Purpose: Whole systems approaches (WSAs) are recommended internationally to promote physical activity and tackle physical activity inequalities. This paper critically examines the literature on WSAs and place-based approaches (PBAs). It argues that a focus on policy directives without attention to operationalization has led to issues such as overlooking local contexts, promoting professional-led approaches, and limiting beliefs about modifiability. The paper seeks to present an alternative explanatory framework to overcome these limitations and provide conceptual architecture to enable the accumulation of knowledge about them.

Methods: Adopting a mixed methods approach influenced by realist evaluation and participatory action research, the study co-designed a new explanatory framework. A scoping literature review identified key attributes from theoretical and empirical studies. Documentary analysis of longitudinal process evaluation reports (N=64) from 12 Local Delivery Pilots (LDPs which are place-based collaboratives supported by Sport England, an arm’s length government body, to develop WSAs and PBAs to increase participation in sports and physical activity and reduce physical activity inequalities) was conducted to synthesise empirical evidence and derive stakeholder-led explanations of change to develop the framework. Stakeholder feedback (N=78 via two workshops) refined the framework which was subsequently tested by the 12 LDPs for utility in capturing unique case-based data.

Findings: The explanatory framework identifies three broad areas of action and ten cross-cutting conditions. Areas of action are: integrating physical activity across sectors, strengthening individual and community capacities, and tackling structural inequalities. Cross-cutting conditions pertain to proposed necessary features of a place to realize these areas of action.

Conclusions: The framework is broad enough for diverse WSAs and PBAs, yet detailed enough to inspire new approaches. The paper underscores the philosophical and ethical importance of this framework as a boundary object, emphasizing its role in centring the problem of physical activity inequalities in the operationalization and research of WSAs and PBAs. Given the rise in the international and national policy recommendations for WSAs and PBAs, the study contributes to bridging the gap between policy directives and effective implementation, providing a tool for evaluating and learning from a variety of approaches to address physical activity inequalities.

Purpose: The application of implementation frameworks in evaluating Healthy Eating and Active Living (HEAL) policies is essential to foster informed decision-making and align programs with policy goals to ultimately enhance well-being in community settings. Given the pivotal role of Louisiana Cooperative Extension Service Family and Consumer Science (LFCS) practitioners in Extension, there is an opportunity to assess implementation aspects and gaps of these policies from their viewpoint. This research aimed to explore the HEAL policy landscape using LFCS practitioners as key informants.

Methods: A cross-sectional quantitative study following the Exploration process phase of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework was conducted in 2023. The survey included 43 questions adapted from two Policy Indicator Checklist (PIC) tools to explore the presence of HEAL policies related to healthy retail, farmer’s markets, public service, community recreation, and safe streets with an option to acknowledge a lack of awareness to gain understanding of knowns and unknowns. LFCS practitioners were recruited via email and Qualtrics. Survey data were analyzed using the PIC scoring system and descriptive statistics.

Results: Thirty-two LCES practitioners from five state regions participated (45% were Nutrition agents). Most (56%) reported experience with implementing HEAL policy, systems, and environmental changes for at least six months. PIC scores for healthy eating policies were 49 of 65 (75%) possible points, whereas active living policies resulted in 91 of 135 (67%) possible points. Farmer’s market provisions scored the highest at 38 out of 42 (90%) and had the lowest percentage of agents reporting a lack of policy awareness (23%). Overall, there were consistently lower scores for healthy eating compared to active living policies across all five regions. All participants either indicated a lack of awareness or noted the absence of policies for healthier public service venues.

Conclusions: Results provide a baseline quantitative score reflecting Louisiana's HEAL policy landscape and LFCS practitioners' awareness. This study suggests exploring policy through the lens of implementation science can help leverage the roles of key practitioners, especially within the Extension context, to advance HEAL policies.

Presenting Author: Ashley Messineo
Corresponding Author: Deborah Salvo (dsalvo@austin.utexas.edu)

Background
Studies on the influence of crime (a social environment factor) on physical activity have yielded mixed results. Furthermore, few studies have examined this relationship in rural areas, despite 43% of the world’s population residing in rural areas and facing unique challenges for physical activity. We examined the association between street crime and physical inactivity in rural versus urban counties in Texas, USA.

Methods
GIS analysis was done using ArcGIS Pro 2.8. County-level prevalence of physical inactivity data were from the CDC PLACES dataset, reporting participation in any leisure-time physical activity during the past 30 days. Counties were categorized as rural or urban based on Texas Department of Housing and Community Affairs criteria. Street crimes (motor vehicle thefts, violent crime, and robbery) per capita were calculated using Texas Department of Public Safety and US Census data.. We tested the association between county-level crimes per capita and physical inactivity prevalence using multinomial linear regression. Additionally, we ran stratified models by county type (rural and urban).

Results
Of 254 counties, 23.6% were urban, and 76.4% rural. The prevalence of physical inactivity ranged from 18% to 46%, with rural counties having a significantly (p<0.001) higher prevalence (mean prevalence= 30.7, sd= 4.5) than urban counties (mean prevalence= 26.5, sd= 4.0). Crimes ranged from 0 to 368 per 1000 inhabitants; and no significant difference was observed by urban versus rural county type. Regression results, unadjusted for rural/urban status, showed a significant association between street crimes and physical inactivity prevalence, with every unit increase in number of crimes per 1000 inhabitants being associated with a 5% lower odds of high physical inactivity prevalence (CI: 0.91-0.99, p= 0.03). However, after adjusting for rural/urban county type, the association was no longer significant (OR: 0.99, CI: 0.95-1.03, p=0.79). Stratified models by rural vs. urban county type found no significant associations between crime and physical inactivity prevalence.

Conclusions
Crimes on the street are not associated with leisure-time physical inactivity in Texas counties. Future studies should examine the effects of crime on active travel, a health behavior that may be more influenced by street safety than exercise, recreation, and sport.

Purpose: To facilitate community empowerment via a community-based participatory approach by systematically gathering substantial and contextually relevant local data about the walkability of neighbourhood environments. However, implementing a participatory method borrowed from an overseas context may not be fitting particularly for diverse communities including Indigenous.

Methods: The Our Voice Citizen Science for Health Equity (Our Voice) method underwent a contextual adaptation for the Aotearoa New Zealand setting. This adaptation involved active engagement with social and health promotion agencies in Auckland, New Zealand. Employing content analysis, the Our Voice method was refined and transformed into the Our Voice Aotearoa NZ giving rise to a new Framework. The framework was developed to incorporate and reflect Māori and Pacific cultural perspectives, giving rise to a novel approach that aligns with the unique ways of being within these indigenous communities.

Results/findings: The Our Voice 4-step process of Discuss, Discover, Advocate and Change was expanded into a 5-step process by adding a step relating to Engagement. The 5-step process was then embedded into a wider framework that included four components: i) Historical and cultural realities ii) Community aspirations, iii) Building bridges and iv) Activation of neighbourhood urban and natural environments, all under the umbrella of active relationship-building.

Conclusions: The Empowering Communities-Wellbeing and Lived Experiences Framework was developed using local input to ensure respect and genuine relationship building with communities before any data collection. The process followed can be used as a guide for researchers in future engagement with communities.

Purpose
Reduction of physical inactivity necessitates effective government policies to cultivate healthy physical activity (PA) environments. The Physical Activity Environment Policy Index (PA-EPI) serves as a monitoring tool to assess the implementation of policies that promote PA. This study aims to assess the extent of PA policy implementation in the Netherlands and identify recommendations for implementation to improve its PA environment, using the PA-EPI.

Methods
Initial steps of the PA-EPI process involved collecting evidence for implementation of PA policy across 45 indicators of good practice. Government officials validated the evidence through survey and consultation, resulting in a Dutch PA-EPI Evidence document. Thereafter, non-government stakeholders (e.g. academics) independently rated the extent of implementation of PA policies by benchmarking the evidence against international best practice using a Likert scale (1: no/little implementation to 5: very high implementation). With aggregated scores implementation gaps will be identified. Finally, government officials (observers) and non-government stakeholders formulate policy recommendations in a workshop, based on these implementation gaps.

Results
Policy documents and letters from ministries, laws and regulations, websites describing policy actions and policy monitoring/evaluation studies were used to compile an extensive document encapsulating Dutch PA policies. For some policy domains evidence for implementation was easily identified (e.g. education, transport and infrastructure support domains) whereas for others this was more difficult (e.g. healthcare and community). The feedback received from fifteen government officials on the evidence document encompassed the arrangement of policy documents, some of which were linked to multiple indicators (across domains). Furthermore, the feedback served to clarify definitions and boundaries of Dutch PA policy. Based on the validation, twenty-three non-government stakeholders have agreed to rate the implementation of PA policies. The results and their associated recommendations for improving PA policy implementation will be presented.

Conclusions
This study will identify which of the indicators are well-implemented and poorly implemented. Action is needed to provide key recommendations to achieve PA policy progress in the Netherlands. The PA-EPI is a valuable tool to create cross-sectoral discussions, develop a national coalition of government and non-government experts and for cross-country comparisons and benchmarking of PA policy implementation.

Purpose: Policy, systems, and environmental (PSE) approaches can sustainably and equitably increase access to healthy food and active living opportunities, but community residents are often not included in the process to create solutions in their own communities. Many researchers and practitioners engage in PSE work with communities, but methods for engaging communities that develop community ownership of changes and uplift community power to implement PSE changes are not well understood. The aim of this evaluation study was to examine the community engagement process by local health departments engaged in PSE initiatives with communities and develop a journey map of the key phases of the process.

Methods: To map the experience of community engagement, we conducted semi-structured interviews via video conference with local county health department staff who work on state-funded, PSE initiatives (n = 6 counties) in a Midwestern state in the United States. Interview questions were developed using a journey mapping approach, which is a method for visual storytelling about how participants experience and interact with processes and systems. Interview questions assessed the expected outcomes of community engagement, activities, barriers, facilitators, and emotions tied to the different phases of the community engagement process. To analyze the data and develop the visual representation of the community engagement journey, we used a qualitative analysis approach proposed by Yin (2016), which included five iterative phases of compiling, disassembling, reassembling, interpreting, and concluding.

Results/findings: We identified four phases of community engagement that local health departments experience as they engage the community in PSE initiatives: activate communities, implement changes, renew relationships and project ideas, and release control. Within each phase, we mapped key steps and conditions that enabled the development and implementation of community-aligned solutions to make progress towards sustainable changes in community health, capacity, connectivity, and power.

Conclusions: This study identified key phases and conditions that support community-led PSE initiatives. These can be used by community leaders, researchers, public health practitioners, and funding entities to support the implementation and assessment of meaningful community engagement in initiatives that seek to increase access to healthy food and active living opportunities.