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Table 1 Summary of four phases of action research in women living in Khorramrudi neighborhood based on the MAPP model

From: Development, implementation and evaluation of the ‘BELIEVE’ program for improving physical activity among women: a mixed method action research study

First phase (Exploratory phase) Identifying the dimensions of the problem and designing strategies for promoting PA
(1) Determining the members of the working committee (2) Determining and creating a shared vision (3) Assessments based on the MAPP model (4) Identifying strategic priorities for promoting PA
Stakeholders divided into three groups, including:
Core research committee (Including the research team),
MAPP committee (Including the head of the Khoramroudi sports club, the health directorate of district 2, the sport directorate of district 2, the sport coach of the club and the head of Khoramroudi health center),
Research community (Participants, the administrator of the district, and the secretary general of Khoramroudi)
The purpose of this phase was to give an appropriate name to the program and determine the vision for it
The research team members, women from Khoramroudi, and the members of the steering committee participated in a focus group discussion
Five major exploratory investigations were carried out:
(1) Determining health priorities of the community and Khoramroudi neighborhood: An evaluation of the Urban HEART project identified insufficient PA as a significant health problem in district 2 of the Tehran municipality and Khoramroudi neighborhood. Thus, this was considered the most suitable setting for the program
(2) Determining the prevalence of PA in women living in the Khoramroudi neighborhood by a cross-sectional study. Sampling was performed on 300 non-pregnant women aged between 18 and 65 years old that administered demographic characteristics and IPAQ to women
(3) Agreeing on the importance of PA in women To reach an agreement on the importance of PA, a FGD was held among the members of the steering committee, the research team members, and the participating women
(4) Identification of barriers and facilitators of PA in women To achieve this goal, both qualitative and quantitative methods were used. Quantitative section by a cross-sectional study with administering the EBBS. Qualitative section by two FGD with 11 and 13 participants (consisting of women, research team members, and the steering committee) and 6 individual semi-structured interviews were held
(5) Identifying the positive and negative forces for change. Positive forces and negative forces were identified through interviewing and interacting with the members of the district council, the health center manager, the sport club managers, sport and health officials, the female members of the local sports center and those living in the district
Evidence based stategic priorities were explored via a systematic review of the literature
A FGD was held with female participants from the district, the members of the research team, personnel of the Khoramroudi health center, and the health director of the social security department of district 2 of the Tehran municipality
The participants were asked to identify strategies that were most important from their point of view, or those which could be resolved using available resources
Second Phase (Action) Development and implementation of practical interventions for promotion of PA and Determining action cycles for improvement of PA
1. Interventions for placement within the programme were co-created via one FGD and 7 individual interviews with all stakeholders
2. Participants acted as co-creators and were asked to provide practical suggestions for the development of a practical intervention and suggest appropriate infrastructures for the implementation of strategies
3. They were also asked to provide details on the time, conditions, how and at what time each intervention should be implemented, and how its progress should be evaluated and monitored
4. Two iterations of a three-step action cycle were conducted (Planning, implementation, and evaluation). This cycle is similar to other continuous improvement cycles based on the spiral of AR involving planning, acting, observing, and reflecting. In both cycles, quantitative and qualitative evaluations were performed
Third phase (Monitoring and Evaluation): Assessing the effectiveness of the program quantitatively and qualitatively
1. For the quantitative study, this study encompassed a pre and post-test semi-experimental design with the aim of determining and comparing PA before, 1 month and 3 months after the intervention among 70 women to join the study to focus on at least one or more of the following three strategies; peer support, improving knowledge about the sports facilities available in the district, and participating in the cognitive behavioral therapy classes by filling in IPAQ. This phase was repeated with another 70 participants, making a total of 140 participants overall
2. For the qualitative study, a qualitative study was also carried out with the aim of explaining the opinions, perceptions, feelings, and experiences of participants about the process and outcome of PA promotion. All women participated in a total of three FGD’s, which were held over a period of 3 months. Also, semi-structured individual interviews were held to monitor and report the promotion of PA in women who did not participate in the FGDs. Data was analysed thematically
Fourth phase (Reflection): Improving strategies to enhance PA in the AR cycles and explaining the process and structure of AR
1. Process explanation Data was collected from the exploratory phase from beginning to end via the researcher’s daily field notes, audio files of FGDs and related transcriptions. Findings of the FGD’s with women, the research team members and the officials of Health and Sport Administrations of Social Deputy of District 2 of Tehran municipality were then used to inform decision-making and planning. The recommendations of all stakeholders in line with our evidential findings were used to promote PA throughout. For data analysis, directed content analysis was used
2. Structural explantation A series of documents, investigations, and internal and external reports were collected and analyzed collectively by the research team members, and a stakeholder group including the social deputy of district 2 in the Tehran municipality, the social deputy of the municipality of Tehran, the district council of Khoramroudi neighborhood and the board of trustees of the district mosques. All correspondences such as formal and informal letters, phone calls, text messages, and e-mails were recorded, and considered as interactions between groups. They were used to develop practical examples of the AR process. The reflections of the Khoramroudi neighborhood’s health authorities, health center, and neighborhood center, as well as the participating women and the results of program evaluation led to the confirmation of the program’s desirability and feasibility