title: The influence of environmental factors on the generalisability of public health research evidence: physical activity as a worked example.
abstract: BACKGROUND
  It is rare that decisions about investing in public health interventions in a city, town or other location can be informed by research generated in that specific place. It is therefore necessary to base decisions on evidence generated elsewhere and to make inferences about the extent to which this evidence is generalisable to the place of interest. In this paper we discuss the issues involved in making such inferences, using physical activity as an example. We discuss the ways in which elements of the structural, physical, social and/or cultural environment (environmental factors [EFs]) can shape physical activity (PA) and also how EFs may influence the effectiveness of interventions that aim to promote PA. We then highlight the ways in which EFs may impact on the generalisability of different types of evidence.
  
  
  CONCLUSIONS
  We present a framework for thinking about the influence of EFs when assessing the generalisability of evidence from the location in which the evidence was generated (place A) to the location to which the evidence is to be applied (place B). The framework relates to similarities and differences between place A and place B with respect to: a) the distributions of EFs; b) the causal pathways through which EFs or interventions are thought to exert their effect on PA and c) the ways in which EFs interact with each other. We suggest, using examples, how this scheme can be used by public health professionals who are designing, executing, reporting and synthesising research on PA; or designing/implementing interventions.
  
  
  CONCLUSIONS
  Our analysis and scheme, although developed for physical activity, may potentially be adapted and applied to other evidence and interventions which are likely to be sensitive to influence by elements of the structural, physical, social and/or cultural environment such as the epidemiology of obesity and healthy weight promotion.
authors.affiliation: Institute for Health and Human Development, University of East London, Water Lane, London, UK. p.n.watts@uel.ac.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Watts
authors.forename: Gemma
authors.initials: G
authors.lastname: Phillips
authors.forename: Mark
authors.initials: M
authors.lastname: Petticrew
authors.forename: Angela
authors.initials: A
authors.lastname: Harden
authors.forename: Adrian
authors.initials: A
authors.lastname: Renton
mesh_terms: D035843:Biomedical Research; D004777:Environment; D015444:Exercise; D006293:Health Promotion; D006801:Humans; D010380:Peer Review; D011634:Public Health; D016032:Randomized Controlled Trials as Topic; D006113:United Kingdom
references.citation: Am J Prev Med. 2005 Feb;28(2 Suppl 2):117-25
references.pmid: 15694519
references.citation: Annu Rev Public Health. 2008;29:253-72
references.pmid: 18031223
references.citation: Lancet. 2005 Jan 1-7;365(9453):82-93
references.pmid: 15639683
references.citation: Am J Public Health. 2003 Feb;93(2):313-7
references.pmid: 12554592
references.citation: Cochrane Database Syst Rev. 2005 Jan 25;(1):CD003180
references.pmid: 15674903
references.citation: BMJ. 2006 Aug 12;333(7563):346-9
references.pmid: 16902217
references.citation: Exerc Sport Sci Rev. 2005 Apr;33(2):69-75
references.pmid: 15821427
references.citation: Am J Prev Med. 2007 Oct;33(4):306-9
references.pmid: 17888857
references.citation: Soc Sci Med. 2006 Dec;63(11):2835-46
references.pmid: 16952415
references.citation: Am J Prev Med. 2002 May;22(4 Suppl):73-107
references.pmid: 11985936
references.citation: J Epidemiol Community Health. 2002 Feb;56(2):119-27
references.pmid: 11812811
references.citation: Am J Prev Med. 2002 Aug;23(2 Suppl):5-14
references.pmid: 12133733
references.citation: CMAJ. 2006 Mar 14;174(6):801-9
references.pmid: 16534088
references.citation: Qual Health Res. 2009 Apr;19(4):492-503
references.pmid: 19299755
references.citation: Health Place. 2005 Sep;11(3):249-60
references.pmid: 15774331
references.citation: Obes Rev. 2007 Sep;8(5):425-40
references.pmid: 17716300
references.citation: BMJ. 2008 Sep 29;337:a1655
references.pmid: 18824488
references.citation: Prev Med. 2008 Jan;46(1):29-32
references.pmid: 17904210
references.citation: Health Place. 2008 Sep;14(3):367-85
references.pmid: 17890137
references.citation: Soc Sci Med. 2009 Mar;68(6):1013-20
references.pmid: 19193480
references.citation: Eval Health Prof. 2006 Mar;29(1):126-53
references.pmid: 16510882
references.citation: Health Promot Int. 2006 Mar;21(1):76-83
references.pmid: 16249192
references.citation: Am J Prev Med. 2009 Apr;36(4 Suppl):S177-81
references.pmid: 19285211
references.citation: Women Health. 2009 Jan-Feb;49(1):84-100
references.pmid: 19485236
references.citation: J Phys Act Health. 2006 Feb;3(s1):S55-S76
references.pmid: 28834525
references.citation: Soc Sci Med. 2006 Aug;63(4):1011-22
references.pmid: 16650513
references.citation: Int J Behav Nutr Phys Act. 2009 Jul 30;6:49
references.pmid: 19643024
references.citation: Prev Med. 2009 Apr;48(4):316-20
references.pmid: 19463491
references.citation: Soc Sci Med. 2002 Jul;55(1):125-39
references.pmid: 12137182