Agenda-setting Policy Analysis on Iranian Physical Activity Promotion Policies: An application of Kingdon’s Multiple Streams Framework

As physical inactivity is presently a global concern, encouraging people to engage in physical activity (PA) is a public health policy priority. This study was conducted to analyze the process of change in the adoption of policies which aim at promoting PA in setting the policy agenda. This qualitative study was conducted using document reviews and semi-structured interviews. A total of 23 key informants from different sections of the policymaking process for PA promotion programs in Iran participated in the study. Purposeful sampling with a maximum variation was used to identify the key informants. Analysis of documents and interviews was conducted on the basis of Kingdon’s multiple streams Framework (MSF): problems, policies, and political streams. The MAXQDA-10 software was used to manage the data analysis process. The problem stream was found to be “the high prevalence of physical inactivity, perceived subjective barriers, and contextual factors for PA” throughout the country. The policy stream focused on integrating PA services into primary health care, scheduling national and global calendar campaigns and events, and using the existing legal structures to promote PA in communities. At the political stream, support for policy documents and various legislative and governing authorities, as well as international support, particularly the World Health Organization 2018–2030 agenda, provided a favorable environment for this issue. Despite the opening of a policy window for developing policies to promote PA, several challenges may hinder the policy implementation process, including a lack of health promotion approach in the health system, lack of inter-sectoral cooperation, COVID-19 pandemic-associated restrictions, and management and structural issues. As the policy window is not being used appropriately, the policymakers must review the policies, with particular attention to the feasibility of policies, the organizational culture of the different ministries, and the mediating and advocating roles of the health sector in operationalizing the policies.