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.

Integrated transport and land-use planning and reduced car dependency proffers a pathway to mobility justice and reduced transport poverty, whilst providing opportunities for potential health benefits and reducing carbon emissions. In spite of this, smaller cities and towns face opposition to the reallocation of road space away from the private car. Traditionally, transport measures have been responsive to growing car-use. To accelerate a behavioural shift to sustainable modes, an evidence-based, transformative approach is required that is consultative in nature, and inclusive of all relevant stakeholders and nurtures innovation. The study aims to achieve this by co-creating a theory of change, with a broad group of stakeholders and the community. Systems science and co-creation techniques were utilised to enable informed decision-making and foster shared learning, resulting in a theory of change formulated by stakeholders with a shared vision. Sixteen objectives were identified under five broad categories, create sustainable systems; design healthy built environments; engage society; empower people and prioritise road safety, informed by the systems-based framework Global Action Plan on Physical Activity. Assumptions, risks and key performance indicators were key elements of the theory of change. Risks identified for successful implementation of the plan were lack of funding and human resources to deliver actions, political challenges, lengthy planning processes, entrenched social norms and resistance from the community. This process, which was adopted, synthesises scientific evidence, a participatory systems approach, informed decision making and the practical application of the embedded researcher, resulting in a pragmatic theory of change to reduce car-dependency and create a shift to sustainable travel modes. The process highlights the importance of stakeholder and community engagement, from participatory mapping of the system to the development of the theory of change to generate local solutions to identified challenges. The resulting theory of change will form the basis of a Sustainable Urban Mobility Plan for Kilkenny City. The theory of change can be adapted to new settings by the participatory processes outlined.

Purpose: ‘Ireland Lights UP’ (ILU) is an annual walking initiative implemented by the Gaelic Athletic Association (GAA) and several other partners in Ireland. The initiative sees more than 1,000 GAA clubs turning on their floodlights for the local community to walk around their grounds over a 7-week period beginning in January. An estimated 35,000 participants take part annually. The initiative has the potential to create sustainable improvements to multiple aspects of physical, social and mental wellbeing. However, there has been limited evaluation of ILU. Methods: This was a mixed methods study consisting of surveys with adult ILU participants in 12 GAA clubs (n = 181) and semi-structured qualitative interviews with ILU co-ordinators at both club (n = 12) and national level (n = 1). Cross-sectional surveys (six Likert scale questions assessing participation and impact on wellbeing) were administrated via an online link to an MS Form or via a structured interview. The qualitative interviews were conducted using zoom, structured using a hybrid of the RE-AIM and PRISM frameworks and analysed using thematic content analysis. Results: The average age of survey respondents was 52.3 years and the majority (73%) were female. Almost 60% of respondents reported that they mostly walked with friends and 77% attended more than half of the organised walks. A high proportion of respondents strongly agreed that they exercised more because of ILU (56.4%), spoke to people they would not normally speak to (45.5%) and intended to maintain their increased walking (54.3%). Almost 66% stated that ILU improved their general health and wellbeing. The key themes elicited from the interviews were narratives around the lasting benefits of ILU, the restoration of connections between people, ring-fencing of quality time with friends and family and increasing social capital and connectedness. Conclusions: Ireland Lights Up is a rare example of a PA programme already operating at scale. The standout benefit of ILU was the creation of social connections at a time when daylight hours are short and PA levels are lower. This study was formative in nature and will help to shape the research design of a more comprehensive evaluation of the implementation of ILU. Support/funding source: non applicable.

Sports clubs are gaining recognition as valuable settings for population health promotion, extending impact beyond traditional sporting populations. Ireland Lights Up (ILU) is a nationwide community walking initiative in which Gaelic Athletic Association (GAA) clubs provide floodlit walking opportunities during winter to engage communities in physical activity (PA). However, there is limited evidence on who such initiatives reach and whether they enage diverse population groups. To address this gap, a mixed methods approach was utilised. Quantitative data was obtained through cross-sectional questionnaires distributed to participants (n=1226) through club networks over a six-week period. Qualitative data was collected through snapshot interviews (n=30) with participants during site visits and triangulated to understand drivers of participation. Findings indicated that most participants were female (76.5%), white (99.5%) and lived in rural areas (80%). Participants had a mean age of 47 years (SD ±11.01 with the majority (84%) as sports club members. Participants reported high levels of health and wellbeing, with a substantial proportion meeting PA guidelines (48.1%). Single and younger participants were more likely to feel lonely compared to married and older participants (P≤0.05). Qualitative findings highlighted three main participation drivers: safety, social interaction and club walking tracks. ILU engages large numbers of participants in PA nationally and successfully engages its target population, including substantial numbers from traditionally underserved rural communities, by employing an innovative approach that addresses seasonal barriers to PA participation. To further maximise reach, community-based PA programmes require research that includes attention to implementation factors such as participant acceptability.