Complexity and physical activity policy: considerations for theory and practice.

Abstract

Background:
Complex systems perspectives have been increasingly adopted to address physical inactivity. Within this, myriad policy actions are deemed important for supporting population physical activity and creating so-called ‘active systems.’ I argue that complexity and systems-thinking have, prior to this thesis, predominantly been applied uncritically and with insufficient consideration of the agents who influence, and are influenced by, the complexity of the physical activity policy environment. There is the need to connect different strands of research, specifically in relation to physical activity policy, evidence-informed Public Health, and complexity.

Aim:
My research aimed to critically assess the understanding and application of complexity theories as a basis for evidence-informed physical activity policy efforts. Specifically, I sought to interrogate the suitability of complexity theories for influencing, developing and implementing physical activity policies; identify conditions that enable more effective complex systems approaches to physical activity policy and programmes; and in doing so, extend understanding concerning complexity theories and their application.

Theory and methods:
Central to my theoretical position has been a reflexive process in which I have located myself within the wider physical activity and Public Health research landscape, and crucially the system I seek to change. This thesis is underpinned by a complex realist ontology, and epistemologically I draw on the notion of different lenses of evidence about policy issues. Methodologically, I employed qualitative and action-orientated methods to explore individuals’ agency and experiences of the physical activity policy system. My own observations and experiences are discussed through a theoretical pluralism.

Study 1:
I explored the processes, values and experiences of physical activity policy-makers in UK national government, in relation to complexity, and how they sought to foster system change. I conducted 10 semi-structured interviews. Three overarching themes were constructed and emphasised that while the idea of complex systems permeated the physical activity sector, uncertainty as to the meaning of complexity and its implications may preclude its application in ways that enhance physical activity policies and programmes. I highlight problematic practices and identify potentially important mechanisms to support system change.

Study 2:
This study was originally a preliminary component of an action research project that was curtailed by the SARS-Cov-2 pandemic. Through five in-depth semi-structured interviews, I examined how local partnerships can be used more effectively to improve the implementation of national physical activity policies. Specifically, I extended knowledge by providing a critical reflection on system leadership, demonstrating how it is enabled and strengthened, how it links to implementation, and how changes in systemic practices and cultures can be stimulated in the physical activity policy domain.

Study 3:
This study responded to outstanding gaps in the evidence, in particular the ongoing uncertainty around the practical applications of complexity theories and systems perspectives. In-keeping with my intended action-orientated approach, I convened a workshop with 19 international experts (from research, policy and practice) to critically reflect on my previous research, drawing attention to issues of conceptual purity and discord between the theory and practice of complexity in the physical activity policy domain. Thereafter, the workshop explored how to optimise the application of complex systems approaches to physical activity policy, by focusing on the action of knowledge mobilisers. Analysis led to the creation of four propositions for advancing complexity theories and systems-based approaches, which set out important considerations concerning the how, when, and why of applying these perspectives.

Concluding remarks:
The general discussion is presented not as a line in the sand, but as both an advancement on previous thinking, and reflection on these and empirical contributions that remain a work in progress. Specifically, I set out current conceptualisations of complexity theories as they pertain to physical activity policy, and discuss considerations for future practice. I conclude by arguing that a reorientation of efforts across research, policy and practice toward agency, mobilisation and application of complex systems perspectives in physical activity policy settings will strengthen collective impact.