PA/SB or determinants in all settings. The certainty of the evidence of the impact of interventions on outcomes ranged from very low to low. Narratively, intervention effects in favour of the experimental group were detected in school setting for the determinants: knowledge of the environment for practicing PA, d = 1.84, 95%CI (1.48, 2.20), behaviour change techniques, d = 0.90, 95%CI (0.09, 1.70), choice provided, d = 0.70, 95%CI (0.36, 1.03), but no corresponding effects on PA or SB were found.

CONCLUSIONS

Weak to minimal evidence regarding the associations between the identified modifiable determinants and adolescents' device-based PA/SB in settings were found, probably due to intervention ineffectiveness. Well-designed and well-implemented multicomponent interventions should further explore the variety of modifiable determinants of adolescents' PA/SB, including policy and environmental variables.

Supporting health and wellbeing in health care employees: a documentary review of organizational policies, strategies and frameworks

Background

Health care workers are crucial for a productive and thriving health care system, yet the health and lifestyle behaviour of key groups within this workforce (for example nurses and healthcare assistants/support workers) is typically poor. The extent of health and wellbeing documents that guide action towards improving their health and wellbeing is unknown. Using one health care system, NHS Scotland, as an example, the aim of this study was to assess the number of NHS health boards with workplace documents focused on health and wellbeing of employees, the quality of these documents and the extent to which they reference lifestyle behaviours, namely physical activity.

Methods

Documentary analysis was undertaken on employee health and wellbeing policies (and wider documents). These were sourced through online searches on Google search engine and Freedom of Information Requests sent to all 14 Scottish NHS Health Boards. Titles and content were assessed for relevance to employee health and wellbeing. Content analysis was used to analyse the included documents against eight predefined codes.

Results

Thirteen documents were retrieved with 11 of the 14 Health Boards having at least one relevant document. The content varied greatly between documents with regards to how many reported the eight codes and the quality of content within these. Nine documents mentioned physical activity but mainly in relation to current activities rather than in the context of a future healthy workforce.

Conclusions

Despite the importance of a healthy, health care workforce, more work is needed to ensure high level documents are able to support these efforts, especially with reference to lifestyle behaviours.

Physical Activity Policies at National and Subnational Levels: A Study in Colombia, Costa Rica, Ecuador, and Mexico

BACKGROUND

National physical activity (PA) policy processes are only beginning to be studied in Latin America, and little attention has focused at the subnational level. This study examined national-subnational relations in the policy process (agenda setting, policy formulation, adoption, implementation, and evaluation) in selected Latin American countries.

METHODS

The Global Observatory for Physical Activity's (GoPA!) INTEGRATE-PA-Pol tool was applied in Colombia, Costa Rica, Ecuador, and Mexico. Data were collected in matched pairs of the capital plus one noncapital city among national and subnational policymakers (n = 27), previously identified by the GoPA! Country Contacts. PA policy development and implementation were assessed using descriptive statistics.

RESULTS

Twenty-three (response rate = 85.2%) informants provided data, mainly from the health sector (52.2%), followed by the sport (26.1%), transport (13.0%), and education (8.7%) sectors. Most informants reported that their countries had a current PA policy embedded within noncommunicable diseases prevention plans (46.2%), other plans (46.2%), or obesity prevention/management/control plans (7.7%). Respondents at the subnational level rated PA promotion as central (64.3%), while the national-level role was important but not central (75.0%). National and subnational policymakers indicated low-to-little involvement in the other level's PA policy processes across the 5 policy stages.

CONCLUSIONS

This study demonstrated that collecting national and subnational PA policy data across countries with the active collaboration of the GoPA! network was feasible. We also successfully identified governmental interactions throughout the PA policy process, suggesting suboptimal engagement between national and subnational levels.

Breaking Barriers: An Innovative Tool to Assess the National and City-Level Physical Activity Policy Development to Practice Disconnect

BACKGROUND

Population-level physical activity increases are improbable without intersectoral collaboration across government levels and sectors to develop and implement physical activity promotion policies. This study aims to provide information about the development of the Interaction between National and Local Government Levels in Development and Implementation of Physical Activity Policies Tool (INTEGRATE PA-Pol). A framework was created to examine the development and implementation of national and subnational physical activity policies and the (mis)alignment between government levels.

METHODS

The work was conducted in 3 phases: (1) a scoping review was carried out to identify local government physical activity promotion policies and instruments for assessing them, (2) an expert group designed 6 questionnaires, and (3) cognitive response testing was employed for validity testing and item modification with a panel of research and policy experts.

RESULTS

The INTEGRATE PA-Pol Tool consists of 6 questionnaires assessing how national and subnational governments collaborate to develop and implement physical activity promotion policies.

CONCLUSION

This tool can assist in better understanding the development and implementation of a public policy monitoring system that will allow for benchmarking and priority setting to comprehend how physical activity promotion policies are designed and executed.

Research- vs. government-driven physical activity policy monitoring: a systematic review across different levels of government

BACKGROUND

Even though the importance of physical activity policy monitoring has increased in the last decade, there is a lack of understanding what different approaches exist and which methodology they employ. In order to address this research gap, this review attempts to map existing approaches of physical activity policy monitoring and to analyse methodological aspects, especially with regards to the roles of governments and researchers.

METHODS

A systematic search was conducted in five scientific databases (PubMed, Scopus, SportDiscus, Psycinfo, Web of Knowledge) in July 2021, and the identified records were screened independently by two reviewers. Records were included if they (a) focused on the monitoring of public policies to promote PA, (b) allowed to compare policies across time, across nations/regions or across policy sectors, and (c) were written in English, German or Russian. During full text analysis, information on methodological aspects was extracted and studies were categorized based on the level of government involvement.

RESULTS

The search yielded in a total of 112 studies. 86 of these studies (76.8%) followed a research-driven approach (little or no government involvement) while only two studies (1.8%) were based on a government-driven approach (led by governments). The remaining 24 studies (21.4%) were based on a co-production approach (strong collaboration between researchers and governments). All in all, 18 different tools for physical activity policy monitoring were identified; key examples are the Report Cards on Physical Activity for Children and Youth (research-driven approach), the HEPA Monitoring Framework (government-driven approach) and the HEPA Policy Audit Tool (co-production approach).

CONCLUSIONS

The level of government involvement in policy monitoring differs significantly, and research-driven, government-driven and co-production approaches can be distinguished. These approaches have different strengths and weaknesses, and can be linked to distinct theories of change and models on research-policy relations. Increasing awareness on the implications of these approaches is key to improve the understanding and further development of physical activity policy monitoring.

What policies are there and what policies are missing? A Photovoice study of adolescents' perspectives on obesity-prevention policies in their local environment

The aim of this study was to investigate adolescents' critical awareness of whether obesity prevention policies targeting physical activity (PA) and nutrition were operating in their local community. Participants were 41 adolescents (aged 16-18, 90% women) recruited from three communities in Poland. Prior to this study, they were involved in obesity-prevention participatory initiatives (conducted within the CO-CREATE project), where obesity-related public policy limitations were analyzed in a youth-led discussion. A Photovoice exercise was designed to capture obesity-related public policies that were either present or absent in young people's local environments. The photographs (N = 213) were coded and mapped according to the policy themes they illustrated, using the MOVING and NOURISHING frameworks. The public policies represented in the photographs are most frequently related to: healthy retail or food service environments; food advertising or promotion; structures and surroundings that promote PA; and infrastructure and opportunities that support public or active transport. Adolescents are critically aware of the presence and lack of specific public policies operating in their local environment, particularly policies affecting structural aspects of food and PA environments. Policy-oriented photovoice exercises may prompt critical awareness among adolescents and empower them to contribute to obesity prevention policy processes.

Assessing the implementation of physical activity-promoting public policies in the Republic of Ireland: a study using the Physical Activity Environment Policy Index (PA-EPI)

BACKGROUND

Government policy can promote physical activity (PA) as part of a multilevel systems-based approach. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework which assesses the implementation of government policy by drawing on the experience of national stakeholders. This study is the first to assess the extent of policy implementation in the Republic of Ireland using the PA-EPI tool, and to provide information on how policy implementation can be improved, with the intention of maximizing its impact on population levels of PA.

METHODS

This mixed-methods research study, comprising eight steps, was carried out in 2022. Information documenting the evidence for implementation of PA policy, across all 45 PA-EPI indicators, was collected via systematic document analysis, and validated via survey and interview with government officials. Thirty-two nongovernment stakeholders rated this evidence on a five-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identified and prioritized critical implementation gaps.

RESULTS

Of the 45 PA-EPI indicators, one received an implementation rating of 'none/very little', 25 received a rating of 'low' and 19 received a 'medium' rating. No indicator was rated as fully implemented. The indicators that received the highest level of implementation related to sustained mass media campaigns promoting PA and PA monitoring. Ten priority recommendations were developed.

CONCLUSIONS

This study reveals substantial implementation gaps for PA policy in the Republic of Ireland. It provides recommendations for policy action to address these gaps. In time, studies utilizing the PA-EPI will enable cross-country comparison and benchmarking of PA policy implementation, incentivizing improved PA policy creation and implementation.

A critical analysis of walking policy in Ireland and its contribution to both national and international development goals

Introduction

Increasing population levels of walking holds benefits for public and planetary health. While individual level interventions to promote walking have been shown to be efficacious, upstream interventions such as policies harness the greatest potential for impact at the population level. However, little is known about the nature and presence of walking policy in Ireland and the extent to which it aligns to national and global goals. This paper aims to provide an overview of local and national walking policy in Ireland and to understand the potential of Irish walking policy to contribute to national and global targets.

Methods

This study used multiple methods to provide a critical overview of walking policy. Firstly, a six-phase process was employed to conduct a content analysis of local and national walking policy in Ireland. Secondly, conceptual linkage exercises were conducted to assess the contribution of walking, and national walking policy in Ireland, to Ireland's National Strategic Outcomes and the United Nations Sustainable Development Goals.

Results

Overall, half (n = 13) of the counties in the Republic of Ireland were found to have no local level walking policies. Results from the content analysis suggest that counties which had walking specific local level policies (n = 2) were outdated by almost two decades. Walking was identified to hold the potential to contribute to over half (n = 6) of Ireland's National Strategic Outcomes, and over half (n = 7) of the United Nations Sustainable Development Goals. Ireland's only national level walking specific policy, the Get Ireland Walking Strategy and Action Plan 2017-2020, was identified to potentially contribute to four of Ireland's National Strategic Outcomes and three United Nations Sustainable Development Goals.

Discussion

Multidisciplinary action is required to update walking-related policy with embedded evaluation and governance mechanisms in all local walking systems. Furthermore, given sufficient collaboration across sectors, walking policy in Ireland has the potential to contribute to a wider breadth of national and global targets beyond the health, sport, tourism, and transport sectors.

Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN)

The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and unhealthy dietary behaviours, which in turn are driven by upstream factors that have not yet been addressed effectively by prevention approaches. Thus, successful policy interventions are required that target entire populations and tackle the 'causes of the causes'. To advance our knowledge on the effective implementation of policies and their impact in terms of improving health behaviours, PEN focused on five research tasks: (i) Adaptation and implementation of a Food Environment Policy Index (Food-EPI) and development of a Physical Activity Environment Policy Index (PA-EPI); (ii) Mapping of health-related indicators needed for policy evaluation and facilitating a harmonized pan-European approach for surveillance to assess the impact of policy interventions; (iii) Refining quantitative methods to evaluate the impact of public policies; (iv) Identifying key barriers and facilitators of implementation of policies; and (v) Advance understanding the equity impact of the development, implementation and evaluation of policies aimed at promoting physical activity and a healthy diet. Finally, and in order to provide concrete evidence for policymaking, existing exemplary policies, namely sugar-sweetened beverages taxation, active transport policies and school policies on nutrition and physical activity were assessed in consideration of these five tasks. At the end of the PEN project's formal runtime, considerable advancements have been made. Here, we present an overview of the most important learnings and outputs.