Barriers to and motives for engagement in an exercise-based cardiac rehabilitation programme in Ireland: a qualitative study

Background: Insuficient physical activity (PA) is a leading risk factor for premature death worldwide. Ireland’s public healthcare system, the Health Service Executive (HSE), has supported the development of the National Exercise Referral Framework (NERF) to tackle low levels of PA amongst those with non-communicable diseases (NCDs). ‘NERF centres’ are medically supervised PA programmes across Ireland that have established referral pathways with local hospitals and general practitioners. ULMedX is one such NERF centre offering exercise-based cardiac rehabilitation (EBCR) with the aim of intervention development to reduce early drop-out and maximise adherence for optimal health benefits. Aim: The purpose of this research was to identify the major factors influencing participants’ adherence and early drop-out at ULMedX. Exploring areas for future development were also prioritised

What young people say about physical activity: the children’s sport participation and physical activity study (CSPPA)

The Children's Sport Participation and Physical Activity (CSPPA) study is a unique multi-centre/discipline study undertaken by three Irish institutions, Dublin City University, University of Limerick and University College Cork. The study sought to assess participation in physical activity, physical education and sport (PAPES) among 10–18 year olds in Ireland. This paper shares what Irish children and young people convey, using their own voices, about their sport and physical activity (PA) experiences and how such experiences may result in their feeling included or excluded in PAPES. Eighteen focus groups (FG) with 124 boys and girls elicited descriptive data from students and were conducted with homogeneous groups of 6–8 boys and girls aged 12–18 years (selected for convenience) identified as male/female, primary/post-primary and generally active/inactive. Five themes (‘being with friends’, ‘variety in activity content’, ‘experiencing fun’, ‘time constraints’ and ‘opportunity to be outside’) ran across the three PAPES opportunities for young people. Overall data revealed that these young people have a positive attitude towards PA which does not diminish as they age despite activity levels decreasing. Other choices of activity participation (e.g. debate, music), or more focused activities took the place of previous choices as young people came to realise what they most enjoyed. If we are to encourage and provide opportunities for young people to choose active lifestyles, it is important that we address what these young people report affects their involvement in PA across a number of contexts. Two such developments within Irish school and community contexts are discussed: Active School Flag initiative and Senior Cycle Physical Education framewor

Implementation of the GAA ‘healthy clubs project’ in Ireland: a qualitative study using the consolidated framework for implementation research

The sports clubs’ role in promoting health has been acknowledged by policy makers and researchers, but there is little evidence on how sports clubs implement health-related interventions. The present article investigates the Gaelic Athletic Association Healthy Club Project (HCP) implementation process (mechanisms, barriers, leverages) over a 10-year timeframe. A case study design helped to produce and compare a data synthesis for five clubs involved since 2013. A qualitative iterative data collection, including document analysis was conducted through 20 focus groups with Healthy Club Officers, coaches, participants and members. The Consolidated Framework for Implementation Research was used in the deductive analysis process, conducted by the first author. Results have shown the success of the HCP in placing health promotion on the agenda of sports clubs leading to informal policy for health promotion, even if activities and recognition are directed toward and coming from the community. This study also underlines the virtuous cycle of the settings-based approach in enhancing membership and volunteer recognition through health promotion actions, and the importance of social good and corporate social activities for sports clubs. Nevertheless, the HCP still relies on limited human resources, is not recognized by competitive oriented adult playing members. and acknowledged as a resource by some coaches, limiting its rootedness in the core business of sports clubs. Future research should empower the HCP community to focus on organizational changes and develop outcomes for individuals, for the club as a whole as well as for the local community.</p

Implementation evaluation of an Irish secondary-level whole school programme: a qualitative inquiry

Whole-of-school programmes (WSPs) are recommended to promote physical activity for adolescents. The Active School Flag (ASF) programme for secondary-level schools is one such WSP. Due to the difficulties of incorporating WSPs into the complex school system, there is a risk of poor implementation. The monitoring of unanticipated influences can help to understand key implementation processes prior to scale-up. The aims of this study were to identify perceived facilitators and barriers to implementing the ASF and recommend evidence-based implementation strategies. Focus groups and interviews (N = 50) were conducted in three schools with stakeholders involved in programme implementation, i.e. school management (n = 5), ASF coordinator (n = 4), student-leaders (aged 15–16 years) (n = 64) and staff committee (n = 25). Transcripts were analysed using codebook thematic analysis and were guided by the Consolidated Framework for Implementation Research. Implementation strategies were identified and were selected systematically to address contextual needs. Three themes surrounding the facilitators and barriers to implementation were generated: intervention design factors (e.g. capacity building and knowledge of implementers; and interest and buy-in for the programme), organizational factors (e.g. optimization of people and the busy school environment) and interpersonal factors (e.g. communication and collaboration). The examination of facilitators and barriers to implementation of the ASF has assisted with the identification of implementation strategies including (not limited to) a shared leadership programme for student leaders and a more flexible timeline for completion. These facilitative implementation strategies may assist in the effective implementation of the ASF.</p

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 frst 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 ofcials. Thirty-two nongovernment stakeholders rated this evidence on a fve-point Likert scale. Aggregated scores were reviewed by stakeholders who collectively identifed 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.</p

Rethinking children’s physical activity interventions at school: A new context-specific approach

Physical activity is important for children’s health. However, evidence suggests that many children and adults do not meet international physical activity recommendations. Current school-based interventions have had limited effect on physical activity and alternative approaches are needed. Context, which includes school setting, ethos, staff, and sociodemographic factors, is a key and largely ignored contributing factor to school-based physical activity intervention effectiveness, impacting in several interacting ways. Conceptualization: Current programs focus on tightly-constructed content that ignores the context in which the program will be delivered, thereby limiting effectiveness. We propose a move away from uniform interventions that maximize internal validity toward a flexible approach that enables schools to tailor content to their specific context. Evaluation designs: Evaluation of context-specific interventions should explicitly consider context. This is challenging in cluster randomized controlled trial designs. Thus, alternative designs such as natural experiment and stepped-wedge designs warrant further consideration. Primary outcome: A collective focus on average minutes of moderate-to-vigorous intensity physical activity may not always be the most appropriate choice. A wider range of outcomes may improve children’s physical activity and health in the long-term. In this paper, we argue that greater consideration of school context is key in the design and analysis of school-based physical activity interventions and may help overcome existing limitations in the design of effective interventions and thus progress the field. While this focus on context-specific interventions and evaluation is untested, we hope to stimulate debate of the key issues to improve future physical activity intervention development and implementation.</p

Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students

Background: The ‘MED-WELL’ programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the ‘MED-WELL’ programme was ofered online instead  of in-person in 2021. The aim of this study is to compare the experiences of participants in the ‘MED-WELL’ programme  online to those that previously participated in the same programme in-person to understand the student experience  and optimize programme delivery. Methods: Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the ‘MED-WELL’ programme when it was ofered in-person, and the other ten  study participants took part in the programme when it was ofered online. All interviews were audio-recorded and  transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive  thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory  of online learning provided the theoretical framework for a deductive approach. Results: Analysis of the data produced fve overarching themes: ‘student-student’, ‘student-teacher’, ‘student-content’,  ‘student-environment’, and ‘efects of a pandemic’. The frst four themes detail distinct types of interaction that participants had with various entities of the 'MED-WELL’ programme and the efects that these interactions had on participant experiences. ‘Efects of a pandemic’ refers to the context of delivering the ‘MED-WELL’ programme online during  a pandemic and how this mode of delivery infuenced participants and the programme. Conclusions: Optimizing the ‘MED-WELL’ programme relies on an understanding of how participants interact with  diferent entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identifed. The fndings from this study can be used to inform similar experiential and educational exercise interventions, and may  help plan for potential future restrictions on in-person educational and exercise-based programmes. </p

Factors related to the implementation and scale-up of physical activity interventions in Ireland: a qualitative study with policy makers, funders, researchers and practitioners

Background Current literature reports a gap between development of efective interventions to promote physical activity and the systematic uptake into real-world settings. Factors relating to implementation and scale-up of physical activity interventions have been examined, however the perspectives of multiple stakeholders from diferent domains are not well researched. The purpose of this study was to examine the perceived factors related to physical activity intervention implementation and scale-up in diferent domains from diferent stakeholders on the island of Ireland.Methods Practitioners, researchers, funders and policy makers in Ireland were invited to take part in a semi-structured interview exploring factors related to the implementation and scale-up of eleven diferent physical activity interventions. A thematic analysis was conducted to identify factors related to the implementation and scale-up of the included interventions. The data collection and analysis were guided by the Consolidated Framework for Implementation Research.Results Thirty-eight participants took part in the interviews which identifed factors related to 1) intervention planning and practical considerations; 2) organisational structures, stafng and resources related to delivery; 3) refection, evaluation and updating of the intervention; and 4) practical consideration related to scale-up. Furthermore, participants referred to the ongoing commitment, engagement, and support needed throughout the implementation process.Conclusions Future research and practice needs to consider how diferent factors are experienced at diferent implementation stages and by the diferent stakeholder groups involved. The fndings highlight multiple inter-related factors that infuence the implementation and scale-up of physical activity interventions, but also identifes many strategies that can be utilised to aid future successes.</p

Evidence of the impact of sport policies on physical activity and sport participation: a systematic mixed studies review

Participation in sport contributes to increased physical activity (PA) levels. Increasing PA is a public health concern due to its recognised impact on health outcomes. International policy actors such as the Council of Europe, the World Health Organisation (WHO) and the International Society for Physical Activity and Health (ISPAH) have recommended that ‘sport for all’ is promoted both for public health and as a basic right. This review aims to evaluate sport related policies aimed at maximising the opportunity to participate in PA and sporting activity. Six electronic Participation in sport contributes to increased physical activity (PA) levels. Increasing PA is a public health concern due to its recognised impact on health outcomes. International policy actors such as the Council of Europe, the World Health Organisation (WHO) and the International Society for Physical Activity and Health (ISPAH) have recommended that ‘sport for all’ is promoted both for public health and as a basic right. This review aims to evaluate sport related policies aimed at maximising the opportunity to participate in PA and sporting activity. Six electronic databases were systematically searched for quantitative, qualitative and review studies investigating how public sport policy affects PA outcomes. The scientific literature was screened according to predetermined eligibility criteria. Following study selection and data extraction, the quality was assessed using modified versions of existing quality assessment tools. Results were synthesised and the context in which policy actions occurred analysed using the Context and Implementation of Complex Interventions (CICI) framework. Database searches identified 3705 unique articles. A total of 93 full-text articles were assessed, with 22 meeting our inclusion criteria. Seven unique ‘policy actions’ were identified and were categorised into the ‘policy areas’ facilities, Financial, Collaboration and Exhortation. Policy actions to promote PA and sport participation have demonstrated qualified success but there is limited evidence of success in engaging hard to reach groups. Therefore, policymakers utilising sport to increase PA should treat it as a complementary intervention alongside other policy actions based on a systems perspective. databases were systematically searched for quantitative, qualitative and review studies investigating how public sport policy affects PA outcomes. The scientific literature was screened according to predetermined eligibility criteria. Following study selection and data extraction, the quality was assessed using modified versions of existing quality assessment tools. Results were synthesised and the context in which policy actions occurred analysed using the Context and Implementation of Complex Interventions (CICI) framework. Database searches identified 3705 unique articles. A total of 93 full-text articles were assessed, with 22 meeting our inclusion criteria. Seven unique ‘policy actions’ were identified and were categorised into the ‘policy areas’ Facilities, Financial, Collaboration and Exhortation. Policy actions to promote PA and sport participation have demonstrated qualified success but there is limited evidence of success in engaging hard to reach groups. Therefore, policymakers utilising sport to increase PA should treat it as a complementary intervention alongside other policy actions based on a systems perspective.</p

Juggling with theory, evidence, practice, and real-world circumstances: Development of a complex community intervention to increase physical activity in inactive adults aged 50 years and older – The Move for Life Study

Despite well-known benefits of physical activity, in Ireland only 38 % of older adults are sufficiently active. Behavioural interventions are rarely developed systematically and, when reported, inadequate description often becomes a barrier for subsequent replication and scalability. In this article, we describe the development and characteristics of Move for Life, an intervention to reach and help inactive adults aged 50 years and older in crease their physical activity. It was designed to fit within existing group-based structured physical activity programmes run by Local Sports Partnerships, thus maximising the likelihood of translation into policy and practice. Constructs from social cognitive theory, self-determination theory, and the conceptual model of group cohesion in exercise informed the conceptual model and the development of behavioural skills, social support, and group cohesion intervention strategies. Physical activity instructors supported by peer mentors, who also contributed to sustaining the intervention, implemented these strategies. Moving away from accounts of inter vention development as a relatively simple linear process, we illustrate the complex interplay of theory, evi dence, practice, and real-world contextual circumstances that shaped the development of Move for Life. Against this backdrop, we discuss issues relevant to the planning and reporting of behavioural and physical activity interventions in public health