Local physical activity policies

Background: Rural U.S. residents experience a disproportionate burden of physical activity (PA) related chronic disease compared to urban residents. Yet, which policy supports have been targeted toward rural PA is unknown. Policy Components: This presentation will describe policy support for PA occurring in rural U.S. areas. Evaluation: A large scoping review was conducted March-June 2020 to identify policy, systems, and environment change approaches occurring in the rural U.S. for PA, healthy eating, and breastfeeding. Search procedures were guided by a science librarian and the PRISMA-ScR and Arksey and O’Malley’s work (2007). Peer-reviewed research was identified using Medline, PubMed, Web of Science, and Agricola. Dissertations were identified using ProQuest Dissertations and Theses A&I. Google/Google Scholar, government, public health, federal nutrition assistance program, Cooperative Extension Services, and related webpages were used to identify grey literature. PA Policy results are reported, and inclusion criteria were: (1) PA focus; (2) about policy factors; (3) specific to U.S. rural populations/places; and (4) English language. Conclusions: In total, 70 sources meeting inclusion criteria were identified and synthesized: 41 original research, 28 grey literature, and 1 graduate research source. PA policy initiatives focused on Complete Streets efforts (i.e., planning/designing/building streets that enable safe access for all users), joint/shared use efforts, Safe Routes to Schools, master plans for greenways, trails, and/or transportation, school health plans, and childcare/school standards. Rural settings for PA policy initiatives included schools (n=42), streets (n=28), trails/sidewalks (n=13), recreation facilities (n=12), and parks (n=9), among others, with many sources referencing multiple settings. Practical implications: Results from this scoping review can inform policy solutions to improve PA in under-resourced rural areas across the U.S. Funding: This study was supported by the Centers for Disease Control and Prevention (CDC) Division of Nutrition, PA, and Obesity, dispersed through Chickasaw Nation Industries.

The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework to support countries in identifying and addressing critical implementation gaps in public policies to enhance physical activity (PA). This presentation will share the process of effective constitution, operation and roles of PA-EPI Expert Coalition (EC) and Citizen Council (CC). EC comprises non-government experts and academics recruited due to their expertise in PA across the policy domains of health, education, sport, workplace, community, urban design, transport and communication. CC comprises a cross-section of society including sufficient diversity in ethnicity, gender, migration status and other underrepresented groups in health equity. The EC rates their governments progress on the creation of a healthy PA environment against PA-EPI indicators of good practice and relative to international best practice exemplars using an evidence document which provides examples of action to back up any score. While the CC review findings, both EC and CC collaborate to formulate comprehensive recommendations for policy action to bridge implementation gaps. Data analyses, EC and CC consented reviews lead to a growing database of internationally recognized examples of best practice in public policy implementation for PA. The EC and CC, help translate findings into country-specific PA-EPI report cards, highlighting examples of good progress by governments as well as areas for development to establish best practice to match or exceed other countries or states. A culture of PA, underpinned by enabling public policy will be the framework to catalyse, chart, and measure a country’s progress towards greater PA, health equity and wellbeing. The PA-EPI process conducted every two-three years will yield greater policy efficiency and health-in-all policies through systematic policymakers, practitioners, researchers and citizen engagement. Funding: HRB (Ireland), NCR&D (Poland), FME&R (Germany), NOforHR&D (Netherlands), EAforHERD&IF (Romania), RC (Lithuania) under the umbrella of Partnership Fostering a European Research Area for Health.

Background and purpose: Changes in the physical environment within communities require administrative and political decisions. The process behind those decisions is fairly unknown. A crucial role could be played by persuasion strategies for decision-makers, but the necessary persuasion often occurs in an unstructured manner. The aim of this contribution is therefore to identify strategies for influencing local decision-makers to prioritize physical activity (PA) promotion on the agenda of communities.

Methods: We interviewed decision-makers from local politics and administration in German urban and rural areas to identify strategies for influencing their decisions regarding PA promotion. We conducted the analysis using qualitative content analysis. Additionally, a German nationwide online survey was undertaken, followed by descriptive analysis.

Results: We conducted n=22 interviews, and the online survey had n=415 participants. Our findings demonstrate, on the one hand, distinct strategies employed by local decision-makers to convince others on their issues, such as mobilizing the public or seeking allies. On the other hand, they provide insights for additional target groups, such as citizens, stakeholders, and researchers, to convince local decision-makers. These include, for instance, utilizing participatory formats, constructing written arguments, or presenting scientific data.

Conclusions and practical implications: To prioritize PA promotion on the agenda of communities, decision-makers need to be convinced. From a scientific perspective, it seems promising to compare the identified persuasion strategies with established theory-driven ones from planning models like Intervention Mapping. Our approach and further research can contribute to the effective planning and implementation of evidence-based multi-level interventions related to changing environmental conditions in communities. Further research is needed to better understand these environmental changes.

Funding: The EUBeKo project was funded from June 2019 until December 2022 by the Federal Ministry of Health in Germany.

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. Purpose: To examine ‘what works’, and identify mechanisms and contextual factors underpinning change, related to 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 involved in the physical activity agenda in Bradford over a period of three years (2021-2024). Data collection included focus groups, semi-structured interviews, Ripple Effects Mapping workshops, researcher observations of key workshops and meetings, and surveys at two time-points (December 2021 and January 2024). Data was analyzed using reflexive thematic analysis. Results: Four themes embody conditions that appear to be critical for working towards PA being embedded in local policy & practice within the Bradford District. These include co-productive working, collaboration within and across organisations, leadership & governance processes, and a learning culture. 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 organizations in relation to the physical activity agenda in January 2024 than in December 2021. Conclusions: Taking a partnership approach is key to embedding physical activity into policy and practice at a local level. Practical implications: System leaders across health and social care, public health, sport and culture, and other relevant sectors should work in partnership to maximise the development and implementation of local physical activity policy. Funding: This research is supported by Sport England Local Delivery Pilot funding.

Background: Synergy is the positive collaborative outcome that intersectoral partnerships aim to achieve. Although the keys to successful partnerships are known, limited research shows how to achieve synergy practically within large-scale partnerships. Purpose: We aimed to understand how large intersectoral partnerships achieve synergy. Methods: We conducted online semi-structured interviews with stakeholders involved in an NGO called Montréal-Métropole en santé, which promotes active living and sustainable eating practices by mobilizing over 150 stakeholders within two intersectoral partnerships: Montréal Physiquement Active (MPA) and Conseil du Système Alimentaire Montréalais (CSAM). A sample of 10 MPA and 12 CSAM stakeholders participated. Audio-recorded interviews were transcribed, and thematic analysis was performed based on the Bergen Model of Collaborative Functioning. Results: Analyses showed that flexible, dynamic, and agile structures were essential in enabling MPA and CSAM to progress towards achieving synergy. Adapting to changing contexts, such as membership turnover and the COVID-19 pandemic, was facilitated by the creation of task groups and steering committees as well as the development of cross-cutting initiatives suited to current needs. Maintaining open and supportive organizational cultures and “safe spaces” were said to be key in weathering change. Tools for successful mobilization, facilitation, and dissemination included small group brainstorming sessions, large-scale summits, one-on-one meetings with new and departing members, and information dashboards. Conclusions: Achieving synergy in intersectoral partnerships is challenging but can be overcome by co-constructing a comprehensive picture of the context as it evolves in real-time. Implementing support tools and strategies that account for the evolving needs and perspectives of stakeholders helps to progress towards positive collaborative outcomes. Practical implications: Synergy in large intersectoral partnerships requires a multipronged approach to support functioning. Our results show tools and strategies that support synergistic functioning along a collaborative continuum allowing for varying degrees of stakeholder involvement. Funding: CIHR Team Grant Program (#IP2—150710).

Background: The degree to which council policies incorporate evidence-based recommendations for creating environments supportive of physical activity is unknown. Purpose: To determine how closely council policies align with evidence-based recommendations for creating activity-supportive environments. Methods: This case study is part of a larger research project exploring physical activity related policies of Australian councils. A validated survey was distributed to 250 purposively selected councils, yielding 57 responses from 52 councils. Two regional Queensland councils were chosen for a case study based on demographic similarities. A verified scoring system assessed policies against evidence-based indicators, with ‘policy presence’ evaluated on a scale of present (1), partial (0.5), or absence (0). ‘Policy quality’ was determined based on standards and targets (e.g., >80% of residences <400m from parks), with scores ranging from ‘no policy / specificity’ (0) to ‘specific standards/aims with measurable targets’ (3). Multiplier scores were applied where policies were either ‘mixed/partially inconsistent’ (-0.5) or ‘inconsistent’ (-1) with evidence-based recommendations. Summary scores quantified overall presence and quality of council policies. Results: While both councils demonstrated high levels of policy presence associated with activity-supportive environments (Council 1: 78%; Council 2: 87%), overall policy quality was relatively low (Council 1: 26%; Council 2: 38%). This was predominantly due to a lack of evidence-based standards and targets within multiple domains. Several policies not aligned with evidence-based recommendations within multiple domains also contributed to low policy quality. Both councils shared policy deficiencies related to health impact assessments, tree canopy cover, walking/cycling targets, access to large parks and daily destinations, street connectivity, dwelling density, and policy performance monitoring. Conclusions: Despite strong policy presence, policy quality requires strengthening across multiple domains. Practical implications: Council policies require strengthening predominantly through the introduction of explicitly defined standards and targets that are evidence-based to improve physical activity. Funding: This research received no funding.