Developing and utilising the physical activity environment policy index: a tool to advance the implementation of physical activity policy in Ireland.

Physical activity is one of the most impactful health behaviours in terms of preventing premature mortality. Supplementing the impact on mortality is the effect that PA has on morbidity and potentially on other beneficial societal outcomes. Unfortunately, the vision of communities and societies which enjoy the full benefits of widespread physical activity participation is not one that is being substantively realised. Research, and action, is required to ameliorate this problem.Theory suggests that public policy can support the achievement of health sustaining levels of physical activity by the general population. However, it is not clear which policies best support physical activity outcomes. Further, audits of existing national level physical activity policies suggest that policy is often poorly implemented. My research contributes to the development of Physical Activity Environment Policy Index (PA-EPI), a new policy research tool that enables the assessment of policy implementation by researchers and the benchmarking and comparison of policy implementation across polities.To provide scientific evidence for the PA-EPI’s development, a systematic review protocol was developed. This protocol outlines the methodology for a series of systematic reviews which identify the evidence behind policies and their effectiveness in supporting physical activity outcomes.Guided by this protocol, four systematic reviews were conducted. The systematic reviews recommended various policy actions as effective in promoting physical activity in Sport, Education, Transport and Mass Media settings.The findings of these reviews informed the development of the PA-EPI. This evidence was synthesized with other forms of evidence in an iterative four-step process culminating in the final PA-EPI framework and monitoring tool and an associated eight-step process for using the tool.The PA-EPI tool was then utilised to perform a policy implementation assessment in Ireland. This identified implementation gaps in the domains of Transport, Urban Design, Healthcare and Health-in-all-policies. Based on these findings a list of recommended implementation actions was formulated and dissemination to a panel of national stakeholders.This project has contributed to the development of a tool which supports physical activity policy implementation research. The PA-EPI is not merely a tool for research, however, but also for physical activity advocacy. The success of the PA-EPI project depends on fostering partnerships with national physical activity stakeholders and policymakers and, over the long term, adoption by the international physical activity research and advocacy community. Future research using the PA-EPI should integrate these insights and investigate promoting health equity within the process and learning from the process how to improve PA policy in the future.</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

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

Hypothetical mechanisms driving physical activity levels in ethnic minority groups living in Europe: a systematically identified evidence-based conceptual systems model

Background In Europe, physical activity levels tend to be lower in ethnic minority groups than the general population. Interventions and policies based on research examining isolated determinants of physical activity have had limited success in increasing physical activity levels. This study used systems dynamics theory and the capability approach theoretical framework to develop a conceptual model of how individual characteristics, institutional and physical environments and the migration context may interact to promote or hinder physical activity in ethnic minority groups living in Europe. Methods A systematic update of Langøien et al.’s 2017 review of the determinants of physical activity in ethnic minority groups living in Europe was conducted. Our target population included individuals of all ages who reported a familial migration background from any low- and middle-income countries or belonging to minority indigenous population in Europe. Outcomes pertaining to non-work related physical activity of light, moderate or vigorous intensity performed in any setting were included. Included studies provided an evidence base from which to derive the causal loop diagrams comprising our conceptual model. Sub-system causal loop diagrams were interpreted in co-author review sessions to explicate non-linear system mechanisms, such as reinforcing and balancing feedback loops. Results Forty-one studies were identifed, of which the majority was qualitative. The conceptual model consisted of 4 causal loop diagrams relating to psychosocial constructs; sociocultural constructs; health and health communication and social and material resources, in interaction with environmental/migration context. Four hypothetical mechanisms were identifed, e.g. hypothesizing that participation in organised activities leads to increased self-efcacy, thereby enabling further participation. Conclusions This study contributes an evidence-based conceptual systems model which elucidates how low levels of physical activity in ethnic minority groups in Europe could be supported by reinforcing and balancing mechanisms involving factors relating to physical and institutional environments, migration context and individuals. A pluralistic approach to literature review, integrating complexity methods such as CLDs into more conventional systematic literature review, supports novel insights into how factors could interact to support persistently low levels of activity, moving beyond the identifcation of potential relationships between isolated factors to indicating the ways in which these relationships are sustained and could be modifed by intervention or policy.</p