Advancing systems approaches to physical activity policy: international systems thinkers’ perspectives on conceptual challenges and practical solutions

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However, descriptive work dominates and there is limited critical and theoretical reflection on applying these approaches, especially in relation to policy. As such, uncertainty and scepticism remain about applying systems approaches and their underlying theoretical constructs. This research engaged system actors and specialists to rethink optimising systems approaches in physical activity policy by focusing on knowledge mobilisation. Methods Nineteen individuals with conceptual and/or applied expertise in physical activity, policy, systems approaches or realism (or a combination of the above), from different countries, sectors and professional backgrounds, participated in a half-day workshop. Guided by methodological principles of action-oriented and translational research, participants critiqued existing research, and generated proposals for advancing the use of systems approaches. Data were collected using a combination of Padlet whiteboards, the Zoom chat function, audio recordings and field notes. A realist-informed thematic analysis was conducted, comprising deductive and inductive elements. Results Offering challenges to existing paradigms, our reforming propositions were constructed from the data concerning advancing systems approaches to physical activity policy. These highlighted the need to: 1) understand why the physical activity policy environment is not naturally conducive to systems approaches; 2) find ways to influence policy as a basis for systems change; 3) create system awareness and affiliation through connection and dialogue; and 4) increase attention on the agency of those seeking to develop systems approaches to create system change. Conclusions The mobilisation and application of knowledge around complexity and systems-thinking to create impactful systems approaches to physical activity policy require refocusing on the needs and practices of system agents. Knowledge creators need to better understand how decision makers behave and their influences, while decisions taken should be sensitive to the impact of adopting systems approaches on implementers. Those enacting systems approaches need support to foster collective identity and resilience. This article sets out novel conceptual and practical steps toward these actions; importantly, we demonstrate expert opinion that enacting such propositions can result in a step change in the effectiveness of systems approaches in the physical activity field and beyond. Physical activity policy systems thinking complexity public health Background Systems approaches are becoming commonplace in the consideration of complex public health challenges, such as physical inactivity [ 1 ]. Sharing some similarities with socioecological models, they focus on interactions, both within and between levels of influence on outcomes, as well as the outcomes arising from attempts to change the system. Such interventions may draw on conventional public health frameworks, or alternatively incorporate theories and methodologies drawn from systems thinking or complexity sciences (e.g. systems mapping or actor network theory), which are designed to explore the non-linear and emergent properties of systems [ 2 , 3 ]. To date, however, research has typically been restricted to describing systems or advocating for the further uptake of systems approaches [ 1 , 4 ]. There has been little critical and theoretical examination of how to do this: neither how these approaches are applied [ 5 ], nor how people acting in physical activity policy settings can respond to and optimally implement these approaches to effect system change. Given that the physical activity system typifies many systems tackling complex public health challenges, in the sense that it comprises diverse actors, diffused responsibilities, unclear hierarchies and unevenly distributed resources, it represents a useful delimited ‘space’ to explore the mobilisation of systems approaches in greater depth. Findings from research at both national and local policy levels have emphasised the importance of strong system leadership and cross-cutting governance in developing systems approaches to physical activity promotion [ 4 , 6 , 7 ]. This evidence base suggests that taking practical and agency-focused steps, such as leadership based on enterprise, discussion, distribution and togetherness, can foster the collaborative multi-agency conditions for more effective physical activity policy development and implementation. Despite this emerging evidence, and the widely acclaimed potential of systems approaches more broadly [ 1 ], our recent work suggests that the concepts of complexity and systems are contested within the physical activity policy space [ 7 ]. Furthermore, there remains considerable scepticism and uncertainty among those acting beyond academia, about how these approaches can be applied in practice to provide added value to existing physical activity promotion efforts and overcome systemic policy-level barriers, such as fragmented and often short-term funding processes that generate competition over collaboration [ 1 , 3 , 7 ]. These challenges may lead to a sense of overly diffused responsibilities and a detachment from the complexity of the policy issue [ 7 ]. Collectively, these findings impress on the physical activity field the need to consider how to mobilise understanding of, and confidence in, systems approaches across different knowledge systems. This will serve as a catalyst for much needed systems approaches that advance system-level enablers, such as legislislation. These are said to shape people’s ability to learn about, communicate and embed new perspectives on physical activity promotion in practice and in action, governance and truly effective partnership working [ 1 ]. Knowledge mobilisation ‘is the activation of available knowledge within a given context. Within this are notions of recognition, movement, active use and context specificity of knowledge [ 8 ].’ Thus, in this context, knowledge mobilisation processes cross (knowledge) systems [ 6 , 9 ]. This is particularly important in considering systems approaches to policy, as their theoretical foundations (i.e. systems thinking and complexity theory) derive from numerous scientific disciplines [ 10 ]. While there is appetite among physical activity policy agents to integrate knowledge created through different scientific, political and practical implementation lenses [ 7 , 11 ], further exploration about how systems approaches may propagate in this policy context is warranted given three outstanding issues. First, the difficulty in translating theoretical components of complexity and systems thinking into real-world policy applications [ 12 ]. Second, the need to understand how and when systems approaches usefully extend existing cross-sector, collaborative efforts in physical activity promotion [ 12 , 13 ]. Third, uncertainty as to whether systems approaches can be suitably understood and translated in order to enable more effective development and implementation of policy [ 14 ]; it is also unclear whether predominant tools, such as participatory systems mapping [ 15 ], are sufficiently instructive to policy agents in this regard. Together these issues indicate a need to bring together invested actors to seek to better understand ways in which we may create, share and use systems approaches, and their underlying conceptual tenets, in ways that complement day-to-day practices and experiences of policy agents. Grounding our approach in realist principles [ 16 , 17 ], we sought specifically to understand who knowledge of these approaches is useful for, how and in what circumstances. Aim This study aimed to bring together an expert group of system actors and diverse specialists to: 1) critically reflect on previous research about the understanding and influence of complexity and systems thinking among national and local physical activity policy stakeholders, drawing attention to issues of conceptual purity, and discord between theory and practice [ 18 ]; and 2) explore perspectives and generate new knowledge concerning how to optimise the application of systems approaches to physical activity policy, by focusing on the actions of knowledge mobilisers, in terms of why, what, via whom and how knowledge mobilisation occurs [ 19 ]. Methods Study design This study was aligned with our wider programme of research [ 4 , 7 ], adopting a complex realist perspective to better understand the context-bound influences on system change (or stasis) [ 16 ]. We used an online workshop design to collect data, which drew upon elements of action-oriented and translational research [ 20 , 21 ], to generate knowledge about the mobilisation of systems approaches to physical activity policy. A detailed exposition of the methodological implications of our approach, which contributed much-needed insight into workshopping as a data collection tool [ 22 ], is published elsewhere. Here we present a precise of our methodological contributions. Workshops are a well-documented knowledge exchange activity, which foster participation and interaction [ 23 ]. However, their use as a data collection tool, especially in online spaces, remains underexamined [ 22 , 23 ]. Ørngreen and Levinsen argued that there are three distinct foci for workshops as a research methodology: i) to achieve a goal; ii) viewing workshops as a practice in which their form and outcome are investigated; or iii) to generate new research data [ 23 ]. However, we demonstrated that, within the complex realist framework, these foci should not be considered mutually exclusive. Our goal was to produce theoretically-grounded recommendations about advancing systems approaches to physical activity policy. Likewise, through constructing knowledge through a dialogical process, whereby researchers and participants shared a single platform as constituent elements of the system of interest, this meant that the workshop and its associated practices were intrinsically tied to our findings. To this end, the workshop foci were not only synergistic, but collectively necessary to produce robust knowledge upon which action could be taken. Facilitation was essential in maintaining a manageable and inclusive environment where all participants engaged as co-creators of knowledge [ 20 ]. Digital tools like Padlet whiteboards provided structure and enhanced collaboration, with pre-populated resources and linked breakout groups fostering collective engagement and dialogue [ 24 ]. Data collected through Padlet, supplemented by field notes, chat box responses, and transcripts, enriched the methodological rigour by ensuring a credible representation of participants’ perspectives [ 22 ]. This workshop served as a case example in using online methods to construct practical and theoretical knowledge, integrating action and translational research principles to mobilise complex systems approaches to physical activity policy [ 20 , 21 ]. Participants Participants were purposively sampled and recruited via both open calls and established networks using email or social media. Targeting reflected broad international stakeholder interest in, and varied perspectives on, systems approaches and/or policy across academic, policy and practice settings, both within and importantly beyond the physical activity context. Twenty-eight individuals were invited, of whom 19 agreed from three countries to participate (11 women, 8 men). No commonalities in those who accepted or declined were noted; given the role-related time pressure of experts, we argue this represents a strong response rate. Additional demographic information was not collected, as it was unjustifiable given the intended analyses. Table 1 shows the disciplinary background, expertise and professional experiences of participants. Table 1 Professional characteristics and experiences of participants Expertise and professional experiences # Profession Physical activity Policy Systems approaches Realism 1 Academic ✓ ✓ ✓ 2 Academic ✓ ✓ 3 Academic ✓ ✓ 4 Academic ✓ ✓ 5 Academic ✓ ✓ 6 Academic ✓ ✓ ✓ 7 Academic ✓ ✓ ✓ 8 Academic ✓ ✓ 9 Academic ✓ 10 Academic ✓ ✓ 11 Academic ✓ ✓ 12 Academic ✓ 13 Policy professional ✓ ✓ ✓ 14 Policy professional ✓ ✓ 15 Policy professional ✓ ✓ 16 Policy professional ✓ ✓ 17 Practitioner ✓ ✓ 18 Practitioner ✓ ✓ 19 Practitioner ✓ ✓ Procedure The research was approved by Durham University Ethics Committee. Prior to the study, participants received an information sheet, had the opportunity to ask questions, and provided digital informed consent. A half-day workshop was held using Zoom video conferencing software in March 2021, which both facilitated international participation and ensured adherence to COVID-19 restrictions in place at that time. One week prior to the event, participants were emailed two pre-recorded videos, for optional viewing. One provided a brief introduction to physical activity for health and current prevalence data, which was designed for those without a physical activity background. The second presented key findings from previous research explaining how complexity is understood among UK physical activity policy-makers and key dimensions of effective systems leadership [ 4 , 7 ], and set out the rationale for the workshop. The workshop itself began with an introductory presentation that explained the conceptual basis of systems approaches to policy, alongside a summary of previous research findings. Thereafter, participants considered three core questions in a combination of breakout group activities and plenaries: 1. To what extent do previous research findings reflect the every-day experiences of those working in physical activity policy settings? 2. How can changes in systemic cultures and practices be stimulated? 3. How can knowledge of complexity and systems thinking be mobilised through systems approaches to physical activity policy? Breakout groups were pre-determined to ensure balanced representation of academic disciplines, and policy and practice stakeholders. Discussions were facilitated by three experienced workshop deliverers (BR, PB and JW) and recorded for transcription. Primary data collection was through the use of Padlet, an online whiteboard platform, to create digital artefacts. Additional File 1 details the content of each Padlet board. This method was supplemented by Zoom chat comments and field notes. Padlet boards were shared with participants for comment during and after the session. Analysis QSR NVivo 12 software was used to store data and manage analyses. Adopting a realist perspective [ 17 ], data were analysed using a pragmatic modification of thematic analysis [ 25 ], enabling comparisons to previous research and integration across the research questions. Following data immersion and recording of preliminary observations, initial codes were generated across the whole dataset for each core question as follows: i) using a deductive framework that consisted of themes identified in previous research [ 4 , 7 ] (Additional File 2). These codes were collated into potential themes that captured, further consolidated and extended key findings from data across all studies; ii) an inductive approach generated both semantic and latent codes that we organised into candidate themes; and iii) a second deductive organising framework identified data extracts that provided information about how systems approaches can be mobilised, in what circumstances these are useful or otherwise, and to whom (Additional File 3). These codes were collated into candidate themes. The candidate themes identified across the research questions were reviewed against the coded data extracts and then against the entire dataset, enabling recurring and salient patterns relevant to all questions to be identified through systematic comparison and iterative refinement. It was not possible to present participant identifiers alongside illustrative quotations, due to the function of anonymity on the Padlet whiteboard. It was also our intention to generate group-level data. To present our findings, we adopted the realist structure of stating dispositions (D), inferences (I) and experiences (E) [ 17 ]: In part because of the existence of D , there is a tendency that I . This manifested in our data which showed E (p. 175). Results Analysis of the workshop discussions resulted in four emergent propositions concerning how to advance systems approaches in physical activity policy. The term emergent is used here in the literal sense (i.e. these are novel propositions intended for further consideration and development), rather than with reference to them having emerged from the data, or to the emergent properties of complex systems. Two relate to influencing the environment in which such approaches are applied, while two present considerations for supporting individuals in creating system change. These findings are discussed in relation to key concepts from systems, policy and behavioural theories. Emergent proposition 1: The current physical activity policy environment is not naturally conducive to systems approaches; it is important to understand why This proposition is comprised from data indicating the context of the physical activity system may constrain efforts to develop systems approaches. Participants’ views and experiences highlighted enduring challenges faced by system agents. As social and structural balancing feedback loops tend to reinforce system norms and ensure the general stability of systems [ 16 , 26 ], it may be assumed that it is challenging to mobilise knowledge of systems and stimulate change if agents are unaccustomed to such perspectives. Evidence of these feedback loops and associated difficulties manifested in our data, as some participants’ experiences meant that they believed systems approaches to be onerous, particularly within the context of a global pandemic but also when faced with numerous complex contemporary societal challenges. Thinking in different ways, and obviously industry and partners all work in [different ways], that’s a really hard work thing to do. There is a significant momentum or force to hinder any change from happening in the first place. We probably all appreciate that, there’s a lot of passionate people who are trying to make change happen, but also a lot of resistance out there, lots of people wanting to return to the way things were in December 2019 [pre-pandemic]. Ignoring negative feedback is a known strategy for navigating complex systems and simplifying decision-making environments [ 10 ]. However, this approach was not evident in our data. Rather, simplification was expressed in terms of having ‘common language on terms, theories, methods and concepts in the physical activity area’ and being ‘pragmatic in application and not getting lost in the science that may scare people.’ While claims have been made to use systems terminology more literally to help realise the potential value of complexity theories through public policy [ 10 ], this seems at odds to the aims of simplification, where analogy [27] indicate a more selective use of these perspectives. Another characteristic perceived to inhibit the use of systems approaches is the way in which timescales and funding processes operate. These factors were often presented in tandem in participants’ reflections. Wider work on the trajectories of complex systems has indicated the benefit of adopting longer-term policy approaches that allow for innovations and patterns in outcomes to arise [28, 29]. However, the short-term targets and budget cycles that still characterise public health policy [30, 31] may preclude effective systems approaches to inactivity. Here, this was demonstrated through many participants’ beliefs that complex systems innovation in the physical activity space is inhibited by short-termism and budgetary constraints. Funders go, “well let’s not do something that might be radical and innovative because we know we are not going to get funding next year. Because it’s going to fail, we’re not going to be able to show that evidence.” So, it’s having that consistency of not working to government cycles, or allowing funders to say, “right we are going to use this money and it is going to be a long-term thing, we are going to believe in that, and we’re not going to judge you next year.” But that’s tricky because everyone wants payback straight away. Relatedly, participants suggested that to support the wider uptake of systems approaches, it is important to ensure scalable learning from well-funded systems-based programmes, such as Sport England’s Local Delivery Pilots, ‘is translatable elsewhere if you don’t actually have the same level of resource.’ Efforts are required to ensure more places have access to the funding needed to adopt and sustain systems approaches to physical activity promotion. Our data reflect considerable discussion about generating evidence to support the implementation of complex systems approaches. ‘There were questions around what are the sources of evidence, [and] how policymakers find those’, and whether ‘we need entirely different ways of thinking about evidence.’ Responses often focused on systems mapping, and the emphasis ‘was very much co-production’ orientated (see proposition three). Complexity-specific methods, such as Qualitative Comparative Analysis or agent-based modelling, were raised in fleeting discussions about evaluation. We haven’t spoken in depth about evaluation, but systems approaches can create many challenges for evaluation – not a reason not to do it, just need better evaluation approaches to deal with complexity. This raises some concerns, as although calls have been made for a complex systems model of evidence for public health [32], agents may be unaware of different types of evidence beyond the traditional linear and hierarchical models to which the sector is accustomed. Lastly, there was an overwhelming sense of uncertainty about complexity and systems-thinking and how these concepts apply to physical activity policy. This was apparent in the 21 distinct queries raised about these concepts among the 19 participants (e.g. see below). Uncertainty was observed in the data through participants’ difficulty in differentiating between systems-based and other perspectives, and how to advance these perspectives meaningfully in the prevailing policy context. To what extent does adopting complexity or systems-thinking look different to historical approaches to partnership working, community development, etc.? Using a bicycle initiative, adapting it, having to learn from it. I was trying to think, well, we can put a complexity language on this, but does it really need it? I don’t know what stops the sector from understanding the value of a complex systems point of view, and what it enables us to have in terms of solutions. There's maybe a need to be realistic in recognising that the centralised mode of government and (associated) hollowed-out local capacity that we have in England/UK presents significant challenges for local systems approaches. While participants recognised that notions of complex systems are increasingly common, their remains a gap between knowledge of complexity and applying it. This may be due to a lack of awareness about the mechanisms that underpin the bridging process, which is manifesting as a collection of contextual barriers experienced by system agents. This is consistent with wider work, showing that complexity itself is poorly defined and its meaning shifts across people and policy sectors [ 10 , 18 ]. Therefore, people tend to be sceptical of, or misapply, these concepts. Emergent proposition 2: Finding a role in influencing policy is key to creating system change. The second proposition sets out for whom and in what circumstances the mobilisation and application of complexity theories in the development of systems approaches to physical activity policy may be particularly effective. From their experiences, participants ‘talked about intervening in the right place in the system’ and recognised that ‘what kind of stakeholders we talk about is important.’ As such, shifting the emphasis from the whole system to the policy domain, something underexamined in relation to physical activity, appeared to our participants to be a significant way to generate system change. Diverse policy actions are necessary to shape physical activity systems [33–35]. This presupposes a need to have key policy agents from across different sectors engaged in physical activity promotion. This was reflected in our data through participants’ consideration of who can impact system change. Having high level engagement up those hierarchies there are in systems, or local authorities or government, and having that buy in and agreement would really help effect change. The way participants here, supporting findings from our previous research [ 4 , 7 ], emphasise the importance of the hierarchy is an interesting contradiction to claims that one of complexity theory’s most important policy contributions is to signal the virtues of bottom-up approaches [ 10 ]. However, policy-making is in itself an inherently complex process [28]. It is plausible, therefore, that policy-makers already have established practices to address complexity and may require less direction in that regard. This sense came through the data in the way that some participants questioned the mobilisation of complexity knowledge among particular groups. For whom is this knowledge on the complexity of the system and how it works relevant? Is it really for policy-makers? […] if we try to educate policy-makers that they should think in terms of complexity and systems, I don’t think that that will work, because their logic of policy behaviour is different. They consider complexity, it’s key for them, but they are not interested in knowledge about complexity. This points toward the need to understand policy processes, and that it may be more effective to mobilise knowledge of complexity and systems approaches among those agents seeking to influence policy-makers, so as to better understand the context in which policymaking occurs. This was most extensively considered by participants with reference to their experiences of policy entrepreneurship (i.e. working collaboratively to identify opportune moments to promote policy innovation) [36]. If you really go for a system change, you should really explore what kind of window of opportunity in the policy area is there. I think this kind of analysis is as important as the [system] mapping. Therefore, if, as participants suggested, ‘we [agents in the physical activity system] think of ourselves as policy entrepreneurs,’ this may result in a two-fold benefit. First, a sense of system-identity underpins effective systems-based practices [37]. However, our previous studies suggested that this is lacking among physical activity policy agents, and that this may present a barrier to operationalising complex systems approaches [ 4 , 7 ]. It may be inferred from these previous studies that people do not always understand their roles in systems and seek to understand how they can better contribute to the system’s desired outcomes. This absence of role clarity was evident in our sample in the way participants discussed how they were ‘trying to make everyone realise that they’re part of this system.’ Policy entrepreneurship provides agents with a clear role, may foster belonging, and generate a crucial ‘activation approach.’ As policy entrepreneurs […] we are a kind of a catalyst to activate local system stakeholders, to develop collaboration within the system. And this works for the national-level, it’s the same approach. If you want to change the physical activity promotion structure, you have to take an active role as a catalyst, and systems-thinking and complexity thinking would help to find the appropriate approach. Second, policy entrepreneurship may create further engagement with policy principles, which aid understanding of the complex dynamic nature of policy systems, and how to influence them. Policy-making is often characterised by long periods of relative stability and incremental change; occasionally, there are brief moments of dramatic change that are typically more enduring [38]. Given the stability observed in population physical activity levels for the better part of quarter of a century, these latter moments are of great interest to those seeking to change the physical activity system. Perhaps influenced by the timing of the workshop (i.e. during a global pandemic), participants’ perceived faith in targeting moments of crisis as key tipping points in system trajectories was observed in the data. Well, there are examples of course of very radical change that have happened, but it’s interesting that they often occur at key crisis points. We’ve already seen a significant shift in the system, in the way the system behaves. And COVID really amplified that. However, linked to the first proposition, caution about the role of complex systems approaches during times of crisis was raised by one participant with extensive experience of policy analysis: When that crisis arises, the policymakers are looking for really, as you say, ready solutions, and simple solutions that fit their interpretations of the crisis. So, I’m not sure that they’ll look at a solution that’ll be immediately before somebody in a crisis that is complexity and systems-thinking. There will often be serious disagreements about policy responses amid crises due to complexity [39]. Nevertheless, it is the role of policy entrepreneurs to be ready with solutions whenever sought by policy-makers. Our data perhaps align then with research in physical activity policy that suggests that for traction these solutions should neither be too modest, nor too radical [40], despite the need for more ambitious policy efforts to shift the dial on global inactivity levels. Through the views of participants expressed in the data, we inferred a possible symbiotic relationship between applications of complexity theories and policy theories in developing systems approaches. Careful consideration, mobilisation and application of these, by the necessary agents, and at the appropriate times, has the potential to effect significant system change, and thus realise the potential of complex systems approaches. This may require advocacy coalitions [41] and a coordinated lobby of entrepreneurs from across the system. Emergent proposition 3: Creating connections and dialogue contribute to system awareness and affiliation. The third proposition concerns established practices in systems approaches, with which many participants were familiar and able to communicate their experiences of developing. However, through the application of a complexity theory lens it helps to explain why these practices may be effective. Complex systems are characterised by so-called multiple scales, which means the boundaries between levels within a system (e.g. local, regional and national) are sites of extensive interaction and interpenetration [28, 42, 43]. Therefore, gathering agents from across the system to discuss policy issues seems an intuitive thing to do. This was reflected in the participants’ belief that ‘just bringing people together’ was foundational to complex systems approaches: Then just having those workshops is bringing those people together […] I guess a lot of it boils down to those relationships doesn’t it, and partnerships. But I suppose even just bringing them along in that journey is a start. However, through observations in the data, we were able to infer three reasons why this is perhaps important. First, given that effective physical activity promotion requires integrated action across multiple domains within the system [33, 35], there is a tendency to try and create buy-in from as many stakeholders as possible. These attempts were observed in participants’ reflections on how they have tried stimulating involvement and ownership of the inactivity issue. A few things have struck me. I’m certainly aware that in physical activity, from a high-level policy perspective, I think we’re still very much working with health and sport, and perhaps talking about the broader system, but perhaps we still haven’t really worked out how to engage with the whole system, and what the even means and what it looks like. People own what they help create. Real change happens in real work. Those who do the work, do the change, connect the system to more of it. Second, people fundamentally need to feel a degree of control in their work, as well as a relationship with others and their environment [44]. As such, bringing people together to address common policy issues may foster a sense of affiliation or relatedness, be that to one another, the problem, or the system more broadly. This sense manifested in the data as some participants expressed the importance of belonging in sustaining systems approaches and preventing feelings of detachment from the system: It’s amazing. When we looked at it, we went, “right, the only thing that was really different [across each area] was the fact that one had been out to tender.” The people had done exactly the same job, but they don’t know who they belong to. It’s mad to see, because you wouldn’t think that would be impacting but it was a huge thing. Things like that can really influence that ownership and that engagement. That can affect people, understanding how they’re part of the bigger picture, or if they don’t know, it’s going to feel disjointed. The third reason is in our view perhaps most important for explaining the mobilisation of complex systems knowledge: it is crucial to facilitate the exchange of ideas, people, politics and power. Another key feature of complex systems is openness (i.e. the exchange of people, ideas and materials) [42]. This seems compatible with processes of co-production and education for raising awareness of systems. Specifically, given that education is both informal and formal [ 20 ], gathering people from across a defined system to stimulate dialogue may be deemed crucial to create an environment in which ‘everybody teaches, everybody learns.’ These ideas were evident in the data: One of the things about when you get people involved in a mapping exercise [for example], they start taking the system seriously […] in other words, public health people started to think about complex systems and about what we’re doing. So, it’s a learning exercise for all concerned. There’s an interactive learning moment where we can learn from each other, and this especially can co-produce new knowledge for solutions for problems in a specific context. Using complexity theories, it is plausible to infer from the data that by creating connections this: i) supports Freire’s concept of dialogical learning [45] as a means to overcome contested knowledge of complex systems; and ii) enables the identification of strange attractors (i.e. the shared vision that drives agents’ actions and beliefs toward new interactions) [46]. This seems appropriate for the emergent nature of systems, which necessitates fluid and interpenetrating networks in response [42]. It is important to reflect, however, on the structures that mould collaborative systems approaches. Durable changes to an otherwise stable policy subsystem may, in part, result from a type of political upheaval or learning [47]. Consequently, it may be prudent to consider the dynamics generated by bringing people together. We observed these ideas through participants’ reflections on the implications of complexity and systems-thinking being typically only understood in any depth by niche groups, and how the concepts are usually framed: I think we've got to recognise talk about systems can become a bit technocratic and I do wonder if we need to integrate that kind of political nature of developing any kind of approach and recognising that this is political and to do with power. Some of the issues of technocracy can just mask the need to address these fundamental questions about politics and power. While some participants suggested that collaborative working can ‘grow that new power’ (i.e. that which is held by the many who then contribute and channel it), in turn leading to a greater sense of control among system agents, our findings point toward the importance of being able to identify and influence particular key agents who have the power and autonomy to affect systems more readily (see proposition two above). In some cases, creating connections has therefore perhaps unexpectedly opened a political dimension to complex systems approaches. The preparedness of system agents to engage with and address this is unclear in our data. However, despite this, it was clear that participants felt that collaborative practices and dialogue certainly have the potential to raise awareness about complexity theories and systems perspectives, and the structures and agents that make-up the systems we seek to change. Emergent proposition 4: Increasing a focus on agency can support those working to create systems change. Our final proposition draws further inference from those set out above to explain how adopting complex systems approaches may be impacting individual agents working in physical activity and systems domains, and how adopting an adjusted perspective may overcome these difficulties. The application of complexity theories to policy has typically focused on analyses of system structures, rather than agency [ 10 ]. It is possible that this has precluded understanding of the factors that facilitate, or inhibit, people to flourish in working amid complexity. The shortcomings of a structure-dominant focus appeared to be a concern among some participants: There was a lot of talking about the solution in this [issue of inactivity] starting from people, in terms of [putting] the complexity and systems into practice, starting with people and see what can we do there. Rather than starting from the structure because that will not work. It just feels like we haven’t really, as a sector, we haven’t particularly got our heads round the fact that we’re working with humans, and we need to take a complexity approach [to doing so]. Questions were raised by participants about who the key agents may be to involve and support in addressing inactivity. While it was suggested that the ‘very senior have influence,’ it was also believed that those ‘on the ground are the ones doing it, so engagement is required across levels.’ Complexity theories reinforce this premise. Complex policy systems appear to have self-organising properties [ 10 ]. This means that they do not typically have focal leaders around which they coalesce, they are unpredictable and difficult to control, and consequently policy failure is common [10, 48]. Needs theories of motivation submit that individuals require a sense of autonomy and competence to flourish, both generally and in organisational settings [44, 49]). If, however, the natural order of complex systems precludes the accomplishment of these needs, it is reasonable to suggest that it may be hard for individual agents to effectively develop complex systems approaches to issues such as inactivity, without being at risk of the deleterious and isolating effects of needs thwarting [50]. The evidenced outcomes of needs thwarting (i.e. disengagement; poorer wellbeing) were present in several participants’ experiences of the ‘issue of competencies’ and the ‘fatigue in our community’ from adopting these perspectives. Everything you said resonates with him. He was interested in this sociological complexity […] and people are actually alienated from understanding the system […] I think some key common threads across this [discussion] are around this idea of alienating. This finding extends our observation of detachment in previous studies [ 7 ], whereby agents become removed from the complexity of both the system and the policy issues. Conceptually, this is problematic, as one cannot stand outside a system they seek to change [51]. However, it is now possible to consider at least one way in which this situation arises. Moreover, it impresses the need to urgently understand the potentially thwarting effects of complex systems approaches, and develop ways to support the needs of individual agents. Without a renewed focus on agency, as the catalyst of system change, current conceptualisations and applications of complexity theories and systems-thinking in physical activity policy may remain partially effective at best. Discussion In this paper, we present findings from an expert stakeholder workshop convened to address research questions concerning how to advance the uptake of complexity theories and systems approaches in the delimited ‘space’ of physical activity policy contexts. Our findings, which validate and extend our previous research [ 4 , 7 ] and add theoretical richness to underpin proposed conditions that may be necessary to ameliorate physical activity inequalities [52], are packaged in four novel propositions that detail how key actions and agents may redress previously underexamined aspects of this transdisciplinary endeavour. While these propositions are necessarily interrelated, we offer core implications of each in turn. That conditions in the physical activity policy context were found to seemingly be non-conducive to the mobilisation and uptake of complex systems perspectives reflects other contexts, where uncertainty about complexity [ 7 , 10 , 18 ], short-termism and inadequate resources and evidence [32, 35] have been identified. While complementing existing evidence, the views of participants in our study suggest that systems approaches are at times incompatible with existing needs, values and practices associated with the physical activity policy domain. Reasons for this are unclear, but may relate to policy-makers’ desire for ready-made solutions to issues [32, 53], or the predominant clinical effectiveness-type models of evidence (e.g. the UK’s NICE guidance) that have traditionally informed public health decision-making [54]. While the need for a complex model of public health evidence informed by social science, and for investigation into approaches to systems knowledge development and use, is clear [32, 55], improving the transdisciplinary integration of different knowledge systems about physical activity remains a challenge [56–58]. We propose that an inability among stakeholders across the physical activity policy system to extend beyond their own notions of complexity to a collective understanding of how, in practice, to address inactivity through a complex systems lens, may serve to create a negative feedback loop that reinforces decision-makers’ persuasion toward traditional models of evidence. However, although the stability of the system and longevity of its characteristics may seem immutable, our findings suggest that it may be possible to address these through a pragmatic approach to adapting and applying complexity, mobilising agents and creating influence at a policy-level. Our findings also question the basis on which agents seek to create system change, and enable the identification of for whom, and in which circumstances, knowledge and application of complexity theories and systems approaches may be particularly effective. While it is necessary to consider the whole system, the amelioration of inactivity depends on robust and decisive policy action [32–34], and it is suggested that efforts be directed toward this. To that end, and given the complexity of policy-making itself [28], it appears that alongside knowledge of policy processes, and a willingness and dexterity to engage with the politics of physical activity promotion [ 5 ], complexity theories may be most useful to those seeking policy change. The potential for system influence may be enhanced if agents across the system seek roles in which they can influence policy. While our findings strongly indicate the importance of policy entrepreneurship [36], they also suggest that broader systems entrepreneurship (see Schlaile et al. [59] for a general introduction) may catalyse opportunities to reorientate the structure and purpose of the policy systems that drive physical (in)activity. To date, however, this remains an unexplored proposition in both public health and policy literatures. Adopting roles as entrepreneurs may also instil agents with a critical sense of much-needed belonging and system-identity [ 7 ], thus enhancing collective motivation [44]. Due to the complexities of physical activity promotion, policy change is typically incremental [40]. However, there are many frameworks that enable the consideration of complex policy contexts and how to influence them, especially in times of acute (e.g. a pandemic) or creeping (e.g. physical inactivity) crises [39]. While beyond the scope of this discussion to critique them, theories and frameworks such as punctuated equilibrium, multiple streams analysis, and advocacy coalition frameworks hold promise [36, 41, 60, 61], including in the physical activity context [62]. If we want ‘policy makers [sic] to take physical activity more seriously [63],’ we need people within the wider system to take influencing policy equally seriously. That participants raised the importance of creating connections and dialogue is not surprising; these aspects are well known features of physical activity policy implementation and systems approaches [6, 64, 65]. However, our findings extend these works to demonstrate why these approaches may be particularly effective in policy settings. Specifically, they serve to reinforce the sense of belonging and ownership, facilitate knowledge mobilisation through dialogical learning [ 20 ] in response to the open and emergent nature of systems practices, and raise awareness about a system’s structures and leverage points [35, 64, 66]. Moreover, this study responded to a lack of critical reflection on systems approaches to inactivity [ 5 ]. Through a realist lens, manifestations of power and politics, some of which constrained system change, were observed in participants’ experiences. System agents need to feel empowered, and through carefully constructed networks that present members with opportunities to engage with key knowledge mobilisation activities, it is possible to foster the necessary agency while overcoming the unique political complexities of physical activity promotion [5, 7, 67]. The final proposition diverts attention from structure-orientated perspectives by emphasising the basic needs of system agents. There are many behavioural theories that can help consider these [44, 68, 69]. However, as one of our most significant findings relates to perceptions of alienation, we propose that self-determination theory warrants further exploration in a systems context [44]. There is little known about the ‘undermining, alienating and pathogenic effects of need thwarting [50]’ in systems, but our understanding of the nature of complex systems (e.g. self-organisation, general stability and common policy failure) are reminiscent of the conditions that induce rigid behavioural patterns, which lead to poor individual wellbeing [49, 50]. We postulate that this possibly transcends individuals to impact the health of the system and urge scholars to consider this hypothesis. As agency is central to system change [ 20 ], without due care and attention to support the needs of key agents, this will be difficult to achieve. To support the collective operationalisation of the reforming propositions set out in this paper, in Table 2 , we set out key practical steps that can be taken by physical activity promotion advocates across practice, policy and research to help advance systems approaches to physical activity policy. Consistent with a systems thinking approach, multiple actions interacting with one another within and across the foci of the propositions will be required, and will differ according to context. Table 2 Key actions to support the operationalisation of propositions Proposition Focus Key Actions 1: Understanding policy environment challenges The physical activity policy environment is often non-conducive to systems approaches. - Address uncertainty about complexity, short-termism, and inadequate resources and evidence. - Bridge gaps between traditional models of evidence (e.g. clinical effectiveness) and the complex systems perspective. - Take a pragmatic approach to applying complexity theories, mobilising agents, and creating influence at a policy level. 2: Influencing policy to drive system change System change depends on robust and decisive policy action, shaped by agents across the system. - Develop knowledge of policy processes and engage with the politics of physical activity promotion. - Adopt roles as policy entrepreneurs to influence change during critical moments, such as crises. - Encourage broader systems entrepreneurship to reorient policy structures and purposes. 3: Creating connections and dialogue Collaboration and dialogue are foundational to systems approaches in physical activity policy. - Build carefully constructed networks to engage agents in knowledge mobilisation activities across different knowledge systems. - Facilitate dialogical learning to foster a shared understanding of system structures and leverage points. - Address power dynamics and politics to overcome barriers to collaboration. 4: Supporting system agents System change relies on the agency of individuals working within systems. - Address psychological needs (e.g. autonomy, competence, belonging) to prevent agent fatigue and alienation. - Explore the implications of self-determination theory in supporting system agents. - Empower agents to develop a sense of system-identity and collective motivation. In sum, we hope this study initiates further critical reflection on the use of systems approaches to physical activity policy, and in public health fields more broadly. By means of inference, we observe that there remains much to explore in relation to agency in complex systems. Theoretical pluralism, which includes perspectives from complexity, policy, sociology, psychology and beyond, coupled with the integration of insight from different knowledge systems, will be necessary to demonstrate the full potential of systems approaches in applied settings. Within this, the notion of conceptual purity [ 18 ] in complexity theories is redundant. Rather a pragmatic and flexible approach to these theories is required to account for the multiple ways agents make sense of systems in which they operate [27]. It would be of benefit to the system if these multiple conceptualisations are mapped for the physical activity policy context. Limitations These findings are limited to the views of a specific group of stakeholders, with its particular understanding and history of developing complex systems approaches to policy and physical activity. Nevertheless, while neither exhaustive nor inscrutable, the propositions outlined represent both conceptual advancements and practical steps to advance these approaches more broadly. We encourage further work to refine and extend understanding of the concepts and issues raised here among diverse policy stakeholders, particularly those implementing policy in local settings. Critical systems heuristics may support the identification of additional stakeholder groups [70]. Programmes should be developed to support the individual needs of agents tasked with working amid considerable complexity. Conclusions This research, considered alongside the existing evidence-base, sets out the current state of complexity theories and systems-thinking as they relate specifically to the physical activity policy context, but with wider application to complex public health issues more broadly. By reflecting critically on the application of these increasingly ubiquitous perspectives, we identified several steps that will reorientate attention toward under-acknowledged aspects of mobilising and applying this knowledge, while offering some challenges and extensions to existing theorising of and in complex systems. Central to this will be greater focus on the needs and practices of system agents. Systems approaches to public health have advanced greatly; however the real value of complexity theories and systems-thinking may only come from meaningful applications that solve policy problems like physical inactivity. This is hard to do, but the path forward is not indiscernible. Our propositions are a steer toward that future. Abbreviations UK United Kingdom Declarations Ethics approval and consent to participate Ethics approval was granted by the Durham University Ethics Committee. Digital informed consent was obtained from participants. Consent for publication Not applicable. Availability of data and materials The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Funding for this research was received from the UKRI Economic and Social Research Council, doctoral studentship grant reference number: ES/J500082/1. Authors’ contributions BR, CDR and EO conceptualised the project. BR, CDR, EO, PB and JW were responsible for the design. BR, PB and JW collected data, which were analysed by BR. The original draft was produced by BR, which was reviewed, edited and approved by all authors. 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The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):1-12. Ulrich W, Reynolds M. Critical Systems Heuristics. In: Reynolds M, Holwell S, editors. Systems approaches to managing change: a practical guide. London: Springer; 2010:243-292. Additional Declarations No competing interests reported. Supplementary Files Additionalfile1Padletboardquestionsandcontent.docx Additionalfile2Deductivecodingframework1previousresearch.docx Additionalfile3Deductivecodingframework2knowledgemobilisation.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Sharing some similarities with socioecological models, they focus on interactions, both within and between levels of influence on outcomes, as well as the outcomes arising from attempts to change the system. Such interventions may draw on conventional public health frameworks, or alternatively incorporate theories and methodologies drawn from systems thinking or complexity sciences (e.g. systems mapping or actor network theory), which are designed to explore the non-linear and emergent properties of systems [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. To date, however, research has typically been restricted to describing systems or advocating for the further uptake of systems approaches [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. There has been little critical and theoretical examination of how to do this: neither how these approaches are applied [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], nor how people acting in physical activity policy settings can respond to and optimally implement these approaches to effect system change. Given that the physical activity system typifies many systems tackling complex public health challenges, in the sense that it comprises diverse actors, diffused responsibilities, unclear hierarchies and unevenly distributed resources, it represents a useful delimited \u0026lsquo;space\u0026rsquo; to explore the mobilisation of systems approaches in greater depth.\u003c/p\u003e \u003cp\u003eFindings from research at both national and local policy levels have emphasised the importance of strong system leadership and cross-cutting governance in developing systems approaches to physical activity promotion [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This evidence base suggests that taking practical and agency-focused steps, such as leadership based on enterprise, discussion, distribution and togetherness, can foster the collaborative multi-agency conditions for more effective physical activity policy development and implementation. Despite this emerging evidence, and the widely acclaimed potential of systems approaches more broadly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], our recent work suggests that the concepts of complexity and systems are contested within the physical activity policy space [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, there remains considerable scepticism and uncertainty among those acting beyond academia, about how these approaches can be applied in practice to provide added value to existing physical activity promotion efforts and overcome systemic policy-level barriers, such as fragmented and often short-term funding processes that generate competition over collaboration [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These challenges may lead to a sense of overly diffused responsibilities and a detachment from the complexity of the policy issue [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Collectively, these findings impress on the physical activity field the need to consider how to mobilise understanding of, and confidence in, systems approaches across different knowledge systems. This will serve as a catalyst for much needed systems approaches that advance system-level enablers, such as legislislation. These are said to shape people\u0026rsquo;s ability to learn about, communicate and embed new perspectives on physical activity promotion in practice and in action, governance and truly effective partnership working [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKnowledge mobilisation \u0026lsquo;is the activation of available knowledge within a given context. Within this are notions of recognition, movement, active use and context specificity of knowledge [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u0026rsquo; Thus, in this context, knowledge mobilisation processes cross (knowledge) systems [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This is particularly important in considering systems approaches to policy, as their theoretical foundations (i.e. systems thinking and complexity theory) derive from numerous scientific disciplines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. While there is appetite among physical activity policy agents to integrate knowledge created through different scientific, political and practical implementation lenses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], further exploration about how systems approaches may propagate in this policy context is warranted given three outstanding issues. First, the difficulty in translating theoretical components of complexity and systems thinking into real-world policy applications [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Second, the need to understand how and when systems approaches usefully extend existing cross-sector, collaborative efforts in physical activity promotion [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Third, uncertainty as to whether systems approaches can be suitably understood and translated in order to enable more effective development and implementation of policy [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]; it is also unclear whether predominant tools, such as participatory systems mapping [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], are sufficiently instructive to policy agents in this regard. Together these issues indicate a need to bring together invested actors to seek to better understand ways in which we may create, share and use systems approaches, and their underlying conceptual tenets, in ways that complement day-to-day practices and experiences of policy agents. Grounding our approach in realist principles [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], we sought specifically to understand who knowledge of these approaches is useful for, how and in what circumstances.\u003c/p\u003e \u003cp\u003eAim\u003c/p\u003e \u003cp\u003eThis study aimed to bring together an expert group of system actors and diverse specialists to: 1) critically reflect on previous research about the understanding and influence of complexity and systems thinking among national and local physical activity policy stakeholders, drawing attention to issues of conceptual purity, and discord between theory and practice [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]; and 2) explore perspectives and generate new knowledge concerning how to optimise the application of systems approaches to physical activity policy, by focusing on the actions of knowledge mobilisers, in terms of why, what, via whom and how knowledge mobilisation occurs [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eStudy design\u003c/p\u003e\n\u003cp\u003eThis study was aligned with our wider programme of research [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e], adopting a complex realist perspective to better understand the context-bound influences on system change (or stasis) [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]. We used an online workshop design to collect data, which drew upon elements of action-oriented and translational research [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e], to generate knowledge about the mobilisation of systems approaches to physical activity policy. A detailed exposition of the methodological implications of our approach, which contributed much-needed insight into workshopping as a data collection tool [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e], is published elsewhere. Here we present a precise of our methodological contributions.\u003c/p\u003e\n\u003cp\u003eWorkshops are a well-documented knowledge exchange activity, which foster participation and interaction [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, their use as a data collection tool, especially in online spaces, remains underexamined [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. \u0026Oslash;rngreen and Levinsen argued that there are three distinct foci for workshops as a research methodology: i) to achieve a goal; ii) viewing workshops as a practice in which their form and outcome are investigated; or iii) to generate new research data [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, we demonstrated that, within the complex realist framework, these foci should not be considered mutually exclusive. Our goal was to produce theoretically-grounded recommendations about advancing systems approaches to physical activity policy. Likewise, through constructing knowledge through a dialogical process, whereby researchers and participants shared a single platform as constituent elements of the system of interest, this meant that the workshop and its associated practices were intrinsically tied to our findings. To this end, the workshop foci were not only synergistic, but collectively necessary to produce robust knowledge upon which action could be taken.\u003c/p\u003e\n\u003cp\u003eFacilitation was essential in maintaining a manageable and inclusive environment where all participants engaged as co-creators of knowledge [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Digital tools like Padlet whiteboards provided structure and enhanced collaboration, with pre-populated resources and linked breakout groups fostering collective engagement and dialogue [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e]. Data collected through Padlet, supplemented by field notes, chat box responses, and transcripts, enriched the methodological rigour by ensuring a credible representation of participants\u0026rsquo; perspectives [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e]. This workshop served as a case example in using online methods to construct practical and theoretical knowledge, integrating action and translational research principles to mobilise complex systems approaches to physical activity policy [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eParticipants\u003c/p\u003e\n\u003cp\u003eParticipants were purposively sampled and recruited via both open calls and established networks using email or social media. Targeting reflected broad international stakeholder interest in, and varied perspectives on, systems approaches and/or policy across academic, policy and practice settings, both within and importantly beyond the physical activity context. Twenty-eight individuals were invited, of whom 19 agreed from three countries to participate (11 women, 8 men). No commonalities in those who accepted or declined were noted; given the role-related time pressure of experts, we argue this represents a strong response rate. Additional demographic information was not collected, as it was unjustifiable given the intended analyses. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the disciplinary background, expertise and professional experiences of participants.\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eProfessional characteristics and experiences of participants\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003eExpertise and professional experiences\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e#\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eProfession\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhysical activity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePolicy\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSystems approaches\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRealism\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAcademic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolicy professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolicy professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolicy professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePolicy professional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePractitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePractitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePractitioner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e✓\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eProcedure\u003c/p\u003e\n\u003cp\u003eThe research was approved by Durham University Ethics Committee. Prior to the study, participants received an information sheet, had the opportunity to ask questions, and provided digital informed consent.\u003c/p\u003e\n\u003cp\u003eA half-day workshop was held using Zoom video conferencing software in March 2021, which both facilitated international participation and ensured adherence to COVID-19 restrictions in place at that time. One week prior to the event, participants were emailed two pre-recorded videos, for optional viewing. One provided a brief introduction to physical activity for health and current prevalence data, which was designed for those without a physical activity background. The second presented key findings from previous research explaining how complexity is understood among UK physical activity policy-makers and key dimensions of effective systems leadership [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e], and set out the rationale for the workshop. The workshop itself began with an introductory presentation that explained the conceptual basis of systems approaches to policy, alongside a summary of previous research findings. Thereafter, participants considered three core questions in a combination of breakout group activities and plenaries:\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e1. To what extent do previous research findings reflect the every-day experiences of those working in physical activity policy settings?\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e2. How can changes in systemic cultures and practices be stimulated?\u003c/p\u003e\n\u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e3. How can knowledge of complexity and systems thinking be mobilised through systems approaches to physical activity policy?\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eBreakout groups were pre-determined to ensure balanced representation of academic disciplines, and policy and practice stakeholders. Discussions were facilitated by three experienced workshop deliverers (BR, PB and JW) and recorded for transcription. Primary data collection was through the use of Padlet, an online whiteboard platform, to create digital artefacts. Additional File 1 details the content of each Padlet board. This method was supplemented by Zoom chat comments and field notes. Padlet boards were shared with participants for comment during and after the session.\u003c/p\u003e\n\u003cp\u003eAnalysis\u003c/p\u003e\n\u003cp\u003eQSR NVivo 12 software was used to store data and manage analyses. Adopting a realist perspective [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e], data were analysed using a pragmatic modification of thematic analysis [\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], enabling comparisons to previous research and integration across the research questions.\u003c/p\u003e\n\u003cp\u003eFollowing data immersion and recording of preliminary observations, initial codes were generated across the whole dataset for each core question as follows: i) using a deductive framework that consisted of themes identified in previous research [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e] (Additional File 2). These codes were collated into potential themes that captured, further consolidated and extended key findings from data across all studies; ii) an inductive approach generated both semantic and latent codes that we organised into candidate themes; and iii) a second deductive organising framework identified data extracts that provided information about how systems approaches can be mobilised, in what circumstances these are useful or otherwise, and to whom (Additional File 3). These codes were collated into candidate themes.\u003c/p\u003e\n\u003cp\u003eThe candidate themes identified across the research questions were reviewed against the coded data extracts and then against the entire dataset, enabling recurring and salient patterns relevant to all questions to be identified through systematic comparison and iterative refinement. It was not possible to present participant identifiers alongside illustrative quotations, due to the function of anonymity on the Padlet whiteboard. It was also our intention to generate group-level data. To present our findings, we adopted the realist structure of stating dispositions (D), inferences (I) and experiences (E) [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e]:\u003c/p\u003e\n\u003cdiv class=\"BlockQuote\"\u003e\n \u003cp\u003eIn part because of the existence of \u003cem\u003eD\u003c/em\u003e, there is a tendency that \u003cem\u003eI\u003c/em\u003e. This manifested in our data which showed \u003cem\u003eE\u003c/em\u003e (p. 175).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAnalysis of the workshop discussions resulted in four emergent propositions concerning how to advance systems approaches in physical activity policy. The term emergent is used here in the literal sense (i.e. these are novel propositions intended for further consideration and development), rather than with reference to them having emerged from the data, or to the emergent properties of complex systems. Two relate to influencing the environment in which such approaches are applied, while two present considerations for supporting individuals in creating system change. These findings are discussed in relation to key concepts from systems, policy and behavioural theories.\u003c/p\u003e \u003cp\u003eEmergent proposition 1: The current physical activity policy environment is not naturally conducive to systems approaches; it is important to understand why\u003c/p\u003e \u003cp\u003eThis proposition is comprised from data indicating the context of the physical activity system may constrain efforts to develop systems approaches. Participants\u0026rsquo; views and experiences highlighted enduring challenges faced by system agents. As social and structural balancing feedback loops tend to reinforce system norms and ensure the general stability of systems [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], it may be assumed that it is challenging to mobilise knowledge of systems and stimulate change if agents are unaccustomed to such perspectives. Evidence of these feedback loops and associated difficulties manifested in our data, as some participants\u0026rsquo; experiences meant that they believed systems approaches to be onerous, particularly within the context of a global pandemic but also when faced with numerous complex contemporary societal challenges.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThinking in different ways, and obviously industry and partners all work in [different ways], that\u0026rsquo;s a really hard work thing to do.\u003c/p\u003e\u003cp\u003eThere is a significant momentum or force to hinder any change from happening in the first place. We probably all appreciate that, there\u0026rsquo;s a lot of passionate people who are trying to make change happen, but also a lot of resistance out there, lots of people wanting to return to the way things were in December 2019 [pre-pandemic].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIgnoring negative feedback is a known strategy for navigating complex systems and simplifying decision-making environments [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, this approach was not evident in our data. Rather, simplification was expressed in terms of having \u003cem\u003e\u0026lsquo;common language on terms, theories, methods and concepts in the physical activity area\u0026rsquo;\u003c/em\u003e and being \u003cem\u003e\u0026lsquo;pragmatic in application and not getting lost in the science that may scare people.\u0026rsquo;\u003c/em\u003e While claims have been made to use systems terminology more literally to help realise the potential value of complexity theories through public policy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], this seems at odds to the aims of simplification, where analogy [27] indicate a more selective use of these perspectives.\u003c/p\u003e \u003cp\u003eAnother characteristic perceived to inhibit the use of systems approaches is the way in which timescales and funding processes operate. These factors were often presented in tandem in participants\u0026rsquo; reflections. Wider work on the trajectories of complex systems has indicated the benefit of adopting longer-term policy approaches that allow for innovations and patterns in outcomes to arise [28, 29]. However, the short-term targets and budget cycles that still characterise public health policy [30, 31] may preclude effective systems approaches to inactivity. Here, this was demonstrated through many participants\u0026rsquo; beliefs that complex systems innovation in the physical activity space is inhibited by short-termism and budgetary constraints.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFunders go, \u0026ldquo;well let\u0026rsquo;s not do something that might be radical and innovative because we know we are not going to get funding next year. Because it\u0026rsquo;s going to fail, we\u0026rsquo;re not going to be able to show that evidence.\u0026rdquo; So, it\u0026rsquo;s having that consistency of not working to government cycles, or allowing funders to say, \u0026ldquo;right we are going to use this money and it is going to be a long-term thing, we are going to believe in that, and we\u0026rsquo;re not going to judge you next year.\u0026rdquo; But that\u0026rsquo;s tricky because everyone wants payback straight away.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRelatedly, participants suggested that to support the wider uptake of systems approaches, it is important to ensure scalable learning from well-funded systems-based programmes, such as Sport England\u0026rsquo;s Local Delivery Pilots, \u003cem\u003e\u0026lsquo;is translatable elsewhere if you don\u0026rsquo;t actually have the same level of resource.\u0026rsquo;\u003c/em\u003e Efforts are required to ensure more places have access to the funding needed to adopt and sustain systems approaches to physical activity promotion.\u003c/p\u003e \u003cp\u003eOur data reflect considerable discussion about generating evidence to support the implementation of complex systems approaches. \u003cem\u003e\u0026lsquo;There were questions around what are the sources of evidence, [and] how policymakers find those\u0026rsquo;, and whether \u0026lsquo;we need entirely different ways of thinking about evidence.\u0026rsquo;\u003c/em\u003e Responses often focused on systems mapping, and the emphasis \u003cem\u003e\u0026lsquo;was very much co-production\u0026rsquo;\u003c/em\u003e orientated (see proposition three). Complexity-specific methods, such as Qualitative Comparative Analysis or agent-based modelling, were raised in fleeting discussions about evaluation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe haven\u0026rsquo;t spoken in depth about evaluation, but systems approaches can create many challenges for evaluation \u0026ndash; not a reason not to do it, just need better evaluation approaches to deal with complexity.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis raises some concerns, as although calls have been made for a complex systems model of evidence for public health [32], agents may be unaware of different types of evidence beyond the traditional linear and hierarchical models to which the sector is accustomed.\u003c/p\u003e \u003cp\u003eLastly, there was an overwhelming sense of uncertainty about complexity and systems-thinking and how these concepts apply to physical activity policy. This was apparent in the 21 distinct queries raised about these concepts among the 19 participants (e.g. see below). Uncertainty was observed in the data through participants\u0026rsquo; difficulty in differentiating between systems-based and other perspectives, and how to advance these perspectives meaningfully in the prevailing policy context.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTo what extent does adopting complexity or systems-thinking look different to historical approaches to partnership working, community development, etc.?\u003c/p\u003e\u003cp\u003eUsing a bicycle initiative, adapting it, having to learn from it. I was trying to think, well, we can put a complexity language on this, but does it really need it?\u003c/p\u003e\u003cp\u003eI don\u0026rsquo;t know what stops the sector from understanding the value of a complex systems point of view, and what it enables us to have in terms of solutions.\u003c/p\u003e\u003cp\u003eThere's maybe a need to be realistic in recognising that the centralised mode of government and (associated) hollowed-out local capacity that we have in England/UK presents significant challenges for local systems approaches.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhile participants recognised that notions of complex systems are increasingly common, their remains a gap between knowledge of complexity and applying it. This may be due to a lack of awareness about the mechanisms that underpin the bridging process, which is manifesting as a collection of contextual barriers experienced by system agents. This is consistent with wider work, showing that complexity itself is poorly defined and its meaning shifts across people and policy sectors [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, people tend to be sceptical of, or misapply, these concepts.\u003c/p\u003e \u003cp\u003eEmergent proposition 2: Finding a role in influencing policy is key to creating system change.\u003c/p\u003e \u003cp\u003eThe second proposition sets out for whom and in what circumstances the mobilisation and application of complexity theories in the development of systems approaches to physical activity policy may be particularly effective. From their experiences, participants \u003cem\u003e\u0026lsquo;talked about intervening in the right place in the system\u0026rsquo;\u003c/em\u003e and recognised that \u003cem\u003e\u0026lsquo;what kind of stakeholders we talk about is important.\u0026rsquo;\u003c/em\u003e As such, shifting the emphasis from the whole system to the policy domain, something underexamined in relation to physical activity, appeared to our participants to be a significant way to generate system change.\u003c/p\u003e \u003cp\u003eDiverse policy actions are necessary to shape physical activity systems [33\u0026ndash;35]. This presupposes a need to have key policy agents from across different sectors engaged in physical activity promotion. This was reflected in our data through participants\u0026rsquo; consideration of who can impact system change.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHaving high level engagement up those hierarchies there are in systems, or local authorities or government, and having that buy in and agreement would really help effect change.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe way participants here, supporting findings from our previous research [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], emphasise the importance of the hierarchy is an interesting contradiction to claims that one of complexity theory\u0026rsquo;s most important policy contributions is to signal the virtues of bottom-up approaches [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, policy-making is in itself an inherently complex process [28]. It is plausible, therefore, that policy-makers already have established practices to address complexity and may require less direction in that regard. This sense came through the data in the way that some participants questioned the mobilisation of complexity knowledge among particular groups.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor whom is this knowledge on the complexity of the system and how it works relevant? Is it really for policy-makers? [\u0026hellip;] if we try to educate policy-makers that they should think in terms of complexity and systems, I don\u0026rsquo;t think that that will work, because their logic of policy behaviour is different. They consider complexity, it\u0026rsquo;s key for them, but they are not interested in knowledge about complexity.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis points toward the need to understand policy processes, and that it may be more effective to mobilise knowledge of complexity and systems approaches among those agents seeking to influence policy-makers, so as to better understand the context in which policymaking occurs. This was most extensively considered by participants with reference to their experiences of policy entrepreneurship (i.e. working collaboratively to identify opportune moments to promote policy innovation) [36].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIf you really go for a system change, you should really explore what kind of window of opportunity in the policy area is there. I think this kind of analysis is as important as the [system] mapping.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTherefore, if, as participants suggested, \u003cem\u003e\u0026lsquo;we [agents in the physical activity system] think of ourselves as policy entrepreneurs,\u0026rsquo;\u003c/em\u003e this may result in a two-fold benefit. First, a sense of system-identity underpins effective systems-based practices [37]. However, our previous studies suggested that this is lacking among physical activity policy agents, and that this may present a barrier to operationalising complex systems approaches [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. It may be inferred from these previous studies that people do not always understand their roles in systems and seek to understand how they can better contribute to the system\u0026rsquo;s desired outcomes. This absence of role clarity was evident in our sample in the way participants discussed how they were \u003cem\u003e\u0026lsquo;trying to make everyone realise that they\u0026rsquo;re part of this system.\u0026rsquo;\u003c/em\u003e Policy entrepreneurship provides agents with a clear role, may foster belonging, and generate a crucial \u003cem\u003e\u0026lsquo;activation approach.\u0026rsquo;\u003c/em\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eAs policy entrepreneurs [\u0026hellip;] we are a kind of a catalyst to activate local system stakeholders, to develop collaboration within the system. And this works for the national-level, it\u0026rsquo;s the same approach. If you want to change the physical activity promotion structure, you have to take an active role as a catalyst, and systems-thinking and complexity thinking would help to find the appropriate approach.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSecond, policy entrepreneurship may create further engagement with policy principles, which aid understanding of the complex dynamic nature of policy systems, and how to influence them. Policy-making is often characterised by long periods of relative stability and incremental change; occasionally, there are brief moments of dramatic change that are typically more enduring [38]. Given the stability observed in population physical activity levels for the better part of quarter of a century, these latter moments are of great interest to those seeking to change the physical activity system. Perhaps influenced by the timing of the workshop (i.e. during a global pandemic), participants\u0026rsquo; perceived faith in targeting moments of crisis as key tipping points in system trajectories was observed in the data.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWell, there are examples of course of very radical change that have happened, but it\u0026rsquo;s interesting that they often occur at key crisis points.\u003c/p\u003e\u003cp\u003eWe\u0026rsquo;ve already seen a significant shift in the system, in the way the system behaves. And COVID really amplified that.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, linked to the first proposition, caution about the role of complex systems approaches during times of crisis was raised by one participant with extensive experience of policy analysis:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen that crisis arises, the policymakers are looking for really, as you say, ready solutions, and simple solutions that fit their interpretations of the crisis. So, I\u0026rsquo;m not sure that they\u0026rsquo;ll look at a solution that\u0026rsquo;ll be immediately before somebody in a crisis that is complexity and systems-thinking.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThere will often be serious disagreements about policy responses amid crises due to complexity [39]. Nevertheless, it is the role of policy entrepreneurs to be ready with solutions whenever sought by policy-makers. Our data perhaps align then with research in physical activity policy that suggests that for traction these solutions should neither be too modest, nor too radical [40], despite the need for more ambitious policy efforts to shift the dial on global inactivity levels.\u003c/p\u003e \u003cp\u003eThrough the views of participants expressed in the data, we inferred a possible symbiotic relationship between applications of complexity theories and policy theories in developing systems approaches. Careful consideration, mobilisation and application of these, by the necessary agents, and at the appropriate times, has the potential to effect significant system change, and thus realise the potential of complex systems approaches. This may require advocacy coalitions [41] and a coordinated lobby of entrepreneurs from across the system.\u003c/p\u003e \u003cp\u003eEmergent proposition 3: Creating connections and dialogue contribute to system awareness and affiliation.\u003c/p\u003e \u003cp\u003eThe third proposition concerns established practices in systems approaches, with which many participants were familiar and able to communicate their experiences of developing. However, through the application of a complexity theory lens it helps to explain why these practices may be effective. Complex systems are characterised by so-called multiple scales, which means the boundaries between levels within a system (e.g. local, regional and national) are sites of extensive interaction and interpenetration [28, 42, 43]. Therefore, gathering agents from across the system to discuss policy issues seems an intuitive thing to do. This was reflected in the participants\u0026rsquo; belief that \u003cem\u003e\u0026lsquo;just bringing people together\u0026rsquo;\u003c/em\u003e was foundational to complex systems approaches:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThen just having those workshops is bringing those people together [\u0026hellip;] I guess a lot of it boils down to those relationships doesn\u0026rsquo;t it, and partnerships. But I suppose even just bringing them along in that journey is a start.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, through observations in the data, we were able to infer three reasons why this is perhaps important.\u003c/p\u003e \u003cp\u003eFirst, given that effective physical activity promotion requires integrated action across multiple domains within the system [33, 35], there is a tendency to try and create buy-in from as many stakeholders as possible. These attempts were observed in participants\u0026rsquo; reflections on how they have tried stimulating involvement and ownership of the inactivity issue.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA few things have struck me. I\u0026rsquo;m certainly aware that in physical activity, from a high-level policy perspective, I think we\u0026rsquo;re still very much working with health and sport, and perhaps talking about the broader system, but perhaps we still haven\u0026rsquo;t really worked out how to engage with the whole system, and what the even means and what it looks like.\u003c/p\u003e\u003cp\u003ePeople own what they help create. Real change happens in real work. Those who do the work, do the change, connect the system to more of it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSecond, people fundamentally need to feel a degree of control in their work, as well as a relationship with others and their environment [44]. As such, bringing people together to address common policy issues may foster a sense of affiliation or relatedness, be that to one another, the problem, or the system more broadly. This sense manifested in the data as some participants expressed the importance of belonging in sustaining systems approaches and preventing feelings of detachment from the system:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt\u0026rsquo;s amazing. When we looked at it, we went, \u0026ldquo;right, the only thing that was really different [across each area] was the fact that one had been out to tender.\u0026rdquo; The people had done exactly the same job, but they don\u0026rsquo;t know who they belong to. It\u0026rsquo;s mad to see, because you wouldn\u0026rsquo;t think that would be impacting but it was a huge thing. Things like that can really influence that ownership and that engagement.\u003c/p\u003e\u003cp\u003eThat can affect people, understanding how they\u0026rsquo;re part of the bigger picture, or if they don\u0026rsquo;t know, it\u0026rsquo;s going to feel disjointed.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe third reason is in our view perhaps most important for explaining the mobilisation of complex systems knowledge: it is crucial to facilitate the exchange of ideas, people, politics and power. Another key feature of complex systems is openness (i.e. the exchange of people, ideas and materials) [42]. This seems compatible with processes of co-production and education for raising awareness of systems. Specifically, given that education is both informal and formal [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], gathering people from across a defined system to stimulate dialogue may be deemed crucial to create an environment in which \u003cem\u003e\u0026lsquo;everybody teaches, everybody learns.\u0026rsquo;\u003c/em\u003e These ideas were evident in the data:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eOne of the things about when you get people involved in a mapping exercise [for example], they start taking the system seriously [\u0026hellip;] in other words, public health people started to think about complex systems and about what we\u0026rsquo;re doing. So, it\u0026rsquo;s a learning exercise for all concerned.\u003c/p\u003e\u003cp\u003eThere\u0026rsquo;s an interactive learning moment where we can learn from each other, and this especially can co-produce new knowledge for solutions for problems in a specific context.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eUsing complexity theories, it is plausible to infer from the data that by creating connections this: i) supports Freire\u0026rsquo;s concept of dialogical learning [45] as a means to overcome contested knowledge of complex systems; and ii) enables the identification of strange attractors (i.e. the shared vision that drives agents\u0026rsquo; actions and beliefs toward new interactions) [46]. This seems appropriate for the emergent nature of systems, which necessitates fluid and interpenetrating networks in response [42].\u003c/p\u003e \u003cp\u003eIt is important to reflect, however, on the structures that mould collaborative systems approaches. Durable changes to an otherwise stable policy subsystem may, in part, result from a type of political upheaval or learning [47]. Consequently, it may be prudent to consider the dynamics generated by bringing people together. We observed these ideas through participants\u0026rsquo; reflections on the implications of complexity and systems-thinking being typically only understood in any depth by niche groups, and how the concepts are usually framed:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think we've got to recognise talk about systems can become a bit technocratic and I do wonder if we need to integrate that kind of political nature of developing any kind of approach and recognising that this is political and to do with power. Some of the issues of technocracy can just mask the need to address these fundamental questions about politics and power.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhile some participants suggested that collaborative working can \u0026lsquo;grow that new power\u0026rsquo; (i.e. that which is held by the many who then contribute and channel it), in turn leading to a greater sense of control among system agents, our findings point toward the importance of being able to identify and influence particular key agents who have the power and autonomy to affect systems more readily (see proposition two above). In some cases, creating connections has therefore perhaps unexpectedly opened a political dimension to complex systems approaches. The preparedness of system agents to engage with and address this is unclear in our data. However, despite this, it was clear that participants felt that collaborative practices and dialogue certainly have the potential to raise awareness about complexity theories and systems perspectives, and the structures and agents that make-up the systems we seek to change.\u003c/p\u003e \u003cp\u003eEmergent proposition 4: Increasing a focus on agency can support those working to create systems change.\u003c/p\u003e \u003cp\u003eOur final proposition draws further inference from those set out above to explain how adopting complex systems approaches may be impacting individual agents working in physical activity and systems domains, and how adopting an adjusted perspective may overcome these difficulties.\u003c/p\u003e \u003cp\u003eThe application of complexity theories to policy has typically focused on analyses of system structures, rather than agency [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. It is possible that this has precluded understanding of the factors that facilitate, or inhibit, people to flourish in working amid complexity. The shortcomings of a structure-dominant focus appeared to be a concern among some participants:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThere was a lot of talking about the solution in this [issue of inactivity] starting from people, in terms of [putting] the complexity and systems into practice, starting with people and see what can we do there. Rather than starting from the structure because that will not work.\u003c/p\u003e\u003cp\u003eIt just feels like we haven\u0026rsquo;t really, as a sector, we haven\u0026rsquo;t particularly got our heads round the fact that we\u0026rsquo;re working with humans, and we need to take a complexity approach [to doing so].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Questions were raised by participants about who the key agents may be to involve and support in addressing inactivity. While it was suggested that the \u003cem\u003e\u0026lsquo;very senior have influence,\u0026rsquo;\u003c/em\u003e it was also believed that those \u003cem\u003e\u0026lsquo;on the ground are the ones doing it, so engagement is required across levels.\u0026rsquo;\u003c/em\u003e Complexity theories reinforce this premise.\u003c/p\u003e \u003cp\u003eComplex policy systems appear to have self-organising properties [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This means that they do not typically have focal leaders around which they coalesce, they are unpredictable and difficult to control, and consequently policy failure is common [10, 48]. Needs theories of motivation submit that individuals require a sense of autonomy and competence to flourish, both generally and in organisational settings [44, 49]). If, however, the natural order of complex systems precludes the accomplishment of these needs, it is reasonable to suggest that it may be hard for individual agents to effectively develop complex systems approaches to issues such as inactivity, without being at risk of the deleterious and isolating effects of needs thwarting [50]. The evidenced outcomes of needs thwarting (i.e. disengagement; poorer wellbeing) were present in several participants\u0026rsquo; experiences of the \u003cem\u003e\u0026lsquo;issue of competencies\u0026rsquo;\u003c/em\u003e and the \u003cem\u003e\u0026lsquo;fatigue in our community\u0026rsquo;\u003c/em\u003e from adopting these perspectives.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eEverything you said resonates with him. He was interested in this sociological complexity [\u0026hellip;] and people are actually alienated from understanding the system [\u0026hellip;] I think some key common threads across this [discussion] are around this idea of alienating.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis finding extends our observation of detachment in previous studies [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], whereby agents become removed from the complexity of both the system and the policy issues. Conceptually, this is problematic, as one cannot stand outside a system they seek to change [51]. However, it is now possible to consider at least one way in which this situation arises. Moreover, it impresses the need to urgently understand the potentially thwarting effects of complex systems approaches, and develop ways to support the needs of individual agents. Without a renewed focus on agency, as the catalyst of system change, current conceptualisations and applications of complexity theories and systems-thinking in physical activity policy may remain partially effective at best.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this paper, we present findings from an expert stakeholder workshop convened to address research questions concerning how to advance the uptake of complexity theories and systems approaches in the delimited \u0026lsquo;space\u0026rsquo; of physical activity policy contexts. Our findings, which validate and extend our previous research [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and add theoretical richness to underpin proposed conditions that may be necessary to ameliorate physical activity inequalities [52], are packaged in four novel propositions that detail how key actions and agents may redress previously underexamined aspects of this transdisciplinary endeavour. While these propositions are necessarily interrelated, we offer core implications of each in turn.\u003c/p\u003e \u003cp\u003eThat conditions in the physical activity policy context were found to seemingly be non-conducive to the mobilisation and uptake of complex systems perspectives reflects other contexts, where uncertainty about complexity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], short-termism and inadequate resources and evidence [32, 35] have been identified. While complementing existing evidence, the views of participants in our study suggest that systems approaches are at times incompatible with existing needs, values and practices associated with the physical activity policy domain. Reasons for this are unclear, but may relate to policy-makers\u0026rsquo; desire for ready-made solutions to issues [32, 53], or the predominant clinical effectiveness-type models of evidence (e.g. the UK\u0026rsquo;s NICE guidance) that have traditionally informed public health decision-making [54]. While the need for a complex model of public health evidence informed by social science, and for investigation into approaches to systems knowledge development and use, is clear [32, 55], improving the transdisciplinary integration of different knowledge systems about physical activity remains a challenge [56\u0026ndash;58].\u003c/p\u003e \u003cp\u003eWe propose that an inability among stakeholders across the physical activity policy system to extend beyond their own notions of complexity to a collective understanding of how, in practice, to address inactivity through a complex systems lens, may serve to create a negative feedback loop that reinforces decision-makers\u0026rsquo; persuasion toward traditional models of evidence. However, although the stability of the system and longevity of its characteristics may seem immutable, our findings suggest that it may be possible to address these through a pragmatic approach to adapting and applying complexity, mobilising agents and creating influence at a policy-level.\u003c/p\u003e \u003cp\u003eOur findings also question the basis on which agents seek to create system change, and enable the identification of for whom, and in which circumstances, knowledge and application of complexity theories and systems approaches may be particularly effective. While it is necessary to consider the whole system, the amelioration of inactivity depends on robust and decisive policy action [32\u0026ndash;34], and it is suggested that efforts be directed toward this. To that end, and given the complexity of policy-making itself [28], it appears that alongside knowledge of policy processes, and a willingness and dexterity to engage with the politics of physical activity promotion [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], complexity theories may be most useful to those seeking policy change. The potential for system influence may be enhanced if agents across the system seek roles in which they can influence policy. While our findings strongly indicate the importance of policy entrepreneurship [36], they also suggest that broader systems entrepreneurship (see Schlaile et al. [59] for a general introduction) may catalyse opportunities to reorientate the structure and purpose of the policy systems that drive physical (in)activity. To date, however, this remains an unexplored proposition in both public health and policy literatures. Adopting roles as entrepreneurs may also instil agents with a critical sense of much-needed belonging and system-identity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], thus enhancing collective motivation [44].\u003c/p\u003e \u003cp\u003eDue to the complexities of physical activity promotion, policy change is typically incremental [40]. However, there are many frameworks that enable the consideration of complex policy contexts and how to influence them, especially in times of acute (e.g. a pandemic) or creeping (e.g. physical inactivity) crises [39]. While beyond the scope of this discussion to critique them, theories and frameworks such as punctuated equilibrium, multiple streams analysis, and advocacy coalition frameworks hold promise [36, 41, 60, 61], including in the physical activity context [62]. If we want \u0026lsquo;policy makers [sic] to take physical activity more seriously [63],\u0026rsquo; we need people within the wider system to take influencing policy equally seriously.\u003c/p\u003e \u003cp\u003e That participants raised the importance of creating connections and dialogue is not surprising; these aspects are well known features of physical activity policy implementation and systems approaches [6, 64, 65]. However, our findings extend these works to demonstrate why these approaches may be particularly effective in policy settings. Specifically, they serve to reinforce the sense of belonging and ownership, facilitate knowledge mobilisation through dialogical learning [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] in response to the open and emergent nature of systems practices, and raise awareness about a system\u0026rsquo;s structures and leverage points [35, 64, 66]. Moreover, this study responded to a lack of critical reflection on systems approaches to inactivity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Through a realist lens, manifestations of power and politics, some of which constrained system change, were observed in participants\u0026rsquo; experiences. System agents need to feel empowered, and through carefully constructed networks that present members with opportunities to engage with key knowledge mobilisation activities, it is possible to foster the necessary agency while overcoming the unique political complexities of physical activity promotion [5, 7, 67].\u003c/p\u003e \u003cp\u003eThe final proposition diverts attention from structure-orientated perspectives by emphasising the basic needs of system agents. There are many behavioural theories that can help consider these [44, 68, 69]. However, as one of our most significant findings relates to perceptions of alienation, we propose that self-determination theory warrants further exploration in a systems context [44]. There is little known about the \u0026lsquo;undermining, alienating and pathogenic effects of need thwarting [50]\u0026rsquo; in systems, but our understanding of the nature of complex systems (e.g. self-organisation, general stability and common policy failure) are reminiscent of the conditions that induce rigid behavioural patterns, which lead to poor individual wellbeing [49, 50]. We postulate that this possibly transcends individuals to impact the health of the system and urge scholars to consider this hypothesis. As agency is central to system change [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], without due care and attention to support the needs of key agents, this will be difficult to achieve.\u003c/p\u003e \u003cp\u003eTo support the collective operationalisation of the reforming propositions set out in this paper, in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, we set out key practical steps that can be taken by physical activity promotion advocates across practice, policy and research to help advance systems approaches to physical activity policy. Consistent with a systems thinking approach, multiple actions interacting with one another within and across the foci of the propositions will be required, and will differ according to context.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey actions to support the operationalisation of propositions\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProposition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFocus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKey Actions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1: Understanding policy environment challenges\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe physical activity policy environment is often non-conducive to systems approaches.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Address uncertainty about complexity, short-termism, and inadequate resources and evidence.\u003c/p\u003e \u003cp\u003e- Bridge gaps between traditional models of evidence (e.g. clinical effectiveness) and the complex systems perspective.\u003c/p\u003e \u003cp\u003e- Take a pragmatic approach to applying complexity theories, mobilising agents, and creating influence at a policy level.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2: Influencing policy to drive system change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystem change depends on robust and decisive policy action, shaped by agents across the system.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Develop knowledge of policy processes and engage with the politics of physical activity promotion.\u003c/p\u003e \u003cp\u003e- Adopt roles as policy entrepreneurs to influence change during critical moments, such as crises.\u003c/p\u003e \u003cp\u003e- Encourage broader systems entrepreneurship to reorient policy structures and purposes.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3: Creating connections and dialogue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollaboration and dialogue are foundational to systems approaches in physical activity policy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Build carefully constructed networks to engage agents in knowledge mobilisation activities across different knowledge systems.\u003c/p\u003e \u003cp\u003e- Facilitate dialogical learning to foster a shared understanding of system structures and leverage points.\u003c/p\u003e \u003cp\u003e- Address power dynamics and politics to overcome barriers to collaboration.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4: Supporting system agents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystem change relies on the agency of individuals working within systems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e- Address psychological needs (e.g. autonomy, competence, belonging) to prevent agent fatigue and alienation.\u003c/p\u003e \u003cp\u003e- Explore the implications of self-determination theory in supporting system agents.\u003c/p\u003e \u003cp\u003e- Empower agents to develop a sense of system-identity and collective motivation.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn sum, we hope this study initiates further critical reflection on the use of systems approaches to physical activity policy, and in public health fields more broadly. By means of inference, we observe that there remains much to explore in relation to agency in complex systems. Theoretical pluralism, which includes perspectives from complexity, policy, sociology, psychology and beyond, coupled with the integration of insight from different knowledge systems, will be necessary to demonstrate the full potential of systems approaches in applied settings. Within this, the notion of conceptual purity [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] in complexity theories is redundant. Rather a pragmatic and flexible approach to these theories is required to account for the multiple ways agents make sense of systems in which they operate [27]. It would be of benefit to the system if these multiple conceptualisations are mapped for the physical activity policy context.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThese findings are limited to the views of a specific group of stakeholders, with its particular understanding and history of developing complex systems approaches to policy and physical activity. Nevertheless, while neither exhaustive nor inscrutable, the propositions outlined represent both conceptual advancements and practical steps to advance these approaches more broadly. We encourage further work to refine and extend understanding of the concepts and issues raised here among diverse policy stakeholders, particularly those implementing policy in local settings. Critical systems heuristics may support the identification of additional stakeholder groups [70]. Programmes should be developed to support the individual needs of agents tasked with working amid considerable complexity.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis research, considered alongside the existing evidence-base, sets out the current state of complexity theories and systems-thinking as they relate specifically to the physical activity policy context, but with wider application to complex public health issues more broadly. By reflecting critically on the application of these increasingly ubiquitous perspectives, we identified several steps that will reorientate attention toward under-acknowledged aspects of mobilising and applying this knowledge, while offering some challenges and extensions to existing theorising of and in complex systems. Central to this will be greater focus on the needs and practices of system agents. Systems approaches to public health have advanced greatly; however the real value of complexity theories and systems-thinking may only come from meaningful applications that solve policy problems like physical inactivity. This is hard to do, but the path forward is not indiscernible. Our propositions are a steer toward that future.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eUK \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; United Kingdom\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthics approval was granted by the Durham University Ethics Committee. Digital informed consent was obtained from participants.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eFunding for this research was received from the UKRI Economic and Social Research Council, doctoral studentship grant reference number: ES/J500082/1.\u003c/p\u003e\n\u003ch2\u003eAuthors’ contributions\u003c/h2\u003e\n\u003cp\u003eBR, CDR and EO conceptualised the project. BR, CDR, EO, PB and JW were responsible for the design. BR, PB and JW collected data, which were analysed by BR. The original draft was produced by BR, which was reviewed, edited and approved by all authors.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe thank all those who gave their time to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNau T, Bauman A, Smith BJ, Bellew W. A scoping review of systems approaches for increasing physical activity in populations. Health Res Policy Sys. 2022;20(1):104.\u003c/li\u003e\n\u003cli\u003eMcGill E, Er V, Penney T, Egan M, White M, Meier P, et al. Evaluation of public health interventions from a complex systems perspective: a research methods review. Soc Sci Med. 2021;272:113697.\u003c/li\u003e\n\u003cli\u003eJebb SA, Finegood DT, Roux AD, Rutter H, Clarkson J, Frank J, et al. Systems-based approaches in public health: where next? Canadian Academy of Health Sciences/The Academy of Medical Science; 2021.\u003c/li\u003e\n\u003cli\u003eRigby B. 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Implement Sci. 2011;6(1):1-12.\u003c/li\u003e\n\u003cli\u003eUlrich W, Reynolds M. Critical Systems Heuristics. In: Reynolds M, Holwell S, editors. Systems approaches to managing change: a practical guide. London: Springer; 2010:243-292.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Physical activity, policy, systems thinking, complexity, public health","lastPublishedDoi":"10.21203/rs.3.rs-5938709/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5938709/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSystems approaches are increasingly used to address the complex issue of population physical inactivity. However, descriptive work dominates and there is limited critical and theoretical reflection on applying these approaches, especially in relation to policy. As such, uncertainty and scepticism remain about applying systems approaches and their underlying theoretical constructs. This research engaged system actors and specialists to rethink optimising systems approaches in physical activity policy by focusing on knowledge mobilisation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eNineteen individuals with conceptual and/or applied expertise in physical activity, policy, systems approaches or realism (or a combination of the above), from different countries, sectors and professional backgrounds, participated in a half-day workshop. Guided by methodological principles of action-oriented and translational research, participants critiqued existing research, and generated proposals for advancing the use of systems approaches. Data were collected using a combination of Padlet whiteboards, the Zoom chat function, audio recordings and field notes. A realist-informed thematic analysis was conducted, comprising deductive and inductive elements.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOffering challenges to existing paradigms, our reforming propositions were constructed from the data concerning advancing systems approaches to physical activity policy. These highlighted the need to: 1) understand why the physical activity policy environment is not naturally conducive to systems approaches; 2) find ways to influence policy as a basis for systems change; 3) create system awareness and affiliation through connection and dialogue; and 4) increase attention on the agency of those seeking to develop systems approaches to create system change.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe mobilisation and application of knowledge around complexity and systems-thinking to create impactful systems approaches to physical activity policy require refocusing on the needs and practices of system agents. Knowledge creators need to better understand how decision makers behave and their influences, while decisions taken should be sensitive to the impact of adopting systems approaches on implementers. Those enacting systems approaches need support to foster collective identity and resilience. This article sets out novel conceptual and practical steps toward these actions; importantly, we demonstrate expert opinion that enacting such propositions can result in a step change in the effectiveness of systems approaches in the physical activity field and beyond.\u003c/p\u003e","manuscriptTitle":"Advancing systems approaches to physical activity policy: international systems thinkers’ perspectives on conceptual challenges and practical solutions","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 14:23:54","doi":"10.21203/rs.3.rs-5938709/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9c4b717-8f7f-4538-a4cc-3b00d94d3476","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-05T08:56:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 14:23:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5938709","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5938709","identity":"rs-5938709","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}