A mixed methods investigation of factors influencing decision-making for new active living infrastructure in different contexts

Physical inactivity increases the risk of many non-communicable diseases. The built environment is an important determinant of physical activity and the ways in which places are designed and built may lock in, or out, opportunities for greater physical activity and improved health outcomes. Policies and guidelines support the creation of active living infrastructure (walking and cycling infrastructure and open spaces); however, local social, environmental and political context may influence what is built in practice. The aim of this mixed methods thesis is to investigate what influences the creation of new active living infrastructure across different contexts. It also explores the value of different methods to demonstrate impacts of new walking and cycling infrastructure. The first two studies are qualitative investigations exploring decision-making for active living infrastructure across three areas of England and in Jamaica. These involve semi-structured interviews with public health practitioners, urban and transport planners, environmental and civil society stakeholders and councillors. I then synthesise the findings from these studies to gain additional insights from across different country contexts. Building on the qualitative study findings, I investigate quantitatively the association of context with use, users and benefit-cost ratios of new walking and cycling infrastructure, using repeat cross-sectional data from 84 new walking and cycling schemes in the United Kingdom (Sustrans’ Connect2 programme). I also explore the association between use and physical activity using pragmatic monitoring data from Connect2 alongside more scientifically rigorous longitudinal cohort data from three of those schemes (the iConnect study). My final qualitative study follows on to investigate issues about perceptions of contextual relevance of case study examples. This involves semi-structured interviews with a sub-sample of participants from the first England qualitative study, using Connect2 walking and cycling route examples and results from my quantitative analysis as discussion prompts. I identified three themes in this thesis: how to bridge the gap between policy and practice for creating active living infrastructure; issues of inequality; and synthesising evaluations across contexts. I find that the benefits of active living infrastructure can be under-valued and suggest that formal and informal roles can facilitate sharing of believable stories, including case studies, to influence decision-makers. Whilst new walking and cycling infrastructure is associated with large relative increases in pedestrians and cyclists, and increases in physical activity, lack of monitoring and evaluation, reliance on market forces, and views on individual agency may be detrimental to tackling inequality. Greater collaboration between public health practitioners and non-health sectors could emphasise multi-sectoral outcomes of active living infrastructure, including wider economic impacts.Funding was provided by the Medical Research Council [grant number MC_UU_12015/6]. The work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged

A Qualitative Analysis of Rural Water Sector Policy Documents

This paper summarises the findings of a review of policy and strategy documents published circa 2008 by a diverse set of eleven development partners in the rural water sector. It was carried out as part of the Triple-S (Sustainable Services at Scale) Initiative using a Qualitative Document Analysis (QDA) approach to assess the extent to which the reviewed documents align with a set of 'building blocks' identified by Triple-S as integral to ensuring sustainable service delivery in the rural water sector. Based on the reviewed documents, the policies of the development partners included in this analysis demonstrate a clear commitment towards a number of important elements believed to be necessary for sustainable service delivery including learning and adaptive management, coordination and collaboration, capacity support for local government, and harmonisation and alignment. However, the analysis of the policy documents results in low scores for planning for asset management (i.e. renewals) and recognition and promotion of alternative service delivery options to community management (e.g. Self-supply of, or delegated management to, the private sector). Thus, this study indicates that these areas, considered by Triple-S to be crucial for improving sustainability, are relatively neglected and merit more attention in the policies of organisations

Abandoning community management for professionalization of water supply in rural Benin

How to achieve sustainability in rural water supply is an ongoing challenge and involvement of the community is often seen as crucial for long term success. However, in Benin community management is generally viewed as a disaster after years of poor management, particularly misuse of funds, which has led to unsustainable systems. As a result, the national strategy has shifted away from community management and towards ‘professionalization’ and promotion of the private sector in rural and small town water management. This study analyses the attitudes of key stakeholders, particularly decision makers, towards four forms of management which local authorities can chose to impose, involving community Water User Associations (WUAs) and the private sector to varying degrees. It shows a strong preference towards excluding WUAs by the water services, who advise local authorities, as well as by facilitators. However, some areas continue to include WUAs to avoid conflict with communities

Decision-making for active living infrastructure in new communities: a qualitative study in England.

BACKGROUND: Urban design can influence population levels of physical activity and subsequent health impacts. This qualitative study investigates local level decision-making for 'active living' infrastructure (ALI)-walking and cycling infrastructure and open spaces in new communities. METHODS: Thirty-five semi-structured interviews with stakeholders, and limited ethnographic observations, were conducted with local government and private sector stakeholders including urban and transport planners, public health practitioners, elected councillors and developers. Interview transcripts were coded and analysed thematically. RESULTS: Public health practitioners in local government could act as knowledge brokers and leaders to motivate non-health stakeholders such as urban and transport planners to consider health when designing and building new communities. They needed to engage at the earliest stages and be adequately resourced to build relationships across sectors, supporting non-health outcomes such as tackling congestion, which often had greater political traction. 'Evidence' for decision-making identified problems (going beyond health), informed solutions, and also justified decisions post hoc, although case study examples were not always convincing if not considered contextually relevant. CONCLUSION: We have developed a conceptual model with three factors needed to bridge the gap between evidence and ALI being built: influential public health practitioners; supportive policies in non-health sectors; and adequate resources.This work was supported by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration [grant numbers 087636/Z/08/Z, ES/G007462/1, MR/K023187/1 to ALG and DO]; and the National Institute for Health Research [grant number 16/137/34 to LF]. ALG and DO are supported by the Medical Research Council (MC_UU_12015/6) and Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. LF is supported by the NIHR Global Health Research Group and Network on Diet and Activity. No funder had any role in the study design; data collection, analysis, or interpretation; in the writing of the report; or in the decision to submit the article for publication

Developing shared understanding through online interdisciplinary collaboration: Reflections from a research project on better integration of health outcomes in future urban development practice

Collaborative working has gained widespread recognition in policy and practice. However, there is less research on the process of doing collaborative research in practice than there is on the epistemological, theoretical, and methodological aspects of such work. In this paper, we address this gap by offering reflections on our practical experience of online interdisciplinary collaboration as part of a wider research project on future urban development practice. We sought to develop a shared understanding of the systems of urban development decision-making. We utilise two established frameworks of interdisciplinarity to reflect on our experience and offer practical recommendations that can help facilitate such work carried out remotely by early career researchers from diverse academic backgrounds. In so doing, our paper offers fresh insights on some of the common issues in interdisciplinary collaboration and on developing shared understanding and intellectual coherence through productive online interactions. As research is evolving to tackle complex problems that require a holistic understanding, our paper contributes to developing replicable methods for remotely conducted interdisciplinary work in the early phases of large-scale collaborative projects

Developing shared understanding through online interdisciplinary collaboration: Reflections from a research project on better integration of health outcomes in future urban development practice

Collaborative working has gained widespread recognition in policy and practice. However, there is less research on the process of doing collaborative research in practice than there is on the epistemological, theoretical, and methodological aspects of such work. In this paper, we address this gap by offering reflections on our practical experience of online interdisciplinary collaboration as part of a wider research project on future urban development practice. We sought to develop a shared understanding of the systems of urban development decision-making. We utilise two established frameworks of interdisciplinarity to reflect on our experience and offer practical recommendations that can help facilitate such work carried out remotely by early career researchers from diverse academic backgrounds. In so doing, our paper offers fresh insights on some of the common issues in interdisciplinary collaboration and on developing shared understanding and intellectual coherence through productive online interactions. As research is evolving to tackle complex problems that require a holistic understanding, our paper contributes to developing replicable methods for remotely conducted interdisciplinary work in the early phases of large-scale collaborative projects

Balancing Autonomy and Collaboration in Large-Scale and Disciplinary Diverse Teams for Successful Qualitative Research

Large scale, multi-organisational collaborations between researchers from diverse disciplinary backgrounds are increasingly recognised as important to investigate and tackle complex real-world problems. However differing expectations, epistemologies, and preferences across these teams pose challenges to following best practice for ensuring high-quality and rigorous qualitative research, while maintaining goodwill and team cohesion across team members. This article presents critical reflections from the real-world experiences of a team navigating the challenges of collaborating on a large-scale, cross-disciplinary interview study. Based on these experiences, we extend the literature on large team qualitative collaboration by highlighting the importance of balancing autonomy and collaboration, and propose eight recommendations to support high quality research and team cohesion. We identify how this balance can be achieved at different times: when centralised decision-making should be prioritised, and autonomy can be allowed. We argue that prioritising time to develop shared understandings, build trust, and creating positive environments that accept and support differing researcher perspectives on qualitative methods is paramount. By exploring and reflecting on these differences, teams can identify how and when to support autonomy in decision-making, when to move forward collaboratively, and how to ensure that shared processes reflect the needs of the whole team. The reflexive findings, emanating from practical experience, can inform large research teams undertaking qualitative studies to explore complex issues. We make an original contribution to qualitative methods research by arguing that balancing autonomy and collaboration is the key to promoting high quality research and cohesion in large teams