PEN PA-EPI

The Physical Activity Environment Policy Index (PA-EPI)

1. What is the PA-EPI? / Why is it Important?
2. How PA-EPI was developed
3. The resulting PA-EPI framework / Good Practice Statements
4. Applying the PA-EPI framework
5. Expression of Interest Form
6. Resources
7. Acknowlegment

1. What is the PA-EPI / Why is it important?

The Physical Activity Environment Policy Index (PA-EPI) is a tool to designed to help answer the overarching question: how much progress have governments made towards good practice in improving PA environments and implementing physical inactivity prevention policies and actions? To address physical inactivity, a ‘healthy‘ PA environment is paramount. The PA environment is defined, for the purpose of the PA-EPI, as the collective physical, economic, political, and sociocultural contexts, opportunities, and conditions that influence one’s PA choices and behaviours.

The goal of the PA-EPI is:

To assess and compare the extent of implementation of national government policies and actions, for creating physically active environments against international best practice, and to identify the major implementation gaps.
To prioritize actions needed to address critical gaps in government policies and infrastructure support for implementation according to their importance and achievability.

Why Important?

The PA-EPI draws on the Food-EPI developed by INFORMAS. The Food-EPI, currently implemented in over 30 countries worldwide, has provided a tool and roadmap on how to progress achievement of healthy and sustainable food environments.
The PA-EPI will contribute to a consolidated approach to PA policy evaluation across Europe and is applicable worldwide.
The PA-EPI (Figure 1) consists of two components (Policies and Infrastructure Support), along with domains and indicators. The policy component comprises the eight PA domains identified in ISPAH’s ‘Eight Investments that work for Physical Activity’ (https://www.ispah.org/resources/key-resources/8-investments/). Within the infrastructure support component, the domains cover leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, workforce development and health-in-all-policies. All domains are relevant to evaluating progress governments have made towards good practice in improving PA environments and implementing physical inactivity prevention policies and actions.
Each of the 15 PA-EPI domains’ has an ideal good practice. There are 45 good practice statements, or indicators of this ideal good practice. The number of statements vary by domain depending on the quantity and quality of evidence available (Figure 2).

Figure 1. PEN Physical Activity Environment Policy Index Framework (PA-EPI)

2. How PA-EPI was developed

The PA-EPI was developed using a combination of literature review, both grey literature and published scientific evidence and expert opinion. This provided an understanding of ‘best international practices’ and formed the basis for the development of the PA-EPI ‘Good Practice Statements’. Overall, the development of the PA-EPI involved an iterative process consisting of four steps. Step one involved desk-based research on key policy documents, PA policy audits and a scientific literature review, to generate the PA-EPI framework and create a draft PA-EPI monitoring tool. An online consultation process was organised for step three involving academic experts and policymaker experts to revise and refine, as appropriate, the PA-EPI monitoring tool. Throughout the process PEN consensus workshops were undertaken to synthesize the information generated (steps two and four).

Figure 2 The Physical Activity Environment Policy Index (PA-EPI) Framework.

A more detailed outline of the methodology used in the development of the PA-EPI can be found in the recent published paper – ‘The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity.’

3. The resulting PA-EPI framework / Good Practice Statements

All domains were considered important to assessing government progress towards good practice in enhancing the PA environment and PA behaviour by applying relevant policies and actions.

Table 1 presents the final formulation of ideal good practice within the PA-EPI policy domains. The good practice statements (GPSs), which are the indicators of ideal good practice are also presented. These GPSs provide a monitoring tool for assessment of implementation of policies and actions.

Table 2 outlines ideal good practice and the GPSs for the infrastructure support domains. These domains are aligned with the Food-EPI and include leadership, governance, monitoring and intelligence, funding and resources, platforms for interaction, developing workforce capacity and health-in-all-policies.

PA-EPI Good Practice Statements

Policy Domains

Table 1 Examples of ‘Good Practice’ statements within physical activity environment Policy Education domain

Education (Schools) There are public policies implemented that aim to impact on healthy physical activity environments and promote and support physical activity within the school setting.
E01	Evidence informed, quality mandatory physical education that promotes and supports the ideals of equity, diversity and inclusion and adheres to defined standards is part of the curricula in all schools.
E02	National and/or subnational initiatives are in place to promote and support school-related physical activity both at school and in other settings. These initiatives should employ an inter-sectoral approach and collaborative multi-agency partnerships (e.g., links with out-of-school sports clubs, active breaks/recess, walking clubs).
E03	There are shared use agreements that utilise school spaces. Community access is supported by initiatives to promote and support opportunities for physical activity for all persons outside of normal school hours.
E04	National and/or sub-national policies are in place to promote and support safe active travel to and from school.

Note. The Good Practice Statements from the other policy domains are in Press in the European Journal of Public Health.

Infrastructure Support Domains

Table 2 Examples of ‘Good Practice’ statements within physical activity environment Infrastructure Support Leadership domain

Leadership The political leadership ensures that there is strong support for the vision, planning, communication, implementation, and evaluation of policies to create health-promoting policy environments to improve population physical activity and reduce related inequalities.
L01	There is strong, visible, political support (at the head of state/cabinet level) for creating health-promoting policy environments to improve population levels of physical activity and reduce inactivity related non-communicable diseases and their related inequalities. Political responsibility for health-related physical activity is clearly allocated within the governmental structures.
L02	There is a comprehensive up-to-date plan (including timeline, targets, funding, priority policy and programme strategies) linked to national needs and priorities to increase population physical activity.
L03	Priorities are given to reduce inequalities in relation to inactivity related non-communicable diseases in the comprehensive plan (above).
L04	There are clearly defined, evidenced informed population physical activity guidelines for all age groups and for people living with non-communicable diseases, pregnant women, and people with disabilities.

Note. The Good Practice Statements for the other infrastructure support domains are in Press in the European Journal of Public Health.

4. Applying the PA-EPI framework

Following the INFORMAS process developed for the Food-EPI the process of conducting the PA-EPI could involve eight steps as noted in Figure 3.

Figure 3 Process for assessing the policies and actions of governments to create healthy physical activity environments and determining the government Healthy Physical Activity Environment Policy Index (PA-EPI) (adapted from Swinburn et al., 2013).

The PA-EPI evidence document provides full details of the current evidence of implementation by the Government for each GPS and includes international best practice examples (benchmarks) for each GPS to support you in the rating process and give you confidence to make those judgements. An example of the PA-EPI evidence document developed for Ireland can be found here.

Conducting the PA-EPI involves establishing a ‘national coalition’, a group of non-government public health and/or other domains stakeholders to manage the process or, alternatively, select or nominate an existing public health NGO or association to take the lead. This group would rate their government’s recent progress on the creation of a healthy PA environment, that is the degree of implementation of policy and infrastructure support in their country against the international best practice for the PA-EPI GPSs. An example of the scorecards can be found here. Ideally, this benchmarking would be a regular, and if possible national event, with scores collated and disseminated publicly. A full detailed protocol on how to apply the PA-EPI framework will be available upon request.

In order to maximise stakeholder involvement, it may be helpful to make adaptations on a country-by-country basis, cognisant of differing political landscapes. These adaptations should be considered in the early applications of the PA-EPI to best identify strengths and weaknesses, all the while acknowledging that changes will compromise comparability. Combining implementation indicators into one summary index will be the final step in assessing government policy implementation. Weighting for all domains, across both components, will be informed by INFORMAS and other public health monitoring indices.

However, country-specific adaptations might be necessary to account for differences in political culture, to achieve a maximum of stakeholder involvement to build policy capacity, and to ensure high-level political support for an adequate policy response. Initial applications of the PA-EPI should consider these issues, reflect upon and test different options for conducting the PA-EPI, and identify their specific strengths and weaknesses. Changing the PA-EPI will compromise comparability and this will also need to be considered. The final step in assessing the level of government policy implementation in the proposed monitoring framework is to combine implementation indicators from all domains across both components into one summary index. Using learnings from INFORMAS and other indexes designed to monitor progress in public health challenges, the relative weighting for each domain and aggregation of individual scores according to defined criteria will assist in this process.

5. Expression of Interest

If you are interested in measuring local physical activity environments in your country and if you would like to join the PEN PA-EPI network, please contact us.

Being part of the PEN PA-EPI network will give you access to our protocols, data collection methods, data and results, as well as support from our core group. If you are interested in joining, we’d love to hear from you!

Professor Catherine Woods

Physical Activity for Health Research Cluster, Health Research Institute, Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland

E-mail: Catherine.Woods@ul.ie

Professor Catherine Woods

Prof Catherine Woods is Chair of PA for Health in the Depart of Physical Education and Sport Sciences at the University of Limerick (UL). She is a member of UL’s Health Research Institute, and Director of Collaboration & Internationalisation within the Physical Activity for Health Research Cluster in UL. Prof Woods' research cuts across the HRI themes of lifestyle, health and technology. She enjoys developing and testing theoretically sound interventions to change population levels of PA, and seeks better, more systematic methods of bringing research, practice and policy closer together to achieve real and sustainable impact. Prof Woods believes that PA is a best buy for public health as it has the potential to improve health and wellbeing for everyone, irrespective of age, ability or condition.

Prof. Woods is the Deputy Coordinator of the PEN project, and chair of WP1 Task 1.2 tasked with leading on the development of a Physical Activity Policy Environment Index (PA EPI) – a monitoring framework to assess government policies and actions for creating a healthy PA environment.

6. Resources

Publications

Gelius, P., Messing, S., Forberger, S. et al. The added value of using the HEPA PAT for physical activity policy monitoring: a four-country comparison. Health Res Policy Sys 19, 22 (2021). https://doi.org/10.1186/s12961-021-00681-6
Volf K, Kelly L, García Bengoechea E et al. Policy Evaluation Network (PEN): Protocol for systematic literature reviews examining the evidence for impact of policies on physical activity across seven different policy domains [version 4; peer review: 3 approved]. HRB Open Res 2022, 3:62 https://doi.org/10.12688/hrbopenres.13089.4
Catherine B. Woods, Kevin Volf, Liam Kelly, Bláthín Casey, Peter Gelius, Sven Messing, Sarah Forberger, Jeroen Lakerveld, Joanna Zukowska, Enrique García Bengoechea. The evidence for the impact of policy on physical activity outcomes within the school setting: A systematic review, Journal of Sport and Health Science, Volume 10, Issue 3, 2021, Pages 263-276, ISSN 2095-2546, https://doi.org/10.1016/j.jshs.2021.01.006

Submissions Currently Under Review

Kevin Volf, Liam Kelly, Enrique García Bengoechea, Bláthín Casey, Peter Gelius, Sven Messing, Sarah Forberger, Jeroen Lakerveld, Nicolette R Den Braver, Joanna Zukowska, Catherine Woods, on behalf of the PEN Consortium. Evidence of the impact of sport policies on physical activity and sport participation: a systematic mixed studies review.

Joanna Zukowskaa, Anna Gobisa, Piotr Krajewskia, Agnieszka Morawiaka, Romanika Okraszewskaa, Catherine B. Woods, Kevin Volf, Liam Kelly, Peter Gelius, Sven Messing, Sarah Forberger, Jeroen Lakervelde and Enrique García Bengoechea on behalf of the PEN consortium. Which transport policies increase physical activity of the whole of society? A Systematic Review.

Nicolette R. den Braver, Enrique Garcia Bengoechea, Sven Messing, Liam Kelly, Linda J Schoonmade, Kevin Volf, Joanna Zukowska, Peter Gelius, Sarah Forberger, Catherine Woods, J Lakerveld on behalf of the Policy Evaluation Network (PEN) Consortium. The impact of mass-media campaigns on physical activity: a review of reviews through a policy lens.

Catherine B. Woods, Liam Kelly, Kevin Volf, Peter Gelius, Sven Messing, Sarah Forberger, Jeroen Lakerveld, Nicolette R. den Braver, Joanna Zukowska, Boyd Swinburn and Enrique García Bengoechea on behalf of the PEN consortium. The development of the Physical Activity Environment Policy Index (PA-EPI): a tool for monitoring and benchmarking government policies and actions to improve physical activity.

7. Acknowledgement

The PEN project is funded by the Joint Programming Initiative (JPI) “A Healthy Diet for a Healthy Life”, a research and innovation initiative of EU member states and associated countries. The funding agencies supporting this work are (in alphabetical order) Germany: Federal Ministry of Education and Research (BMBF); Ireland: Health Research Board (HRB); Italy: Ministry of Education, University and Research (MIUR); The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw); New Zealand: University of Auckland, School of Population Health; Norway: Research Council of Norway (RCN); and Poland: National Centre for Research and Development (NCBR). Additionally, the French partners acknowledge support through the Institute National de la Recherche Agronomique (INRA).

Many people have contributed to the development of this Physical Activity Policy Environment Index. We would like to thank our Policy Evaluation Network (PEN colleagues), in particular, Dr. Janas Harrington, Dr. Maartje Poleman, Dr. Anna Gobis and Dr. Aurelie VanHoye. We would also like to acknowledge the support of the INFORMAS research group, in particular Prof. Boyd Swinburn and Dr. Stefanie Vandevijvere. We would also like to thank the academic experts and the policymaker experts who took part in our online consultation.

Authors: Catherine Woods 1; Liam Kelly 1; Kevin Volf 1; Bláthín Casey 1; Peter Gelius 2; Sven Messing 2; Sarah Forberger 3; Jeroen Lakerveld 4,5; Nicole den Braver 4,5, Joanna Zukowska 6; Enrique García Bengoechea 1 on behalf of the PEN consortium

Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland.
Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany.
Amsterdam Public Health Research institute, The Netherlands
Upstream Team, Amsterdam UMC, VU University Amsterdam, The Netherlands
Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland.