Doing what’s necessary to enable partners to create the conditions for physical activity in their place.

Background: Together an Active Future (TaAF) is a place-based collective of change leaders from across organisations (local government, health, education, voluntary, faith and leisure). Its uniqueness lies in its non-hierarchical, cross-organisational and shared role model structure. The initiative has been implemented across 6 districts in the northwest of England. TaAF aims to establish locally driven cross-policy considerations for tackling physical activity inequalities in a place that has a likelihood of sustainable impact. Methods: To identify what works (enablers), for whom and in which circumstances, when creating the conditions necessary to address physical activity inequalities. Using a realist methodology, we used a combined approach of embedded process evaluation and multiple researcher-led methods. Qualitative data collection methods were employed which included 65 Stories of Significant Change, 30 Ripple Effect Mapping sessions, 62 Semi-Structured Interviews and 6 Focus Groups. The data was analysed using hermeneutic-interpretive text analysis. Participants: Over 100 participants took part in the study to explore the experiences of key stakeholders who are connected to the TaAF collaboration in a professional or participation capacity. Participants include employees, senior leaders and patients from a diverse range of systems and organisations in Lancashire. Findings: A total of 11 themes emerged from the data, which identified individual and systems enablers. The findings highlight the journey of individual behaviours through the system that can lead to favourable conditions for tackling physical activity inequalities. Individual Behaviours. The behaviours of an individual can contribute to systems/ organisational behaviour change. Participants highlighted these behaviours can easily slip and lead to siloed and disconnected working. System Enablers. Building from individual behaviours (when working relationally), these system behaviours lead to a greater likelihood of creating conditions for physical activity in a place. This also increases the likelihood of sustained and embedded systems behaviours or culture change, and in turn, increases the sustainability of the individual behaviours. Conditions for Change. These are features or ‘conditions’ that may be necessary for place-based approaches to address inequalities (Shearn et al., 2022). These conditions represent the national current understanding, based on existing theory and emerging evidence from similar initiatives in England; however, they continue to be refined as our understanding of systemic transformation grows.