Anna Le Gouais

Tackling complex system challenges like creating healthy environments requires understanding priorities and structures affecting multiple actors. This qualitative study, involving 132 multi-sectoral stakeholders spanning the urban development decision-making system, explores how to influence healthier place-making. Using thematic analysis we develop themes around competing stakeholder priorities; structural 'rules' and influential relationships; and justifying a focus on health, requiring greater clarity and consensus around definitions of 'healthy' urban development. Building on the socio-ecological model we highlight how a multi-faceted approach is required for change at multiple levels in the complex system to target individual actor motivations, organisational priorities and structural 'rules'.

Large scale, multi-organisational collaborations between researchers from diverse disciplinary backgrounds are increasingly recognised as important to investigate and tackle complex real-world problems. However differing expectations, epistemologies, and preferences across these teams pose challenges to following best practice for ensuring high-quality and rigorous qualitative research, while maintaining goodwill and team cohesion across team members. This article presents critical reflections from the real-world experiences of a team navigating the challenges of collaborating on a large-scale, cross-disciplinary interview study. Based on these experiences, we extend the literature on large team qualitative collaboration by highlighting the importance of balancing autonomy and collaboration, and propose eight recommendations to support high quality research and team cohesion. We identify how this balance can be achieved at different times: when centralised decision-making should be prioritised, and autonomy can be allowed. We argue that prioritising time to develop shared understandings, build trust, and creating positive environments that accept and support differing researcher perspectives on qualitative methods is paramount. By exploring and reflecting on these differences, teams can identify how and when to support autonomy in decision-making, when to move forward collaboratively, and how to ensure that shared processes reflect the needs of the whole team. The reflexive findings, emanating from practical experience, can inform large research teams undertaking qualitative studies to explore complex issues. We make an original contribution to qualitative methods research by arguing that balancing autonomy and collaboration is the key to promoting high quality research and cohesion in large teams.

High quality evaluations of new walking and cycling routes are scarce and understanding contextual mechanisms influencing outcomes is limited. Using different types of data we investigate how context is associated with change in use of new and upgraded walking and cycling infrastructure, and the association between infrastructure use and overall physical activity. We conducted repeat cross-sectional pre-post analysis of monitoring data from a variety of walking and cycling routes built in 84 locations across the United Kingdom (the Connect2 programme, 2009–2013), using four-day user counts (pre n = 189,250; post n = 319,531), next-to-pass surveys of route users (pre n = 15,641; post n = 20,253), and automatic counter data that generated estimates of total annual users. Using multivariable logistic regression, we identified contextual features associated with 50% increase and doubling of pedestrians, cyclists, and sub-groups of users. We combined insights from monitoring data with longitudinal cohort data (the iConnect study) from residents living near three Connect2 schemes. Residents were surveyed by post at baseline, one-year (n = 1853) and two-year follow-up (n = 1524) to investigate associations between use of the new infrastructure and meeting physical activity guidelines. The routes were associated with increased use (median increase in cyclists 52%, pedestrians 38%; p < 0.001). Large relative increases were associated with low baseline levels (e.g. odds of doubling cycling were halved for each additional 10,000 annual cyclists at baseline: OR 0.52, 95% CI 0.31, 0.77). Use was associated with meeting physical activity guidelines in both repeat cross-sectional and longitudinal analyses (users vs. non-users after one year, OR 2.07, 95% CI 1.37, 3.21; after two years, OR 2.00, 95% CI 1.37, 2.96). This examination of use, users, benefit-cost ratios, and physical activity associated with new walking and cycling infrastructure across contexts, using multiple types of data, suggests that building walking and cycling infrastructure could improve population health and reduce inequalities.

"This paper summarises the findings of a review of policy and strategy documents published circa 2008 by a diverse set of eleven development partners in the rural water sector. It was carried out as part of the Triple-S (Sustainable Services at Scale) Initiative using a Qualitative Document Analysis (QDA) approach to assess the extent to which the reviewed documents align with a set of ???building blocks??? identified by Triple-S as integral to ensuring sustainable service delivery in the rural water sector. Based on the reviewed documents, the policies of the development partners included in this analysis demonstrate a clear commitment towards a number of important elements believed to be necessary for sustainable service delivery including learning and adaptive management, coordination and collaboration, capacity support for local government, and harmonisation and alignment. However, the analysis of the policy documents results in low scores for planning for asset management (i.e. renewals) and recognition and promotion of alternative service delivery options to community management (e.g. self- supply of, or delegated management to, the private sector). Thus, this study indicates that these areas, considered by Triple-S to be crucial for improving sustainability, are relatively neglected and merit more attention in the policies of organisations."

A local plan is a statutory policy document that supports urban development decisions across a local government area in England. Local plans are reported to need more specific requirements for development proposals regarding wider health determinants to address potential health outcomes and health inequalities. This study reviews the integration of Health in Local Plans of seven local planning authorities through documentary analysis methods. A review framework was formulated based on health and planning literature regarding local plans, health policy and determinants of health and dialogue with a local government partner. The findings identify opportunities to strengthen the consideration of Health in Local Plans, including ensuring that policies are informed by local health priorities and signpost national guidance, strengthening health-related requirements for developers (e.g., indoor air quality, fuel poverty and security of tenure) and improving implementation of requirements for developers (e.g., through adoption of health management plans and community ownership). The study identifies further research needs regarding how policies are interpreted by developers in practice, and on national guidance for Health Impact Assessment. It highlights the benefit of undertaking a comparative review, contrasting local plan policy language and identifying opportunities to share, adapt and strengthen planning requirements regarding health outcomes.