Identifying the Contextual Factors Affecting the Policymaking of Physical Activity in Iran: A Qualitative Study

Extended Abstract

Background
The reduced level of physical activity is a current global concern. To address this concern, therefore, encouraging physical activity should be highlighted by public health policymakers of the countries. Policies are tools to create healthy behavior change and support the implementation of behavior change interventions and, therefore, are critical to the implementation of interventions and their outcomes. Governments have shown an increasing interest in using behavioral science evidence when designing the public policies. To arrive at smart decisions on physical activity, the planners and policymakers need to recognize the diversity of different geographical regions, the obstacles and requirements in each region, as well as the social, cultural, and economic factors. This study, therefore, aimed to identify the relevant factors contributing to the policies on physical activity in Iran.

Methods
In this qualitative study, the analytical framework was adopted to interview 23 key informants from October 2020 to February 2021. This analytical framework involves a type of qualitative content analysis that summarizes and categorizes the data thematically in order to facilitate the analysis. This analysis includes several interrelated but independent steps that allow for tematic analysis. The participants were selected from three groups of key informants (i.e., relevant experts, executive officers in organizations, as well as senior managers and provincial and national policymakers) who had experience (i.e., rich information) related to the studied phenomenon. First, an initial list was prepared by the research team using purposive sampling with maximum variation (i.e., expertise, professional experience, organizational position, gender, and beneficiary organization). During the interviews with the key informants, other people were also introduced as the rich sources of information. To conduct the interviews, the first author invited the participants to participate in the study after explaining the study objectives through making telephone calls or attending their workplaces. The interviews were conducted with a prior appointment at the workplace of the participants. The participants were provided with a brief explanation about the study objectives at the beginning of each interview session, and were asked to sign an informed consent form before the interview. The interviews were recorded using two digital voice recorders after obtaining the participants consent and assuring the confidentiality of their identities and conversations. The interviews and the analysis of the results were continued until the data saturation was reached. In this study, the analytical framework included three stages: description, analysis, and interpretation. MAXQDA-10 software was used for data management.

Results
In the present study, the contextual factors affecting the policies on physical activity in Iran were identified. Lichter's model was employed to categorize these factors which were divided into four specific categories, including managerial-structural factors (i.e., manpower, technical factors, equipment and facilities, financial factors, planning and implementation problems, intra-organizational factors, and inter-organizational structural factors). Managerial-structural factors were some of the relevant factors mentioned by almost all key informants, which affected the different dimensions and stages of policymaking process concerning the physical activities in Iran. Next theme was socio-cultural factors (i.e., the lack of proper exercise culture in society, lack of a health-oriented lifestyle in the society, cultural limitations of women's sports, improper cultural atmosphere in some clubs and parks, obstacles caused by job conditions, low status of sports among families and school institutions, high cost of sporting goods and services for the families, as well as economic and livelihood problems of households). These contextual factors affecting the policy on physical activity in Iran and highlighted by all key informants were the socio-economic factors. The third theme included political factors (i.e., politicization, lack of priority for public sports and physical activities at the macro-policy level, and political pressure) and legal factors (i.e., lack of commitment to implement policies at different levels and absence of executive guarantee in the laws). The fourth theme was situational factors. This contextual factor was categorized into three subclasses based on the study findings as follows: perceived environmental factors, changes in people's lifestyles, and restrictions caused by Corona. According to Lichter, situational factors are transitory, non-permanent, or special factors that may affect a health policy. These factors affect, directly or indirectly, the physical activities of a society and its policymaking process at different stages.

Conclusion
It was concluded that the contextual factors had a strong effect on the policymaking processes regarding the physical activity in Iran. It was also found that the interaction between these factors may have changed the policies at different stages of policymaking, including formulation and implementation of the policies. According to the study findings, the most important contextual factors influencing the physical activity policy in Iran were determined to be managerial-structural factors, economic-social factors, political factors, and situational factors. In order to develop and adopt effective policies with greater enforceability, therefore, it was recommended that the policymakers and various stakeholders in the field of health and physical activity should gain a correct understanding of the relevant factors and their key roles affecting the policymaking processes.