'They build roads, not cycle paths': a qualitative study of Pacific children's physical activity barriers.

The Pacific Islands have high rates of non-communicable diseases (NCDs), which are preventable by ensuring healthy levels of physical activity (PA) and sedentary behaviour in childhood. This study explored barriers and facilitators to children meeting PA and sedentary behaviour guidelines through the lens of stakeholders involved in the care and education of children in four Pacific Islands. Qualitative interviews were conducted English or French in Fiji (n = 10), French Polynesia (n = 6), New Caledonia (n = 7), and Wallis and Futuna (n = 4) between 2019 and 2022. French recordings were transcribed using HappyScribe.com and translated. Deductive and inductive qualitative analysis was conducted and presented based on Bronfenbrenner's ecological theory and classified into the five categories of the Social Ecological Model (SEM). At the intrapersonal level, concerns were expressed about the lack of awareness of PA and sedentary behaviour guidelines from children and caregivers. At the intrapersonal level, negative caregiver attitudes towards PA perceived inability to control screen time rules were highlighted, alongside challenges within school settings. At the organizational level, the importance of sports organizations to provide opportunities for children to be active was highlighted. At the environmental level, the lack of urban planning, green space, and safe outdoor areas emerged as key barriers. At the policy level, the need for policy changes to support PA promotion in schools, particularly regarding prescriptive curricula, was stressed. Future interventions need to be culturally responsive, while including strategies that consider the urban-rural divide in the Pacific Islands. Schools and religious institutions can play a key role in promoting active lifestyles for children.