Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England

James D Nobles; Charlotte Fox; Alan Inman-Ward; Tom Beasley; Sabi M Redwood; Russell  Jago; Charlie E M Foster

doi:10.1136/bmjopen-2022-063638

Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England

James D Nobles^*
, Charlotte Fox
, Alan Inman-Ward
, Tom Beasley
, Sabi M Redwood
, Russell Jago
, Charlie E M Foster

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

20 Citations (Scopus)

67 Downloads (Pure)

Abstract

Objectives: Systems approaches aim to change the environments in which people live, through cross-sectoral working, by harnessing the complexity of the problem. This paper sought to identify: a) the strategies which support the implementation of We Can Move (WCM), b) the barriers to implementation, c) key contextual factors that influence implementation, and d) impacts associated with WCM.

Design: A multi-methods evaluation of WCM was completed between April 2019 and April 2021. Ripple Effects Mapping (REM) and semi-structured interviewers were used. Framework and content analysis were systematically applied to the dataset.

Setting: We Can Move - a physical activity orientated systems approach being implemented in Gloucestershire, England.
Participants: 31 stakeholder interviews and 25 stakeholders involved in 15 REM workshops.

Results: A white-water rafting analogy was developed to present the main findings. The successful implementation of WCM required a facilitative, well-connected, and knowledgeable guide (i.e. the lead organisation), a crew (i.e. wider stakeholders) who’s vision and agenda aligned with WCM’s purpose, and a flexible delivery approach that could respond to ever-changing nature of the river (i.e. local and national circumstances). The context surrounding WCM further strengthened and hampered its implementation. Barriers included evaluative difficulties, a difference in stakeholder and organisational perspectives, misaligned expectations and understandings of WCM, and COVID-19 implications (COVID-19 also presented as a facilitative factor). WCM was said to strengthen cohesion and collaboration between partners, benefit other agendas and policies (e.g. mental health, town planning, inequality), and improve physical activity opportunities and environments.

Conclusions: This paper is one of the first to evaluate a systems approach to increasing physical activity. We highlight key strategies and contextual factors that influenced the implementation of WCM and demonstrate some of the wider benefits from such approaches. Further research and methodologies are required to build the evidence base surrounding systems approaches in public health.

Original language	English
Article number	e063638
Pages (from-to)	1-22
Number of pages	22
Journal	BMJ Open
Volume	12
Issue number	8
Early online date	8 Aug 2022
DOIs	https://doi.org/10.1136/bmjopen-2022-063638
Publication status	Published - 8 Aug 2022

Bibliographical note

Funding Information:
The main impacts, however, as per this analysis, were relational and sectoral . There was said to be improved cohesion and collaboration between stakeholders involved in, or on the periphery of, WCM, and many examples were given. As previously noted, we found that at least 82 organisations were involved in WCM and that 23 networks were attended or organised. Being part of WCM enabled stakeholders to feel like they were part of something bigger, an initiative or way of working that went beyond their own organisation. This was supported by the generation and dissemination of new funding via WCM—enabling organisations to come together. It was through these new or improved relationships that we saw cross-sectoral impacts; for example, the work of WCM aligned with and supported the work being undertaken on mental health, air quality, tackling inequality and town planning (among others). And many commented that their own mindset (ie, a way of thinking) and that of their senior leaders had started to change due, in part, to their involvement in WCM. Lastly, through the REM, we found that WCM and physical activity had been integrated into a minimum of six policies across the county, ranging from the Health and Wellbeing Strategy (county-wide) to City Planning policies (city-wide) to Transport Planning policies (city-wide).

Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Evaluating "We Can Move": A Whole Systems Approach to Addressing Physical Inactivity in Gloucestershire
Nobles, J. (Co-Investigator), Redwood, S. (Co-Investigator), Mamluk, L. (Co-Investigator), Hill, L. (Co-Investigator), Jago, R. (Co-Investigator) & Foster, C. E. M. (Principal Investigator)
1/05/19 → 30/04/21
Project: Research

Cite this

Nobles, J. D., Fox, C., Inman-Ward, A., Beasley, T., Redwood, S. M., Jago, R., & Foster, C. E. M. (2022). Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England. BMJ Open, 12(8), 1-22. Article e063638. https://doi.org/10.1136/bmjopen-2022-063638

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abstract = "Objectives: Systems approaches aim to change the environments in which people live, through cross-sectoral working, by harnessing the complexity of the problem. This paper sought to identify: a) the strategies which support the implementation of We Can Move (WCM), b) the barriers to implementation, c) key contextual factors that influence implementation, and d) impacts associated with WCM. Design: A multi-methods evaluation of WCM was completed between April 2019 and April 2021. Ripple Effects Mapping (REM) and semi-structured interviewers were used. Framework and content analysis were systematically applied to the dataset. Setting: We Can Move - a physical activity orientated systems approach being implemented in Gloucestershire, England. Participants: 31 stakeholder interviews and 25 stakeholders involved in 15 REM workshops. Results: A white-water rafting analogy was developed to present the main findings. The successful implementation of WCM required a facilitative, well-connected, and knowledgeable guide (i.e. the lead organisation), a crew (i.e. wider stakeholders) who{\textquoteright}s vision and agenda aligned with WCM{\textquoteright}s purpose, and a flexible delivery approach that could respond to ever-changing nature of the river (i.e. local and national circumstances). The context surrounding WCM further strengthened and hampered its implementation. Barriers included evaluative difficulties, a difference in stakeholder and organisational perspectives, misaligned expectations and understandings of WCM, and COVID-19 implications (COVID-19 also presented as a facilitative factor). WCM was said to strengthen cohesion and collaboration between partners, benefit other agendas and policies (e.g. mental health, town planning, inequality), and improve physical activity opportunities and environments. Conclusions: This paper is one of the first to evaluate a systems approach to increasing physical activity. We highlight key strategies and contextual factors that influenced the implementation of WCM and demonstrate some of the wider benefits from such approaches. Further research and methodologies are required to build the evidence base surrounding systems approaches in public health. ",

author = "Nobles, \{James D\} and Charlotte Fox and Alan Inman-Ward and Tom Beasley and Redwood, \{Sabi M\} and Russell Jago and Foster, \{Charlie E M\}",

note = "Funding Information: The main impacts, however, as per this analysis, were relational and sectoral . There was said to be improved cohesion and collaboration between stakeholders involved in, or on the periphery of, WCM, and many examples were given. As previously noted, we found that at least 82 organisations were involved in WCM and that 23 networks were attended or organised. Being part of WCM enabled stakeholders to feel like they were part of something bigger, an initiative or way of working that went beyond their own organisation. This was supported by the generation and dissemination of new funding via WCM—enabling organisations to come together. It was through these new or improved relationships that we saw cross-sectoral impacts; for example, the work of WCM aligned with and supported the work being undertaken on mental health, air quality, tackling inequality and town planning (among others). And many commented that their own mindset (ie, a way of thinking) and that of their senior leaders had started to change due, in part, to their involvement in WCM. Lastly, through the REM, we found that WCM and physical activity had been integrated into a minimum of six policies across the county, ranging from the Health and Wellbeing Strategy (county-wide) to City Planning policies (city-wide) to Transport Planning policies (city-wide). Publisher Copyright: {\textcopyright} 2022 BMJ Publishing Group. All rights reserved.",

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Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England. / Nobles, James D; Fox, Charlotte; Inman-Ward, Alan et al.
In: BMJ Open, Vol. 12, No. 8, e063638, 08.08.2022, p. 1-22.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Navigating the river(s) of systems change

T2 - a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England

AU - Nobles, James D

AU - Fox, Charlotte

AU - Inman-Ward, Alan

AU - Beasley, Tom

AU - Redwood, Sabi M

AU - Jago, Russell

AU - Foster, Charlie E M

N1 - Funding Information: The main impacts, however, as per this analysis, were relational and sectoral . There was said to be improved cohesion and collaboration between stakeholders involved in, or on the periphery of, WCM, and many examples were given. As previously noted, we found that at least 82 organisations were involved in WCM and that 23 networks were attended or organised. Being part of WCM enabled stakeholders to feel like they were part of something bigger, an initiative or way of working that went beyond their own organisation. This was supported by the generation and dissemination of new funding via WCM—enabling organisations to come together. It was through these new or improved relationships that we saw cross-sectoral impacts; for example, the work of WCM aligned with and supported the work being undertaken on mental health, air quality, tackling inequality and town planning (among others). And many commented that their own mindset (ie, a way of thinking) and that of their senior leaders had started to change due, in part, to their involvement in WCM. Lastly, through the REM, we found that WCM and physical activity had been integrated into a minimum of six policies across the county, ranging from the Health and Wellbeing Strategy (county-wide) to City Planning policies (city-wide) to Transport Planning policies (city-wide). Publisher Copyright: © 2022 BMJ Publishing Group. All rights reserved.

PY - 2022/8/8

Y1 - 2022/8/8

N2 - Objectives: Systems approaches aim to change the environments in which people live, through cross-sectoral working, by harnessing the complexity of the problem. This paper sought to identify: a) the strategies which support the implementation of We Can Move (WCM), b) the barriers to implementation, c) key contextual factors that influence implementation, and d) impacts associated with WCM. Design: A multi-methods evaluation of WCM was completed between April 2019 and April 2021. Ripple Effects Mapping (REM) and semi-structured interviewers were used. Framework and content analysis were systematically applied to the dataset. Setting: We Can Move - a physical activity orientated systems approach being implemented in Gloucestershire, England. Participants: 31 stakeholder interviews and 25 stakeholders involved in 15 REM workshops. Results: A white-water rafting analogy was developed to present the main findings. The successful implementation of WCM required a facilitative, well-connected, and knowledgeable guide (i.e. the lead organisation), a crew (i.e. wider stakeholders) who’s vision and agenda aligned with WCM’s purpose, and a flexible delivery approach that could respond to ever-changing nature of the river (i.e. local and national circumstances). The context surrounding WCM further strengthened and hampered its implementation. Barriers included evaluative difficulties, a difference in stakeholder and organisational perspectives, misaligned expectations and understandings of WCM, and COVID-19 implications (COVID-19 also presented as a facilitative factor). WCM was said to strengthen cohesion and collaboration between partners, benefit other agendas and policies (e.g. mental health, town planning, inequality), and improve physical activity opportunities and environments. Conclusions: This paper is one of the first to evaluate a systems approach to increasing physical activity. We highlight key strategies and contextual factors that influenced the implementation of WCM and demonstrate some of the wider benefits from such approaches. Further research and methodologies are required to build the evidence base surrounding systems approaches in public health.

AB - Objectives: Systems approaches aim to change the environments in which people live, through cross-sectoral working, by harnessing the complexity of the problem. This paper sought to identify: a) the strategies which support the implementation of We Can Move (WCM), b) the barriers to implementation, c) key contextual factors that influence implementation, and d) impacts associated with WCM. Design: A multi-methods evaluation of WCM was completed between April 2019 and April 2021. Ripple Effects Mapping (REM) and semi-structured interviewers were used. Framework and content analysis were systematically applied to the dataset. Setting: We Can Move - a physical activity orientated systems approach being implemented in Gloucestershire, England. Participants: 31 stakeholder interviews and 25 stakeholders involved in 15 REM workshops. Results: A white-water rafting analogy was developed to present the main findings. The successful implementation of WCM required a facilitative, well-connected, and knowledgeable guide (i.e. the lead organisation), a crew (i.e. wider stakeholders) who’s vision and agenda aligned with WCM’s purpose, and a flexible delivery approach that could respond to ever-changing nature of the river (i.e. local and national circumstances). The context surrounding WCM further strengthened and hampered its implementation. Barriers included evaluative difficulties, a difference in stakeholder and organisational perspectives, misaligned expectations and understandings of WCM, and COVID-19 implications (COVID-19 also presented as a facilitative factor). WCM was said to strengthen cohesion and collaboration between partners, benefit other agendas and policies (e.g. mental health, town planning, inequality), and improve physical activity opportunities and environments. Conclusions: This paper is one of the first to evaluate a systems approach to increasing physical activity. We highlight key strategies and contextual factors that influenced the implementation of WCM and demonstrate some of the wider benefits from such approaches. Further research and methodologies are required to build the evidence base surrounding systems approaches in public health.

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M1 - e063638

ER -

Navigating the river(s) of systems change: a multi-methods, qualitative evaluation exploring the implementation of a systems approach to physical activity in Gloucestershire, England

Abstract

Bibliographical note

UN SDGs

Access to Document

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Projects

Evaluating "We Can Move": A Whole Systems Approach to Addressing Physical Inactivity in Gloucestershire

Cite this