Contextually responsive implementation of place-activation interventions for promoting physical activity in marginalized urban peripheries in Mexico - Contextually responsive implementation of place-activation interventions for promoting physical activity in marginalized urban peripheries in Mexico PROJECT SUMMARY Background: Mexico is an upper-middle income country with high levels of poverty, inequities, urbanization (79%), and NCD burden (77% of all deaths), including a major diabetes and obesity crisis. Given this public health emergency, multiple bold, large-scale evidence-based interventions (EBIs) to improve healthy eating have been implemented. However, commensurate action for physical activity promotion, another critical determinant of obesity, diabetes, and multiple other NCDs, remains lacking. Within the context of Mexican cities, people living in marginalized urban peripheries (low-income neighborhoods on the outskirts of metropolitan areas) comprise a high-need population with multiple challenges, including limited access to spaces and programs for leisure-time physical activity. Place-activation interventions are research-proven strategies (i.e., EBIs) for increasing physical activity in urban settings, by optimizing the use of new or rehabilitated public open places through community-engaged, multisectoral approaches. Goal: This proposal seeks to reduce the burden of physical inactivity in Mexico through an urban equity approach, by increasing the uptake of place-activation EBIs in marginalized urban peripheries. Methods: We will conduct a mixed-methods study in up to 10 major metropolitan areas of Mexico where our team has existing partnerships. Our study will test multisectoral engagement methods to advance active dissemination and implementation (D&I) for increasing the uptake of place-activation EBIs in marginalized urban peripheries. We will pursue three specific aims: (1) use a mixed methods approach to adapt place- activation EBIs for use in our study settings (surveys, interviews, and focus groups); (2) conduct a hybrid III group-randomized controlled trial testing the effectiveness of active D&I methods for improving the reach, adoption and implementation of place-based EBIs (15 intervention neighborhoods with recent public open space improvements will receive an active D&I strategy, and 15 comparison neighborhoods with recent public open space improvements will serve as controls); and, (3) use a community-engaged, participatory approach to examine the potential for longer-term maintenance and scalability of place-activation EBIs (GIS interviews, co-creation workshops, concept mapping). Our work will be guided by the “necessity- vs. choice-based physical activity models” framework for contextually-responsive physical activity promotion in LMICs; and the adapted version of the RE-AIM D&I framework for scaling up physical activity interventions globally. Innovations and Impact: This study is innovative and impactful as it will be the first to test state-of-the- science, active D&I methods for improving the uptake of effective, place-based physical activity EBIs in a high- need, hard to reach, and underserved population. As such, it will provide critical evidence for addressing the growing burden of physical inactivity and NCD inequities in Mexico. Further, it will help build urgently needed capacity for D&I science and physical activity research in Mexico.
