Agenda-setting policy analysis on Iranian physical activity promotion policies: An application of Kingdon’s Multiple Streams Framework

Abstract Background: Since physical inactivity is currently a global concern, encouraging individuals to physical activity (PA) is a priority in public health policies. This study was conducted to analyse the process of change in adopting policies aimed at promoting PA in policy agenda-setting.Methods: This qualitative study was conducted by using document review and semi-structured interviews with 23 key informants of different sections and levels of the policy-making process of the PA promotion programs in Iran. Purposive sampling with maximum variation was used to identify key informants. Analysis of documents and interviews was performed based on the Kingdon’s multiple streams Framework (MSF): problem, policy and political streams. MAXQDA-10 software was applied to manage data analysis process. Result: The problem stream was found to be the high prevalence of physical inactivity, perceived subjective barriers, and contextual factors for PA within the country. The policy stream focused on integrating PA services into primary health care, conducting national and global calendar campaigns and events, and existing legal structures to promote PA in the community. In the political stream, the support of national documents and various legislative and governing authorities, as well as international support, especially the World Health Organization’s 2018-2030 program, provided a favourable environment for this issue. Conclusion: Despite the opening of a policy window for policy-making to promote PA in Iran, several challenges were identified that hindered the policies; the championship and professional approach in the Ministry of Sports, lack of inter-sectoral cooperation, restrictions due to international sanctions and the Covid-19 pandemic, and managerial-structural problems. As the policy window is not used in an appropriate manner, the policymakers need to revisit the policies, with a particular attention to feasibility of the policies, the organizational culture of different Iranian ministries, and the mediating and advocating roles of the Ministry of health in operationalizing the policies.