A co-designed systems mapping project to understand determinants of physical activity in urban NSW, Australia

Background: Despite numerous health benefits and extensive promotion efforts, 35% of Australian adults did not meet the WHO physical activity (PA) guidelines in 2022. To meet the WHO goal of reducing physical inactivity by 15% by 2030, a multi-sectoral system approach is urgently needed.
Purpose: We report the process and findings from a co-designed systems mapping project to present environmental, social, and policy determinants of PA for children and adults in the context of urban New South Wales (NSW), Australia.
Methods: A qualitative participatory group concept mapping workshop was held in May 2023 with 19 researchers and stakeholders working in education, transportation, urban planning, community, health, and sport and recreation. Initial maps were developed and refined using further online feedback from the participants. Interviews were conducted with additional policy makers from relevant sectors to further refine the maps.
Results: Two systems maps were co-created, identifying over 100 variables influencing PA and their interconnections. Five domains emerged from the adults’ map – social and community, policy, built environment and transportation, healthcare, and workplace; four for the children’s map – family, school, transportation, and community and environment. The maps share similarities such as regarding potential drivers within the transportation, community and built environment sectors; however, the children’s map has an additional focus on the school setting and the adults’ map on workplace and healthcare settings. Interviews with policy makers provided further unique insights into understanding and intervening in the PA system for children and adults.
Conclusions: This co-designed participatory systems mapping process, supplemented by stakeholders interviews, provided a unique opportunity to bring together stakeholders across sectors to understand the complexity within the PA system and begin to identify leverage points for tackling the systemic drivers of physical inactivity in NSW.
Funding: Australia National Health and Medical Research Council, NSW Ministry of Health