Re-imagining methods to evaluate a systems approach to improving physical activity, We Can Move.

Background: We Can Move (WCM) is a large systems approach that works with local communities and organisations to improve the physical activity environments across Gloucestershire, England.

Purpose: Evaluating such a complex approach is challenging. Here, we aim to bring to life a selection of innovative methods used to understand how WCM influenced the physical activity system.

Methods: Nine participatory systems mapping (PSM) workshops were carried out with 100 stakeholders to understand the factors influencing population level physical activity. Social Network Analysis (SNA) determined which stakeholders, and organisations, were engaged in WCM over time (n=2599). Lastly, 15 Ripple Effects Mapping (REM) workshops were conducted with 25 stakeholders to explore how WCM impacted the physical activity system. Findings were triangulated, centred around the systems map.

Results: The WCM systems map included 198 factors spanning 12 themes, from school and workplace influences, to physical activity opportunities, to political and systems leadership. The SNA identified that most stakeholders were able to influence physical activity opportunities (45%) and the school environment (22%). Those categorised as “co-owners” were predominantly seen to influence the political and systems leadership theme. These findings were largely mirrored through the REM analyses, indicating that some areas of the system, such as the workplace and transportation options, were yet to be substantially targeted.
Conclusions: The evaluation of WCM provided a noteworthy opportunity to test, develop, and triangulate a series of innovative methods, the findings from which enabled a comprehensive and nuanced understanding for how this complex systems approach functioned.

Practical implications: The triangulation of PSM, SNA, and REM provided detailed insight around system functioning, enabling future intervention and policy modification.

Funding: The evaluation of WCM was commissioned by Active Gloucestershire and supported by the NIHR ARC West.