Evaluating a whole systems approach to addressing low levels of physical activity

Lack of physical activity is a major public health issue in many rich countries. In England, one in four women and one in five men do less than 30 minutes of moderate activity a week.

There are many complex reasons for low levels of physical activity across a population, with a recent academic paper identifying 45 factors – from air quality, to cycling infrastructure, to an individuals’ level of disposable income.

In Gloucestershire, one in five adults do less than 30 minutes of physical activity each week. Active Gloucestershire’s we can move programme is a whole systems approach which looks at the complex web of factors that cause a problem, and then aims to identify parts of the system that can be changed.

We can move aims to help people in Gloucestershire become more physically active. To achieve this, they want to make physical activity the norm by targeting the physical environment including transport infrastructure, workplaces, communities and schools. This requires help and support from the County Council, NHS trusts, the voluntary and community sector and citizens themselves.

NIHR ARC West and colleagues from the University of Bristol’s School for Policy Studies were Active Gloucestershire’s evaluation partner for we can move between April 2019 and April 2021.

The evaluation of a whole systems approach is difficult. The researchers used a range of techniques, including:

• Systems mapping to understand the broad and diverse causes of low physical activity in Gloucestershire
• Interviews with a wide range of people who were involved in, or impacted by, the we can move programme
• Annual surveys of stakeholders who were involved in we can move
• Ripple effects mapping to explore the wider, anticipated and unanticipated, impacts of we can move. This is a method that we have identified and adapted for the specific purpose of better understanding whole systems approaches.
• Audits of the processes followed by Active Gloucestershire staff when implementing we can move
• An analysis of the stakeholder database to determine how many people were involved in we can move and the area of the system that they influence

The evaluation report (PDF) has just been published. This report helped to demonstrate the impact that we can move has had on the local systems, but it has also found several areas of we can move that can be strengthened. The evaluation has been used by Active Gloucestershire and their partners to reflect on, and adapt, the we can move programme.

Dr James Nobles said:

“It has been a privilege to work so closely with the Active Gloucestershire team. I was embedded at Active Gloucestershire, which meant I could see how the organisation worked on the ground, and hear the kinds of conversations that were happening around we can move.

“Before the pandemic, I was spending at least one day a week in the Active Gloucestershire offices to develop a thorough knowledge of we can move. This embedded role ensured our evaluation was fit for purpose and answered the questions which were most important.”

Tom Beasley from Active Gloucestershire said:

“The evaluation process and working with ARC West has been a helpful, supportive and positive. Not only have we got a detailed, honest and balanced evaluation of we can move which will help us to shape the next phase of our work. ARC West have also left a legacy of evaluation tools, advice and learning that is impacting the county’s health and wellbeing system.

We’ve benefited from having James embedded in our team for the last two years, this approach has enabled him to gain a deep understanding of the work and as a result we’ve been able to learn together and make ongoing adjustments. We’re looking forward to continuing to use many of the approaches in the next phase of our evaluation.”