Qualitative Assessment of Facilitators of and Barriers to Physical Activity Policy, Systems, and Environment Change in Rural West Virginia.

Policy, systems, and environment (PSE) change interventions are an evidence-based approach to take in rural areas of the US to improve physical activity (PA) rates. However, there is a need to understand the unique factors that affect such interventions in rural areas. This study used a descriptive, qualitative design to capture the perspectives of 25 key informants across eight participating counties as part of a federally funded project. After purposive recruiting of participants via community-based coalition meetings and snowball sampling, trained researchers conducted semi-structured interviews via Zoom. Multiple team members developed a hierarchical coding structure of facilitators of and barriers to PA-related PSE change, including policy, systems, environmental, and interpersonal factors. Systems factors, when conceptualized using a resources-based model of public health capacity, were more often mentioned as facilitating or presenting a barrier to PSE change than were interpersonal, policy, or environmental factors. Specifically, the existence (or absence) of organizations and their financial and operational priorities were critical determinants of PA PSE change. The findings from this qualitative descriptive study can be used by rural practitioners to identify key facilitators of community-based PA PSE change to focus on based on the size and scope of the environmental change and may offer guidance for researchers doing similar work.