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Pettican A, Southall-Edwards R, Reinhardt GY, Gladwell V, Freeman P, Low W, Copeland R, Mansfield L. Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions. BMC Public Health 2024; 24:636. [PMID: 38418996 PMCID: PMC10903012 DOI: 10.1186/s12889-024-18051-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Physical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently. METHODS The aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM's design, implementation and/or delivery. Data was analysed using Braun and Clarke's reflexive thematic analysis. RESULTS Four themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change. CONCLUSIONS These findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.
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Affiliation(s)
- Anna Pettican
- School of Health and Social Care, University of Essex, Wivenhoe Park, CO4 3SQ, Colchester, UK.
| | - Robert Southall-Edwards
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
- Institute of Health and Well-being, University of Suffolk, Waterfront Building, Ipswich, UK
| | | | - Valerie Gladwell
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
- Institute of Health and Well-being, University of Suffolk, Waterfront Building, Ipswich, UK
| | - Paul Freeman
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Wivenhoe Park, Colchester, UK
| | - William Low
- School of Social Sciences, Heriot-Watt University, Edinburgh, Scotland, UK
| | - Robert Copeland
- Advanced Well-being Research Centre, Sheffield Hallam University, Olympic Legacy Park, Sheffield, UK
| | - Louise Mansfield
- Division of Sport, Health and Exercise Sciences, Heinz Wolff Building, Brunel University London, Uxbridge, UK
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Meredith SJ, Cox NJ, Ibrahim K, Higson J, McNiff J, Mitchell S, Rutherford M, Wijayendran A, Shenkin SD, Kilgour AHM, Lim SER. Factors that influence older adults' participation in physical activity: a systematic review of qualitative studies. Age Ageing 2023; 52:afad145. [PMID: 37595070 PMCID: PMC10438214 DOI: 10.1093/ageing/afad145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Despite the advantages of physical activity (PA), older adults are often insufficiently active to maximise health. Understanding factors that influence PA engagement will support well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adults' engagement in PA. METHODS We searched six electronic databases for studies of community-dwelling older adults (≥70 years) including qualitative methods. We excluded studies of a single-disease group, individuals with cognitive impairment and care home residents. Methodological rigour was assessed with the Critical Appraisal Skills Programme, and framework synthesis was applied using the Capability Opportunity Motivation-Behaviour (COM-B) model, which hypothesises that behaviour is influenced by three factors: capability, opportunity and motivation. RESULTS Twenty-five studies were included in the review (N = 4,978; mean 79 years) and 32 themes were identified. Older adults' capability was influenced by functional capacity (e.g. strength) and perceived risk of injury from PA (e.g. falls). Opportunity was impacted by the environment 'fit' (e.g. neighbourhood safety), the availability of social interaction and socio-cultural ageing stereotypes. PA was motivated by identifying as an 'exerciser', health gains and experiencing positive emotions (e.g. enjoyment), whereas negative sensations (e.g. pain) reduced motivation. CONCLUSIONS The qualitative synthesis showcased a complex web of interacting factors influencing PA between the sub-domains of COM-B, pinpointing directions for intervention, including a focus on whole systems approaches. There was a lack of research exploring PA influences in the oldest old and in low-income countries. Future research should seek to involve under-served groups, including a wider diversity of older people.
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Affiliation(s)
- Samantha J Meredith
- Academic Geriatric Medicine, Southampton, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
| | - Natalie J Cox
- Academic Geriatric Medicine, Southampton, UK
- NIHR Southampton Biomedical Research Centre, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Southampton, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
| | | | | | | | | | | | - Susan D Shenkin
- NHS Lothian, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
| | - Alixe H M Kilgour
- NHS Lothian, Edinburgh, UK
- The University of Edinburgh, Edinburgh, UK
| | - Stephen E R Lim
- Academic Geriatric Medicine, Southampton, UK
- NIHR ARC Wessex, University of Southampton, Southampton, UK
- University Hospital Southampton NHS FT, Southampton, UK
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Eastwood D, Varney J, Pringle A, Vishnubala D. Physical Activity Clinical Champions: a peer-to-peer physical activity education programme in England. Br J Sports Med 2023; 57:897-898. [PMID: 37385717 DOI: 10.1136/bjsports-2023-107269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Affiliation(s)
- David Eastwood
- Moving Healthcare Professionals Programme, Office for Health Improvement and Disparities, London, UK
| | - Justin Varney
- Director of Public Health, Birmingham City Council, Birmingham, Birmingham, UK
| | - Andy Pringle
- Clinical Exercise and Rehabilitation Research Centre, School of Human Sciences, University of Derby, Derby, UK
| | - Dane Vishnubala
- Moving Healthcare Professionals Programme, Office for Health Improvement and Disparities, London, UK
- School of Biomedical Sciences, University of Leeds, Leeds, UK
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Nobles J, Fox C, Inman-Ward A, Beasley T, Redwood S, Jago R, Foster C. Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England. BMJ Open 2022; 12:e063638. [PMID: 35940842 PMCID: PMC9364398 DOI: 10.1136/bmjopen-2022-063638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Systems approaches aim to change the environments in which people live, through cross-sectoral working, by harnessing the complexity of the problem. This paper sought to identify: (1) the strategies which support the implementation of We Can Move (WCM), (2) the barriers to implementation, (3) key contextual factors that influence implementation and (4) impacts associated with WCM. DESIGN A multi-methods evaluation of WCM was completed between April 2019 and April 2021. Ripple Effects Mapping (REM) and semi-structured interviewers were used. Framework and content analysis were systematically applied to the dataset. SETTING WCM-a physical activity orientated systems approach being implemented in Gloucestershire, England. PARTICIPANTS 31 stakeholder interviews and 25 stakeholders involved in 15 REM workshops. RESULTS A white-water rafting analogy was developed to present the main findings. The successful implementation of WCM required a facilitative, well-connected and knowledgeable guide (ie, the lead organisation), a crew (ie, wider stakeholders) who's vision and agenda aligned with WCM's purpose, and a flexible delivery approach that could respond to ever-changing nature of the river (ie, local and national circumstances). The context surrounding WCM further strengthened and hampered its implementation. Barriers included evaluative difficulties, a difference in stakeholder and organisational perspectives, misaligned expectations and understandings of WCM, and COVID-19 implications (COVID-19 also presented as a facilitative factor). WCM was said to strengthen cohesion and collaboration between partners, benefit other agendas and policies (eg, mental health, town planning, inequality), and improve physical activity opportunities and environments. CONCLUSIONS This paper is one of the first to evaluate a systems approach to increasing physical activity. We highlight key strategies and contextual factors that influenced the implementation of WCM and demonstrate some of the wider benefits from such approaches. Further research and methodologies are required to build the evidence base surrounding systems approaches in Public Health.
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Affiliation(s)
- James Nobles
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - Charlotte Fox
- Royal Borough of Windsor and Maidenhead Council, Maidenhead, UK
| | | | | | - Sabi Redwood
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
| | - Russ Jago
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
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