Determinants of physical activity promotion in primary care from the patient perspective of people at risk of or living with chronic disease: a COM-B analysis.

BACKGROUND: Chronic disease (CD) accounts for more than half of the overall global disease burden and physical activity (PA) is an established evidence-based strategy for the prevention and management of CD. Global policy emphasises the value of embedding PA into primary healthcare, highlighting the positive effects on PA behaviour. However, there is limited implementation of PA protocols in primary care, and research is needed to guide its integration into routine practice. The voice of the patient is underrepresented in the literature, resulting in the absence of critical insights into determinants of PA promotion in primary care. The purpose of the research was to identify the perspectives of people at risk of or living with CD on the determinants of PA promotion in primary care and to map these determinants across the six COM-B constructs. METHODS: Semi-structured interviews (n = 22), guided by the COM-B model were conducted with people aged 35-60 years, at risk of or living with CD and not meeting the PA guidelines. A hybrid analytic approach of thematic inductive and deductive analysis was applied to the participant transcripts guided by a COM-B informed coding framework. RESULTS: In total, 37 determinants across constructs related to capability, opportunity and motivation were prominent, examples include; physical capability constraints, the conflation of exercise with weight management, credibility of the health services in PA advice, communication styles in PA promotion, expectations of tailored support for PA, social support, accessibility, and integration of PA into routine habits. CONCLUSION: Exploring the determinants of PA promotion through the lens of the COM-B model facilitated a systematic approach to understanding the primary care user perspective of the healthcare professional (HCP) broaching the topic of PA. Findings emphasise the value of HCPs being supported to broach the issue of PA in a therapeutic and patient-centred manner using diverse and flexible approaches, while highlighting the importance of tailored, accessible PA opportunities that build self-efficacy and foster social support. The research provides valuable learnings to support PA promotion and the development of strategies in primary care through encompassing the perspective of those living with or at risk of CD.

Trends in recreational walking trail usage in Ireland during the COVID-19 pandemic: Implications for practice.

Despite its potential utility for the outdoor recreation sector, there is no centralised surveillance system for recreational walking trails in Ireland and thus trail usage in Ireland during the COVID-19 pandemic is unknown. This paper aims to report trends in footfall count data on Irish trails during the COVID-19 period and to triangulate findings with openly available mobility data. This descriptive study analysed changes in footfall counts gathered from passive infrared sensors on 33 of Ireland's recreational walking trails between January 2019 and December 2020. The relationship between Google Community Mobility Report (GCMR) data and footfall counts was analysed to corroborate trends in footfall data. Total footfall increased by 6% between 2019 and 2020 on trails included in this analysis. Notably, mean trail usage was between 26% and 47% higher in October-December 2020 than during the same period in 2019. A strong correlation between GCMR data from 'parks' and footfall count data was found. The conclusions of this study are twofold. Firstly, the COVID-19 pandemic increased trail usage in Ireland, especially on trails closer to urban areas and there is potential for this to be a lasting legacy. Secondly, combining multiple data sources can provide trail managers with more detailed representations of trail usage and currently these are not harmonised. Future research should examine ways to encourage sustained recreational walking trail use in new users and implement novel ways to coordinate datasets across systems to monitor visitors on Irish recreational walking trails. Management implications: This paper presents a number of implications for trail management teams to consider:•Openly available datasets pertaining to mobility, such as Google Community Mobility Reports, can be utilised to corroborate data collected from footfall sensors in place on trails. Furthermore, there may be potential for Google Trends data to help trail management teams gauge interest in specific trails and parks during defined time frames.•There is considerable potential to sustain the COVID-19 legacy of increased trail use, especially for trails closer to urban areas, through promotional campaigns and continued trail maintenance.•There is a need to work across sectors and disciplines within the recreational walking system to identify potential data sources and opportunities for further data collection.

Beyond the big city: using a systems approach to cultivate a cycling culture in small cities and towns in Ireland.

Urban mobility and how people move in our towns and cities is garnering more attention, as solutions are sought to multiple challenges faced by residents; health and physical inactivity, climate change, air quality, urbanisation and accessibility. Traditional, siloed approaches limit impact and collaborative, systems approaches hold promise. However, systems approaches often remain theoretical and few practical applications of their added value have been demonstrated. This study illustrates how a systems approach can be used to underpin the development of a 9-step process to generate solutions for action on active mobility. The development of a systems map and a theory of change framework are key outputs of this 9-step process. The purpose of this paper is to describe how a systems map was developed in an Irish town utilising broad stakeholder engagement to map the variables that influence cycling in the town and to identify the leverage points for transformational interventions.

A critical analysis of walking policy in Ireland and its contribution to both national and international development goals.

Introduction: Increasing population levels of walking holds benefits for public and planetary health. While individual level interventions to promote walking have been shown to be efficacious, upstream interventions such as policies harness the greatest potential for impact at the population level. However, little is known about the nature and presence of walking policy in Ireland and the extent to which it aligns to national and global goals. This paper aims to provide an overview of local and national walking policy in Ireland and to understand the potential of Irish walking policy to contribute to national and global targets. Methods: This study used multiple methods to provide a critical overview of walking policy. Firstly, a six-phase process was employed to conduct a content analysis of local and national walking policy in Ireland. Secondly, conceptual linkage exercises were conducted to assess the contribution of walking, and national walking policy in Ireland, to Ireland's National Strategic Outcomes and the United Nations Sustainable Development Goals. Results: Overall, half (n = 13) of the counties in the Republic of Ireland were found to have no local level walking policies. Results from the content analysis suggest that counties which had walking specific local level policies (n = 2) were outdated by almost two decades. Walking was identified to hold the potential to contribute to over half (n = 6) of Ireland's National Strategic Outcomes, and over half (n = 7) of the United Nations Sustainable Development Goals. Ireland's only national level walking specific policy, the Get Ireland Walking Strategy and Action Plan 2017-2020, was identified to potentially contribute to four of Ireland's National Strategic Outcomes and three United Nations Sustainable Development Goals. Discussion: Multidisciplinary action is required to update walking-related policy with embedded evaluation and governance mechanisms in all local walking systems. Furthermore, given sufficient collaboration across sectors, walking policy in Ireland has the potential to contribute to a wider breadth of national and global targets beyond the health, sport, tourism, and transport sectors.

Using systems science methods to enhance the work of national and local walking partnerships: practical insights from Ireland.

BACKGROUND: Physical activity (PA) literature is dominated by individual-level descriptive studies, which are known to have limited impact on population PA levels. Leveraging systems science methods offers opportunities to approach PA in a manner which embraces its inherent complexity. This study describes how participatory systems mapping and social network analysis (SNA) were used to understand the work of local and national level walking systems in Ireland. METHODS: Two adapted participatory action research workshops with multisectoral stakeholders were used to develop a systems map for walking in Cork, Ireland. The Global Action Plan for Physical Activity 2018-2030 (GAPPA) map was used as a framework to categorize workshop outcomes. Secondly, SNA methods were used to analyse the communication network between partners of Get Ireland Walking, a national walking promotion initiative, as defined within their strategic plan and the actual communication network as experienced by the partners. RESULTS: The systems mapping process allowed stakeholders to identify 19 suggested actions for the Cork walking system. The SNA found that there were considerably fewer communication ties between partners in the actual communication network than in the strategy defined network. CONCLUSION: The systems mapping process was a useful catalyst for engaging stakeholders in cross-sectoral communication and the GAPPA was a practical way to organize workshop outcomes. Social network analysis methods highlighted that the communication network of a national level walking promotion partnership is not working as planned. Overall, the use of systems science methods can provide practical insights for local and national level walking systems.

From training to practice: the impact of ENGAGE, Ireland's national men's health training programme.

Ireland's National Men's Health Policy recommended developing training programmes tailored to the needs of those working in health and allied health professionals and ENGAGE was developed to meet that recommendation. This study evaluated the impact of ENGAGE on frontline service providers' self-reported knowledge, skills, capacity and practice up to 5-months post training. Between 2012 and 2015, ENGAGE Trainers (n = 57) delivered 62 1-day training programmes to 810 participants. This study was conducted on a subset of those training days (n = 26) and participants. Quantitative methodologies were used to collect pre (n = 295), post (n = 295) and 5-month post (n = 128) training questionnaire data. Overall, participants were highly satisfied with the training immediately post training (8.60 ± 1.60 out of 10) and at 5-month follow up (8.06 ± 1.43 out of 10). Participants' self-reported level of knowledge, skill and capacity in identifying priorities, engaging men and influencing practice beyond their own organisation increased immediately following training (P < 0.001) and, with the exception of improving capacity to engage men and influencing practice beyond their organisation, these improvements were sustained at 5-month post training (P < 0.001). The vast majority of service providers (93.4%) reported that ENGAGE had impacted their work practice up to 5-month post training. The findings suggest that ENGAGE has succeeded in improving service providers' capacity to engage and work with men; improving gender competency in the delivery of health and health related services may increase the utilisation of such services by men and thereby improve health outcomes for men.

A process evaluation of a Training of Trainers (TOT) model of men's health training.

This study set out to identify the mediators of diffusion of a Training of Trainers (ToT) programme; focusing on ENGAGE, Ireland's national men's health training programme, we explored the process (planning, implementation and maintenance) of using a ToT model of training to affect change in gender sensitive health and social service provision for men. Our findings indicate that an experiential learning approach in combination with mechanisms for feedback and fostering peer-based support during training and beyond are key strategies that foster individual (Trainer), community (of Trainers) and organizational (Trainer workplaces) level ownership. Moreover, by adapting in response to feedback, ENGAGE was able to remain relevant over a number years and to different cohorts of Trainers. As such, core strategies used by ENGAGE could be used to inform new models of health training elsewhere.

Active Travel to Primary Schools in Ireland: An Opportunistic Evaluation of a Natural Experiment.

BACKGROUND: There is a paucity of intervention studies assessing active travel to school as a mechanism to increase physical activity. This paper describes the impact of a community-wide intervention on active travel to primary schools in 2 Irish towns. METHODS: This was a repeat cross-sectional study of a natural experiment. Self-report questionnaires were completed by 5th and 6th grade students in 3 towns (n = 1038 students in 2 intervention towns; n = 419 students in 1 control town) at baseline and by a new group of students 2 years later at follow-up. The absolute change in the proportion of children walking and cycling to school (difference in differences) was calculated. RESULTS: There was no overall intervention effect detected for active travel to or from school. This is despite an absolute increase of 14.7% (1.6, 27.9) in the proportion of children that indicated a preference for active travel to school in the town with the most intensive intervention (town 2). CONCLUSIONS: Interventions designed to increase active travel to school hold some promise but should have a high-intensity mix of infrastructural and behavioral measures, be gender-specific, address car dependency and focus on travel home from school initially.

A qualitative study of lifestyle counselling in general practice in Ireland.

BACKGROUND: There is limited information in Ireland on the attitudes of GPs and practice nurses to lifestyle counselling and the strategies or approaches they use. Furthermore, there is no national framework or resources to support the systematic and uniform provision of lifestyle counselling. OBJECTIVES: To explore the views of Irish primary health care practitioners about behavioural risk factor management in particular to the provision of lifestyle counselling. To identify barriers to behavioural risk factor management and to inform the development of a risk factor management toolkit for general practice. METHODS: The research design is a qualitative study consisting of six focus groups with primary health care practitioners in urban and rural locations in the Republic of Ireland. Two focus groups were conducted with GPs, two with practice nurses, one with a mixed group of GPs and practice nurses and one with a Primary Care Team. In total, 56 participants, aged 30-64 years, attended the focus groups. Descriptive analysis was performed. RESULTS: GPs and practice nurses experienced considerable barriers to lifestyle counselling. These include insufficient time, patient resistance, lack of funding for prevention and lack of training. Participants were aware of the value of patient-centred lifestyle counselling; however, the provision of simple lifestyle information and advice was the predominant strategy used. CONCLUSIONS: GPs and practice nurses regularly conduct lifestyle counselling despite considerable barriers. It is essential that they are supported to carry out lifestyle counselling as part of a systematic 'whole practice approach' to prevention in general practice.