ORIGINAL ARTICLE The “ripple effect”: Health and community perceptions of the Indigenous Marathon Program on Thursday Island in the Torres Strait, Australia Rona Macniven M.Sc. 1,2 | Suzanne Plater MPhil (Med) 3 | Karla Canuto PhD 4,5 | Michelle Dickson MEd 3 | Josephine Gwynn PhD 2,6 | Adrian Bauman PhD, MBBS 1 | Justin Richards PhD 1 1 Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, The Charles Perkins Centre (D17), Sydney, NSW, Australia 2 Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, NSW, Australia 3 Sydney School of Public Health, The University of Sydney, NSW, Australia 4 College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia 5 Apunipima Cape York Health Council, Westcourt, QLD, Australia 6 Faculty of Health Sciences, The Charles Perkins Centre, The University of Sydney, The Charles Perkins Centre (D17), NSW, Australia Correspondence Rona Macniven, Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. Email: rona.macniven@sydney.edu.au Abstract Issue addressed: Physical inactivity is a key health risk among Aboriginal and Torres Strait Islander (Indigenous) Australians. We examined perceptions of the Indigenous Marathon Program (IMP) in a remote Torres Strait island community. Methods: Semi-structured interviews with community and program stakeholders (n = 18; 14 Indigenous) examined barriers and enablers to running and the influence of the IMP on the community. A questionnaire asked 104 running event participants (n = 42 Indigenous) about their physical activity behaviours, running motivation and perceptions of program impact. Qualitative data were analysed using thematic con- tent analysis, and quantitative data were analysed using descriptive statistics. Results: Interviews revealed six main themes: community readiness, changing social norms to adopt healthy lifestyles, importance of social support, program appeal to hard-to-reach population groups, program sustainability and initiation of broader healthy lifestyle ripple effects beyond running. Barriers to running in the community were personal (cultural attitudes; shyness) and environmental (infrastructure; weather; dogs). Enablers reflected potential strategies to overcome described barri- ers. Indigenous questionnaire respondents were more likely to report being inspired to run by IMP runners than non-Indigenous respondents. Conclusions: Positive “ripple” effects of the IMP on running and broader health were described to have occurred through local role modelling of healthy lifestyles by IMP runners that reduced levels of “shame” and embarrassment, a common bar- rier to physical activity among Indigenous Australians. A high initial level of commu- nity readiness for behaviour change was also reported. So what? Strategies to overcome this “shame” factor and community readiness measurement should be incorporated into the design of future Indigenous physical activity programs. KEYWORDS aboriginal and torres strait islanders, physical activity, program evaluation, qualitative methods, quantitative methods Received: 4 October 2017 | Accepted: 6 February 2018 DOI: 10.1002/hpja.43 Health Promot J Austral. 2018;1–10. wileyonlinelibrary.com/journal/hpja © 2018 Australian Health Promotion Association | 1