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An evaluation of the coverage of theoretically based implementation factors in disseminated classroom physical activity programs.

ABSTRACT: Classroom-based physical activity (CBPA) is increasingly recommended as a method to support children's physical activity, health, and academic performance. Many adoption-ready programs exist to aid in the implementation of CBPA in schools; yet, implementation rates remain low. The purpose of this study was to evaluate the extent to which resources provided by adoption-ready CBPA programs addressed theory-based implementation contextual factors to support implementation. Existing CBPA programs (N = 37) were identified through Internet searches and all materials (e.g., implementation guides) provided by each program were coded for their inclusion of 51 implementation factors based on the Consolidated Framework for Implementation Research (CFIR). Analyses were conducted to compare inclusion of implementation factors across CFIR Domains and by three program groupings: free (yes/no), research evidence (yes/no), and targeted to teacher only (vs. school). Programs covered a mean of 25.9 per cent (SD = 18.7 per cent) of the 14 Inner Setting implementation factors, 34.2 per cent (SD = 18.0 per cent) of the 6 Characteristics of Individuals implementation factors, and 34.8 per cent (SD = 24.3 per cent) of the 8 Process implementation factors. Programs with research evidence covered more implementation factors than programs without research evidence (43.7 vs. 25.9 per cent; p < .05). Although numerous adoption-ready CBPA programs are available and have many strengths, their inclusion of theory-based factors that support or inhibit implementation is generally low. Consideration of such factors, including organizational climate and teacher-level behavior change, is likely critical to supporting ongoing school-wide implementation of CBPA. Research is needed to develop and test effective strategies for addressing these factors to support more widespread CBPA implementation.

SUBMITTER: Calvert HG

PROVIDER: S-EPMC7543079 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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An evaluation of the coverage of theoretically based implementation factors in disseminated classroom physical activity programs.

Calvert Hannah G HG Lane Hannah G HG Bejarano Carolina M CM Snow Kelli K Hoppe Kate K Alfonsin Nicole N Turner Lindsey L Carlson Jordan A JA

Translational behavioral medicine 20201001 4

Classroom-based physical activity (CBPA) is increasingly recommended as a method to support children's physical activity, health, and academic performance. Many adoption-ready programs exist to aid in the implementation of CBPA in schools; yet, implementation rates remain low. The purpose of this study was to evaluate the extent to which resources provided by adoption-ready CBPA programs addressed theory-based implementation contextual factors to support implementation. Existing CBPA programs (N ...[more]

PMID: 30590851

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Project description:BACKGROUND:Increasing children's physical activity (PA) at school is critical to obesity prevention and health promotion. Implementing novel, low-cost PA programs offers potential to contribute to children's in-school PA, particularly in resource-constrained schools. This evaluation describes implementation fidelity, reach, and dose of two PA programs in the Fueling Learning through Exercise (FLEX) Study. METHODS:Thirteen diverse, low-income Massachusetts elementary schools were recruited and randomized to the 100 Mile Club walking/running program (n?=?7) or CHALK/Just Move classroom activity break PA program (n?=?6). Intervention programs were delivered across two school years. Surveys with program champions/teachers and children, in-session measurement of children's PA by accelerometry (Actigraph GT3X) in a subset of schools, and key informant interviews were used to collect information on implementation, including fidelity, dose, reach, and sustainability, and to calculate an implementation score. RESULTS:Six CHALK/Just Move schools implemented the program in both years. Two schools randomized to 100 Mile Club did not implement at all, and only three schools implemented both years. Implementing schools had similar implementation scores (range?=?0-3; 100 Mile Club?=?2.0 vs. CHALK/Just Move?=?1.9) but fidelity to core and enhanced elements differed between programs. In 100 Mile Club schools, dose of program delivered was greater than in CHALK/Just Move schools (34.9 vs. 19.7?min per week). Dose of PA received per session was also greater in 100 Mile Club schools (n?=?55, 2 schools) compared with CHALK/Just Move schools (n?=?160, 2 schools) (13.6?min vs. 2.7?min per session). A slightly higher proportion of eligible children participated in CHALK/Just Move compared to 100 Mile Club (54.0% vs. 31.2%). Both programs were well received by champions/teachers and students. CONCLUSIONS:Program implementation varied across programs and schools, and erosion in delivery was seen over the two years. However, among implementing schools, additional PA was delivered and received, and the programs were generally well-received. Although school resource issues remain barriers to implemention, this evaluation demonstrates that low-cost programs may enhance PA opportunities. Future research should evaluate how multiple programs can be implemented to increase children's PA at school. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT02810834 . Registered May 11, 2015.

Project description:BACKGROUND:In 2015, YMCA afterschool programs (ASPs) across South Carolina, USA pledged to achieve the YMCA physical activity standard calling for all children to accumulate 30 min of moderate-to-vigorous physical activity (MVPA) while attending their ASPs. This study presents the final two-year outcomes from the dissemination and implementation efforts associated with achieving this MVPA standard. METHODS:Twenty ASPs were sampled from all South Carolina YMCA-operated ASPs (N?=?97) and visited at baseline (2015) and first (2016) and second year (2017) follow-up. All ASPs were provided training to increase MVPA during the program by extending the scheduled time for activity opportunities and modifying commonly played games to increase MVPA. The RE-AIM framework was used to evaluate the statewide intervention. Accelerometer-derived MVPA was the primary outcome. Intent-to-treat (ITT) models were conducted summer 2017. Programs were also classified, based on changes in MVPA from 2015 to 2016 and 2016-2017, into one of three categories: gain, maintain, or lost. Implementation, within the three groups, was evaluated via direct observation and document review. RESULTS:Adoption during the first year was 45% of staff attending training, with this increasing to 67% of staff during the second year. ITT models indicated no increase in the odds of accumulating 30 min of MVPA after the first year for either boys (odds ratio [OR] 1.06, 95CI 0.86-1.31) or girls (OR 1.14, 95CI 0.87-1.50), whereas an increase in the odds was observed during the second year for boys (OR 1.31, 95CI 1.04-1.64) and girls (OR 1.50 95CI 1.01-1.80). Programs that lost MVPA (avg. -?5 to -?7.5 min/d MVPA) elected to modify their program in a greater number of non-supportive ways (e.g., reduce time for activity opportunities, less time spent outdoors), whereas ASPs that gained MVPA (avg. +?5.5 to +?10.1 min MVPA) elected to modify their program in more supportive ways. CONCLUSIONS:The statewide study demonstrated minimal improvements in overall MVPA. However, child MVPA was dramatically influenced by ASPs who elected to modify their daily program in more supportive than non-supportive ways, with no one program modifying their program consistently across the multi-year initiative. These findings have important implications for organizations seeking to achieve the MVPA standard. TRIAL REGISTRATION:Clinical Trial Registration: NCT02394717 .

Project description:BACKGROUND:Interventions that work must be effectively delivered at scale to achieve population level benefits. Researchers must choose among a vast array of implementation frameworks (>?60) that guide design and evaluation of implementation and scale-up processes. Therefore, we sought to recommend conceptual frameworks that can be used to design, inform, and evaluate implementation of physical activity (PA) and nutrition interventions at different stages of the program life cycle. We also sought to recommend a minimum data set of implementation outcome and determinant variables (indicators) as well as measures and tools deemed most relevant for PA and nutrition researchers. METHODS:We adopted a five-round modified Delphi methodology. For rounds 1, 2, and 3 we administered online surveys to PA and nutrition implementation scientists to generate a rank order list of most commonly used; i) implementation and scale-up frameworks, ii) implementation indicators, and iii) implementation and scale-up measures and tools. Measures and tools were excluded after round 2 as input from participants was very limited. For rounds 4 and 5, we conducted two in-person meetings with an expert group to create a shortlist of implementation and scale-up frameworks, identify a minimum data set of indicators and to discuss application and relevance of frameworks and indicators to the field of PA and nutrition. RESULTS:The two most commonly referenced implementation frameworks were the Framework for Effective Implementation and the Consolidated Framework for Implementation Research. We provide the 25 most highly ranked implementation indicators reported by those who participated in rounds 1-3 of the survey. From these, the expert group created a recommended minimum data set of implementation determinants (n?=?10) and implementation outcomes (n?=?5) and reconciled differences in commonly used terms and definitions. CONCLUSIONS:Researchers are confronted with myriad options when conducting implementation and scale-up evaluations. Thus, we identified and prioritized a list of frameworks and a minimum data set of indicators that have potential to improve the quality and consistency of evaluating implementation and scale-up of PA and nutrition interventions. Advancing our science is predicated upon increased efforts to develop a common 'language' and adaptable measures and tools.

Project description:BACKGROUND:Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. OBJECTIVE:This paper presents adolescents' and teachers' perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. METHODS:A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. RESULTS:Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. CONCLUSIONS:RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

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An evaluation of the coverage of theoretically based implementation factors in disseminated classroom physical activity programs.

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An evaluation of the coverage of theoretically based implementation factors in disseminated classroom physical activity programs.

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