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Background Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences – positive and negative – frequently arise. Evaluating such approaches is difficult and new methods are warranted. Methods Ripple Effects Mapping (REM) is a qualitative method which can capture the wider impacts, and adaptive nature, of a systems approach. Using a case study example from the evaluation of a physical activity-orientated systems approach in Gloucestershire, we: a) introduce the adapted REM method; b) describe how REM was applied in the example; c) explain how REM outputs were analysed; d) provide examples of how REM outputs were used; and e) describe the strengths, limitations, and future uses of REM based on our reflections. Results Ripple Effects Mapping is a participatory method that requires the active input of programme stakeholders in data gathering workshops. It produces visual outputs (i.e., maps) of the programme activities and impacts, which are mapped along a timeline to understand the temporal dimension of systems change efforts. The REM outputs from our example were created over several iterations, with data collected every 3–4 months, to build a picture of activities and impacts that have continued or ceased. Workshops took place both in person and online. An inductive content analysis was undertaken to describe and quantify the patterns within the REM outputs. Detailed guidance related to the preparation, delivery, and analysis of REM are included in this paper. Conclusion REM may help to advance our understanding and evaluation of complex systems approaches, especially within the field of Public Health. We therefore invite other researchers, practitioners and policymakers to use REM and continuously evolve the method to enhance its application and practical utility.

Approximately 200,000 coaches cease coaching each year in the United Kingdom alone. The reasons for this dropout are not fully understood, but they could be linked to the stressful nature of coaching and the potential for this to impede health and psychological well-being (PWB). The aim of this meta-synthesis is to systematically search for and draw together the qualitative research evidence on coaches' experiences of stressors, primary appraisals, emotions, coping, and PWB. Using a rigorous and systematic search protocol, 11 studies were identified, assessed for research quality, and synthesized thematically to generate new insight. The findings highlight the plethora of stressors that coaches can experience, the impact of coaches' appraisals on PWB, and the coping families that coaches can use to foster adaptation. In doing so, the meta-synthesis deepens our understanding of coaches' stress transactions and their experiences of PWB. There is a significant lack of qualitative research evidence on coaches' appraisals and PWB. Qualitative and or longitudinal research is warranted to develop knowledge in these areas. Such research should be used to develop interventions that are applicable to different coaching populations (e.g. working parents and part-time coaches) to help minimize stressors, facilitate positive appraisals and emotions, and foster PWB.

Whole systems approaches are increasingly being advocated as a way of responding to complex public health priorities such as obesity and physical inactivity. Due to the complex and adaptive nature of such systems, researchers are increasingly being embedded within host organisations (i.e., those which facilitate the whole systems approach) to work with key stakeholders to illuminate and understand mechanisms of change and develop a culture of continuous improvement. While previous literature has reported on the benefits and challenges of embedded researchers in health care, little is known about the experiences and learnings of those situated within these complex whole systems approaches. In this paper, we present our reflections of being embedded researchers within four distinct whole systems approaches and outline recommendations and considerations for commissioners working with or seeking support from an embedded researcher.

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