The "ins" and "outs" of physical activity policy implementation: inadequate capacity, inappropriate outcome measures, and insufficient funds

Elementary school compliance with a state recess minimum requirement by racial and geographic factors: a cross-sectional study

BACKGROUND

Recess is a part of school-based physical activity promotion offered worldwide with equitable recess access a social justice issue. From a policy perspective, in the U.S. few states currently require elementary school recess and little is known about its implementation. The purpose of this study was to determine the current implementation of one state system as a case study to investigate minimum recess requirement and to compare the implementation between school geographic and racial factors.

METHODS

A cross-sectional, observational study of the implementation of one state's minimum daily recess requirement of 40-minutes recess was conducted during the 2023-2024 academic year. A school audit of provided recess time was conducted of all public elementary schools in Arkansas through an online search of bell schedules, a survey sent to principals and physical education teachers, and phone call surveys to school offices. Key demographic and geographic features of the schools included enrollment data (e.g., race, grade, and % Free-and-Reduced Lunch composition), rurality, and region.

RESULTS

Recess information was obtained from 384 (73%) of 526 eligible schools with an average student enrollment of 398 students (SD 154), 19.8% (SD 27.9) Black student enrollment, and 63.8% (SD 20.0%) students receiving free-and-reduced lunch. 306 (85.5%) schools met recess requirements. There were no differences in meeting recess requirements by rurality. Of schools with higher Black student enrollment (≥ 25% Black enrollment), 75.3% met recess requirements compared to 89.5% in schools with lower Black enrollment (< 25% Black enrollment, OR 0.36, 95%CI: 0.16, 0.78, p =.010). There were differences in survey-reported available playground spaces and equipment between by meeting recess requirements and Black student enrollment (p <.05).

CONCLUSIONS

Schools in a state with a 40-minute daily recess requirement reported high compliance with the state policy. However, students in schools with higher Black student enrollment were less likely to meet the 40-minute recess requirement, and thus strategies are needed to ensure all students have access to recess opportunities. Ensuring equal access to recess through wide-reaching place-based and policy-based strategies may be a step in reducing health and education disparities, especially among populations where disparities are greatest.

Evaluation of the initial rollout of the physical activity referral standards policy in Scotland: a qualitative study

OBJECTIVES

Physical activity referral schemes (PARS) allow healthcare professionals to refer patients for physical activity support. Evidence of effectiveness is equivocal. Public Health Scotland has developed 'physical activity referral standards' that aim to enhance quality, reduce variability in design and delivery and build further evidence of what works. This study evaluated stakeholder perspectives on the initial reach, adoption, implementation and effectiveness of the standards.

DESIGN

A qualitative study using individual, online, semistructured interviews to explore stakeholder awareness and willingness to use the standards. We analysed data using the framework method within the context of the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework.

SETTING

Data were collected across 28 local authorities in rural and urban areas of Scotland between December 2022 and June 2023.

PARTICIPANTS

73 stakeholders, including scheme managers (n=34), senior managers from provider organisations (n=9), healthcare professionals (n=19) (general practitioners, nurses, occupational therapists and physiotherapists) and policy stakeholders (n=11).

RESULTS

72.6% of stakeholders were aware of the physical activity referral standards, and they were widely welcomed. Healthcare professionals were the least informed. Participants appeared willing to adopt the standards, and stakeholders reported using them to help with service planning, audit delivery processes, identify service gaps, inform monitoring and evaluation plans and understand and communicate the roles and responsibilities of different partners. Barriers to implementation included lack of healthcare professional awareness, funding and workforce capacity. Views about the minimum dataset (suggested essential or desirable data fields to be collected for monitoring and evaluation) contained in the standards were divided. Some thought it useful, but others considered it onerous or aspirational, and it was unclear whether all service delivery stakeholders would have the resources or capacity to collect and analyse the data.

CONCLUSIONS

The delivery of the standards could be enhanced by a comprehensive communication strategy and by addressing the lack of funding, workforce delivery capacity and skills/capacity required to collect and interpret the proposed minimum national dataset.

Navigating Physical Activity Promotion and Policy in the Post-COVID-19-Pandemic Era

BACKGROUND

There is limited evidence on the priorities and opportunities associated with promoting population physical activity (PA) participation for the post-COVID-19-pandemic future.

PURPOSE

This study assessed government-led PA promotion efforts before and during the COVID-19 pandemic, along with post-COVID-19-pandemic priorities and recommendations.

METHODS

Two separate cross-sectional surveys conducted in 2023. Survey 1 was targeted at the Global Observatory for Physical Activity (GoPA!) Country Contacts. Survey 2 also included key international informants representing influential stakeholders in PA policy implementation.

RESULTS

There were 68 respondents to Survey 1, collectively representing 61 countries. An additional 37 people, including representatives from 14 key international stakeholders responded to Survey 2. Eighty-two percent of countries had national PA policies. COVID-19 widely disrupted PA policy implementation. Less than 40% of countries integrated PA into their COVID-19 response plan and more than 75% reported policies that restricted PA participation. Although most respondents indicated that government PA priorities did not change due to the COVID-19 pandemic, one in five countries reported that cross-sectoral partnership had become more important during this period. Less than a third of postpandemic governments reported as highly engaged despite the widespread proliferation of PA policies and plans prior to the pandemic. There were variations according to country, region, and income.

CONCLUSIONS

Elevating PA promotion on the public health agenda is crucial for the post-COVID-19-pandemic era. At a policy level, it is critical to focus on adequate resourcing, cross-sectoral partnerships, integrated interventions, and inequities in participation. These factors have become increasingly important in the postpandemic PA policy landscape.

Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network

We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.

Challenges, opportunities and solutions for local physical activity stakeholders: an implementation case study from a cross-sectoral physical activity network in Northeast England

Background

Increasingly, national policy initiatives and programmes have been developed to increase physical activity (PA). However, challenges in implementing and translating these policies into effective local-level programmes have persisted, and change in population PA levels has been small. This may be due to insufficient attention given to the implementation context, and the limited interactions between local policy-makers, practitioners and researchers. In this paper we use a case study of a cross-sectoral network in Northeast England, to identify the local-level challenges and opportunities for implementing PA policies and programmes, particularly the updated 2019 UK PA guidelines.

Methods

Five focus groups (n = 59) were conducted with practice partners, local policy-makers and researchers during an initial workshop in April 2018. Through facilitated discussion, participants considered regional priorities for research and practice, along with barriers to implementing this agenda and how these may be overcome. During a second workshop in December 2018, overarching findings from workshop one were fedback to a similar group of stakeholders, along with national policy-makers, to stimulate feedback from delegates on experiences that may support the implementation of the UK PA guidelines locally, focusing on specific considerations for research, evidence and knowledge exchange.

Results

In workshop one, three overarching themes were developed to capture local challenges and needs: (i) understanding complexity and context; (ii) addressing the knowledge and skills gap; and (iii) mismatched timescales and practices. In workshop two, participants’ implementation plans encompassed: (i) exploring a systems approach to implementation; (ii) adapting policy to context; and (iii) local prioritising.

Conclusions

Our findings suggest that academics, practitioners and policy-makers understand the complexities of implementing PA strategies, and the challenges of knowledge exchange. The updated UK PA guidelines policy presented an opportunity for multiple agencies to consider context-specific implementation and address enduring tensions between stakeholders. An organically derived implementation plan that prioritises PA, maps links to relevant local policies and supports a context-appropriate communication strategy, within local policy, practice and research networks, will help address these. We present 10 guiding principles to support transferable knowledge exchange activities within networks to facilitate implementation of national PA policy in local contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09847-3.

A Systems Approach Helps Explain Significant Improvements in Local Wellness Policies Among SNAP-Ed-Supported School Districts

OBJECTIVE

To assess changes in written local wellness policies (LWPs) across time within Supplemental Nutrition Assistance Program Education (SNAP-Ed)-participating districts.

DESIGN

Sequential, explanatory mixed methods.

SETTING

From October 1, 2015 to September 30, 2016, SNAP-Ed agencies submitted LWPs from partner school districts in Arizona. They received back scores and customized recommendations. To assess changes, LWPs were rescored between October 1, 2017 and September 30, 2018.

PARTICIPANTS

Sixteen local SNAP-Ed agencies worked with 57 districts.

INTERVENTIONS

Districts' LWP revisions supported by SNAP-Ed agencies during the 2-year pre-post period.

MAIN OUTCOME MEASURES

Policy comprehensiveness and strength from 0 (worst) to 100 (best), measured by the Wellness School Assessment Tool.

ANALYSIS

Paired t test to compare pre-post scores. Content analysis of State Educational Agency administrative reviews and thematic analysis of SNAP-Ed narrative reports to explore causation.

RESULTS

Total scores increased (comprehensiveness: +12.4, P < .001, 95% confidence interval, 8.1-16.7; strength: +13.5, P < .001, 95% CI, 9.3-17.7). Improvements were also found for comprehensiveness by section, except Nutrition Education, and for strength across all sections. Qualitative findings suggest that SNAP-Ed interventions combined with state and federal influence contributed to the improvements.

CONCLUSIONS AND IMPLICATIONS

Local wellness policies in SNAP-Ed-supported districts improved over time. State and federal LWP guidelines can work synergistically with SNAP-Ed interventions to influence improvements.

Translating School Physical Education and Activity Policies into Practice: A Case Study

Background

Public health experts recommend school-based policies as a population based approach to increase youth physical activity. The purpose of this case study is to describe one, largely rural, state's efforts to translate this recommendation into practice. Details about the genesis, implementation and evolution of two state level policies (physical education and physical activity), as well as in-house efforts of a State Department of Education to monitor policy compliance and challenges encountered are described. Two specific years are highlighted, due to policy and monitoring enhancements made during those particular time periods.

Methods

Data for this paper come from the West Virginia Department of Education for two time periods: 2013-2014 and 2014-2015 (n=369 elementary schools). Descriptive statistics for quantitative data and content analysis for qualitative data were used to document school level compliance and provide context for implementation challenges.

Results

Greater than 70% of school principals reported achievement of physical education and physical activity policy expectations for each year. Limited staff was the predominant explanation for nonfulfillment of physical education expectations, followed by lack of time and facilities. Recess and classroom-based physical activity were the primary strategies used to comply with the physical activity expectations. PE and PA policy compliance varied significantly by certain school characteristics in each school year studied.

Conclusions

Further investigation is warranted on how states translate public health policy recommendations into practice, including how physical education and physical activity policies are developed and monitored at the state level and how to support states and schools with monitoring and implementation challenges.

What works best when implementing a physical activity intervention for teenagers? Reflections from the ACTIVE Project: a qualitative study

OBJECTIVE

This paper explores what aspects of a multicomponent intervention were deemed strengths and weaknesses by teenagers and the local council when promoting physical activity to young people.

DESIGN

Qualitative findings at 12 months from a mixed method randomised control trial.

METHODS

Active Children Through Incentive Vouchers-Evaluation (ACTIVE) gave teenagers £20 of activity enabling vouchers every month for a year. Peer mentors were also trained and a support worker worked with teenagers to improve knowledge of what was available. Semistructured focus groups took place at 12 months to assess strengths and weaknesses of the intervention. Eight focus groups (n=64 participants) took place with teenagers and one additional focus group was dedicated to the local council's sport development team (n=8 participants). Thematic analysis was used to analyse the data.

RESULTS

Teenagers used the vouchers on three main activities: trampolining, laser tag or the water park. These appeal to both genders, are social, fun and require no prior skill or training. Choice and financial support for teenagers in deprived areas was considered a strength by teenagers and the local council. Teenagers did not engage with a trained peer mentor but the support worker was considered helpful.

CONCLUSIONS

The ACTIVE Project's delivery had both strengths and weakness that could be used to underpin future physical activity promotion. Future interventions should focus on improving access to low cost, fun, unstructured and social activities rather than structured organised exercise/sport. The lessons learnt from this project can help bridge the gap between what is promoted to teenagers and what they actually want from activity provision.

TRIAL REGISTRATION NUMBER

ISRCTN75594310.

A Case Study of a New State Model for Assessing Local Wellness Policies

BACKGROUND

In 2016, the United States Department of Agriculture issued a final rule to strengthen local wellness policies (LWPs). As school districts pursue compliance, states can provide critical guidance by leveraging support from intermediary programs such as the Supplemental Nutrition Assistance Program-Education (SNAP-Ed). After Arizona SNAP-Ed piloted a statewide model for assessing LWPs, we evaluated that model by exploring local SNAP-Ed agency experiences with the pilot. Our case study objectives were to determine the model's feasibility and utility from the perspective of local agencies supporting school districts during LWP review and revision.

METHODS

We used open-ended semistructured interviews with the 13 local SNAP-Ed agencies who engaged in each LWP assessment phase and analyzed data using constant comparative analysis.

RESULTS

Participants found the model feasible and useful. Five themes emerged, 3 of which tracked strongly with successful LWP review and revision: local agency staff comprehension, the openness of local agency staff and district/school personnel to the process, and the local agency's engagement of the district/school throughout the process.

CONCLUSIONS

Leveraging local agency support can be an effective strategy to improving LWPs, given understanding, buy-in, and staff engagement. Findings can inform agencies seeking to engage intermediaries in LWP assessment and revision.

Physical and Social Contexts of Physical Activity Behaviors of Fifth and Seventh Grade Youth

BACKGROUND

The purpose of this study was to characterize the temporal, social, and physical contexts for physical activities commonly reported in a diverse cohort of 753 boys and girls from fifth to seventh grade.

METHODS

Data were obtained from a multilevel longitudinal study, the Transitions and Activity Changes in Kids. The Physical Activity Choices instrument assessed previous 5-day participation in specific physical activities and their temporal, social, and physical contexts. Mixed model repeated measure analyses of variance and multinomial analyses examined sex differences and change over time.

RESULTS

Fifth grade boys and girls reported participation in similar activities at similar frequencies, which declined significantly by seventh grade. One temporal pattern, playing with younger children, changed over time from "both inside/outside" to "outside" school. Boys and females reported more activities performed in class/team groups over time. Most activities took place primarily at home for all participants in both grades.

CONCLUSIONS

Boys and girls reported declines in the variety and frequency of activities from fifth to seventh grade. There were sex-specific patterns in physical activities and groups; however, all participants reported home as the primary location and a shift to class/team groups over time. Schools are well-positioned to provide additional physical activity opportunities.