From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

Liliana Leone,Caterina Pesce

doi:10.3390/ijerph14101193

Abstract

Background: Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Methods: Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002–2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested. Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.

Highlights

Worldwide trends of inactivity, which increase with economic development urge societies to invest in physical activity (PA) promotion to counteract the growing social and economic costs of multiple non-communicable diseases associated with insufficient PA levels [1]
Our findings indicate that the current European Union (EU) attention to obesity and physicallyactivity in strategic documents [10] depends on the confluence of multiple mechanisms and related outcomes (Table 1, Step I). (1) A mechanism of scientific legitimation underlies the dissemination of the anti-obesity discourse prompted by the WHO scientific view
As evidence and guidance delivery alone are not sufficient to influence practitioners and policy maker behaviours [34,36,75], the review analysed key steps of the long path that goes from the agenda setting to guidelines adoption and implementation, highlighting specific threats at each step

Summary

Introduction

Worldwide trends of inactivity, which increase with economic development urge societies to invest in physical activity (PA) promotion to counteract the growing social and economic costs of multiple non-communicable diseases associated with insufficient PA levels [1]. Ecological models of health promotion applied to PA clearly show that the multi-level processes that shape health are beyond the interests and expertise of health disciplines alone. Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education). Results: The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. Conclusions: The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies

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Conclusion