The implementation of physical activity policies in the Netherlands: a study applying the Physical Activity Environment Policy Index (PA-EPI)

Abstract

Background: Continuing high levels of population physical inactivity necessitate effective government policies to cultivate healthy physical activity (PA) environments. The Physical Activity Environment Policy Index (PA-EPI) is a monitoring framework and tool to assess the implementation of policies that promote PA. This study aims to assess the extent of PA policy implementation in the Netherlands and identify recommendations for action to improve its PA environment, using the PA-EPI.

Methods: The PA-EPI application was a stepwise process in which evidence of policy implementation was collected and validated by government officials. A cross-sectoral coalition of non-government independent experts then rated the extent of implementation of 45 indicators of ideal good practice, comparing them against international best practice. On the basis of these expert ratings, a scorecard categorized indicators into high, medium, low or none/very little implementation. In turn, future implementation recommendations were identified by independent experts, prioritized and disseminated.

Results: The evidence validation by government officials (N = 15) yielded minor changes. Independent experts (N = 14) gave 10 out of the 45 indicators a low implementation score, 28 a medium score and 7 a high score. The policy domain of transport and the infrastructure support domain of monitoring and intelligence received high implementation scores. The policy domains of mass media and workplace and the infrastructure support domains of leadership, funding and resources and workforce development received only low scores. Some domains received both high and low implementation scores (i.e. the policy domains of education and sport and recreation for all and the infrastructure support domain of governance). A total of 36 policy recommendations and 26 infrastructure support recommendations were identified. The top prioritized policy recommendations fell within the urban design, education, transport, and sport and recreation for all domains. For infrastructure support, the top prioritized recommendations related to the leadership, funding and resources, and governance domains.

Conclusions: The results reveal important policy implementation gaps and strengths across several domains in the Netherlands. Prioritized recommendations are provided for the government to address these implementation gaps and monitor policy change.

Fig. 1

Timeline of the eight step PA-EPI process

Fig. 2

Participants in the PA-EPI process across different phases of data collection

Fig. 3

Example from questionnaire sent to government officials

Fig. 4

Results of the implementation rating for the policy domains of the PA-EPI. ¹This is a brief description of the indicators. The full description can be found in the paper on the development of the PA-EPI [13]

Fig. 5

Results of the implementation rating for the infrastructure support domains of the PA-EPI. ¹This is a brief description of the indicators. The full description can be found in the paper on the development of the PA-EPI [13]

Fig. 6

Prioritization of the 36 recommendations for the policy domains. The numbers represent each recommendation. The five highest-priority recommendations, based on importance and achievability, are displayed in light orange circles

Fig. 7

Prioritization of 26 recommendations for the infrastructure support domains. The numbers represent each recommendation. The five highest-priority recommendations, based on importance and achievability, are displayed in light green circles