Barriers and facilitators to the implementation of a school-based physical activity policy in Canada: application of the theoretical domains framework

A behaviour change intervention to reduce sedentary behaviour in chronic obstructive pulmonary disease: a qualitative study

OBJECTIVES

To document the experiences of people with chronic obstructive pulmonary disease (COPD) who underwent a behaviour change intervention to reduce sedentary behaviour (SB) in a clinical trial.

DESIGN AND PARTICIPANTS

Qualitative study using semi-structured interviews to explore perspectives of the behaviour change intervention and specific intervention components in people with stable COPD on the waitlist for pulmonary rehabilitation.

SETTING

Three outpatient pulmonary rehabilitation programmes in Sydney, Australia.

INTERVENTIONS

The six-week behaviour change intervention with once weekly contact with a physiotherapist aimed to reduce SB by replacing it with light-intensity physical activity (PA) and by breaking up prolonged SB.

MAIN OUTCOME MEASURES

Of 30 participants who completed the behaviour change intervention, interviews were conducted with 13 participants and analysed using the 'capability, opportunity, motivation, behaviour (COM-B)' framework of behaviour change.

RESULTS

Intervention components regarded as most helpful by participants were verbal education on health consequences on SB, goal setting, and self-monitoring of, and feedback on, step count using activity trackers. There was a clear preference during goal setting to increase PA rather than to reduce SB. Physical limitations and enjoyment of SB were the most reported barriers to reducing SB.

CONCLUSIONS

Goal setting, verbal education, and self-monitoring of, and feedback on step count, were viewed positively by people with COPD and may show promise for reducing SB and increasing PA based on individual preference. CONTRIBUTION OF THE PAPER.

Development of a School Health Policy Implementation Survey: A Delphi Study

Data on school health policy implementation are limited due to the absence of a validated measurement tool. The purpose of this study was to create and pilot a school health policy implementation survey. A modified, four-round Delphi process was used to achieve consensus on content and format of the survey. The final 76-item survey was piloted in 655 schools with a return rate of 57.1% (n  =  378). Seven schools participated in environmental audits. Based on the audits, survey responses represented an accurate description of school practices for 84.2% (n  =  64) of questions. The remaining 15.8% (n  =  12) of survey items were eliminated or revised. This measurement tool begins to fill the research gap between the evaluation of written school health policy and implementation. Further, this tool may be used by school nurses in alignment with the Framework for 21st Century School Nursing Practice.

Key influences on university students' physical activity: a systematic review using the Theoretical Domains Framework and the COM-B model of human behaviour

BACKGROUND

Physical activity is important for all aspects of health, yet most university students are not active enough to reap these benefits. Understanding the factors that influence physical activity in the context of behaviour change theory is valuable to inform the development of effective evidence-based interventions to increase university students' physical activity. The current systematic review a) identified barriers and facilitators to university students' physical activity, b) mapped these factors to the Theoretical Domains Framework (TDF) and COM-B model, and c) ranked the relative importance of TDF domains.

METHODS

Data synthesis included qualitative, quantitative, and mixed-methods research published between 01.01.2010-15.03.2023. Four databases (MEDLINE, PsycINFO, SPORTDiscus, and Scopus) were searched to identify publications on the barriers/facilitators to university students' physical activity. Data regarding study design and key findings (i.e., participant quotes, qualitative theme descriptions, and survey results) were extracted. Framework analysis was used to code barriers/facilitators to the TDF and COM-B model. Within each TDF domain, thematic analysis was used to group similar barriers/facilitators into descriptive theme labels. TDF domains were ranked by relative importance based on frequency, elaboration, and evidence of mixed barriers/facilitators.

RESULTS

Thirty-nine studies involving 17,771 participants met the inclusion criteria. Fifty-six barriers and facilitators mapping to twelve TDF domains and the COM-B model were identified as relevant to students' physical activity. Three TDF domains, environmental context and resources (e.g., time constraints), social influences (e.g., exercising with others), and goals (e.g., prioritisation of physical activity) were judged to be of greatest relative importance (identified in > 50% of studies). TDF domains of lower relative importance were intentions, reinforcement, emotion, beliefs about consequences, knowledge, physical skills, beliefs about capabilities, cognitive and interpersonal skills, social/professional role and identity, and behavioural regulation. No barriers/facilitators relating to the TDF domains of memory, attention and decision process, or optimism were identified.

CONCLUSIONS

The current findings provide a foundation to enhance the development of theory and evidence informed interventions to support university students' engagement in physical activity. Interventions that include a focus on the TDF domains 'environmental context and resources,' 'social influences,' and 'goals,' hold particular promise for promoting active student lifestyles.

TRIAL REGISTRATION

Prospero ID-CRD42021242170.

Using the R = MC2 heuristic to understand barriers to and facilitators of implementing school-based physical activity opportunities: a qualitative study

BACKGROUND

Schools are a key setting for supporting youth physical activity, given their broad reach and diverse student populations. Organizational readiness is a precursor to the successful implementation of school-based physical activity opportunities. The R = MC2 heuristic (Readiness = Motivation x Innovation-Specific Capacity x General Capacity) describes readiness as a function of an organization's motivation and capacity to implement an innovation and can be applied to better understand the implementation process. The purpose of this study was to explore the barriers to and facilitators of implementing school-based physical activity opportunities in the context of organizational readiness.

METHODS

We analyzed interview data from 15 elementary school staff (principals, assistant principals, physical education teachers, and classroom teachers) from a school district in Texas. We focused on factors related to adopting, implementing, and sustaining a variety of school-based physical activity opportunities. We used the Framework Method to guide the analysis and coded data using deductive (informed by the R = MC2 heuristic) and inductive approaches. Themes were generated using the frequency, depth, and richness of participant responses.

RESULTS

Four themes emerged from the data: (1) implementation is aided by the presence of internal and external relationships; (2) physical activity opportunities compete with other school priorities; (3) seeing the benefits of physical activity opportunities motivates school staff toward implementation; and (4) staff buy-in is critical to the implementation process. Themes 1-3 aligned with subcomponents of the R = MC2 heuristic (intra- and inter-organizational relationships, priority, and observability), whereas Theme 4 (staff buy-in) related to multiple subcomponents within the Motivation component but was ultimately viewed as a distinct construct.

CONCLUSION

Our results highlight and explain how key readiness constructs impact the implementation of school-based physical activity opportunities. They also highlight the importance of obtaining staff buy-in when implementing in the school setting. This information is critical to developing readiness-building strategies that help schools improve their capacity to deliver physical activity opportunities effectively.

TRIAL REGISTRATION

Not applicable.

Increasing chronic disease preventive care in community mental health services: clinician-generated strategies

BACKGROUND

People with a mental health condition experience a high prevalence of chronic disease risk behaviours e.g., tobacco smoking and physical inactivity. Recommended 'preventive care' to address these risks is infrequently provided by community mental health services. This study aimed to elucidate, among community mental health managers and clinicians, suggestions for strategies to support provision of preventive care.

METHODS

Three qualitative focus groups (n = 14 clinicians) were undertaken in one regional community mental health service to gather perspectives of barriers to preventive care provision, deductively coded against the domains of the Theoretical Domains Framework (TDF). Drawing on the learnings from the focus groups, individual interviews (n = 15 managers and clinicians) were conducted in two services to identify suggestions for strategies to increase preventive care. Strategies were inductively coded and mapped into TDF domains.

RESULTS

Barriers were identified across a wide range of TDF domains, most notably knowledge and environmental context and resources. Nine strategies were identified across three themes: training, resources and systems changes; mapping to all 14 TDF domains.

CONCLUSION

Future research seeking to increase implementation of preventive care may be guided by these findings. There is need for greater recognition and resourcing of preventive care as a priority and integral component of mental health treatment.

Supporting meaningful research partnerships: an interview study applying behavior change theory to develop relevant recommendations for researchers

Research partnerships, while promising for ensuring translation of relevant and useable findings, are challenging and need support. This study aimed to apply behavior change theory to understand and support researchers' adoption of a research partnership approach and the Integrated Knowledge Translation (IKT) Guiding Principles for conducting and disseminating spinal cord injury (SCI) research in partnership. Using an IKT approach, SCI researchers across Canada and the USA completed a survey (n = 22) and were interviewed (n = 13) to discuss barriers and facilitators to deciding to partner and follow the IKT Guiding Principles. The Behaviour Change Wheel, Theoretical Domains Framework (TDF), and Mode of Delivery Ontology were used to develop the survey, interview questions, and guided analyses of interview data. COM-B and TDF factors were examined using descriptive statistics and abductive analyses of barriers and facilitators of decisions to partner and/or use the IKT Guiding Principles. TDF domains from the interview transcripts were then used to identify intervention, content, and implementation options. 142 factors (79 barriers, 63 facilitators) related to deciding to partner, and 292 factors (187 barriers, 105 facilitators) related to deciding to follow the IKT Guiding Principles were identified. Barriers to partnering or use the IKT Guiding Principles were primarily related to capability and opportunity and relevant intervention options were recommended. Interventions must support researchers in understanding how to partner and use the IKT Guiding Principles while navigating a research system, which is not always supportive of the necessary time and costs required for meaningful research partnerships.

Exploring Barriers and Facilitators to Physical Activity in Adults with ADHD: A Qualitative Investigation

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by executive dysfunction. Physical activity (PA) may improve executive dysfunction; however, specific barriers and facilitators to PA participation for adults with ADHD have not been formally documented, which was the aim of the present study. Thirty adults with ADHD completed virtual semi-structured interviews, which were analyzed thematically and guided by the Theoretical Domains Framework. Expressions of both barriers and facilitators to PA were identified. Themes such as executive dysfunction (described as forgetfulness, difficulty with sustained focus, and time management), poor self-esteem, and lack of motivation were seen as barriers to PA. Key facilitators were tied to the benefits of being physically active including improvements in executive functioning, mood, and mental health during and after activity, as well as the enjoyment of being active with others. To better support adults with ADHD in initiating physical activity, it is crucial to develop unique resources that are tailored to their specific needs. These resources should be designed to minimize barriers and maximize facilitators, while also supporting the awareness and acceptance of neurodiverse experiences.

Barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence: a qualitative analysis using the theoretical domains framework

BACKGROUND

Stress urinary incontinence during pregnancy is closely related to the occurrence of postpartum and long-term urinary incontinence. Early pelvic floor management is of great significance in promoting the recovery of pelvic floor tissues in pregnant women. However, effective management of urinary incontinence is far from achievable owing to the low adherence of pregnant women in partaking in pelvic floor rehabilitation. As a comprehensive framework for behavioural theory, the Theoretical Domain Framework allows for comprehensive identification of behavioural determinants. Using Theoretical Domain Framework, this study aimed to identify barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence.

METHODS

A descriptive, qualitative design was used in this study. Face-to-face semi-structured interviews were conducted with pregnant women with stress urinary incontinence based on the Theoretical Domain Framework. The data were analysed using a combination of inductive and deductive methods.

RESULTS

Twenty pregnant women with stress urinary incontinence were interviewed. Seven themes were summarised and used to explain the pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence. The seven themes were (1) individual knowledge and experience of pelvic floor management, (2) judgments about expected outcomes, (3) interactions of interpersonal situations, (4) environment, resources, and decision-making processes, (5) personal goal-setting and efforts towards behaviour change, (6) emotional influences on decision-making, and (7) personal characteristics. Besides the "Optimism" domain, 13 of the 14 Theoretical Domains Framework domains were found to influence pregnant patients' pelvic floor rehabilitation behaviours after deductive mapping of themes to the Theoretical Domains Framework. In addition, the inductive analysis generated a theme of personal characteristics that did not map to any of the Theoretical Domains Framework domains.

CONCLUSIONS

The pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence are complex and are affected by many factors. The findings confirm the need for multiple interventions to support pelvic floor management in pregnant women with stress urinary incontinence, focusing on enhancing knowledge and skills in pelvic floor care and using appropriate behaviour change techniques (such as prompts) to provide a supportive environment.

Mind the gap: Danish school heads' ability to implement a national physical activity school requirement

In 2014, the Danish government introduced a wide-ranging reform of primary and lower secondary education that applied to all public schools. A distinctive feature was that it became mandatory for schools to provide an average of 45 min of daily physical activity (PA). The capacity for change of local school heads and the schools overall are considered key to fulfilling such a policy-driven requirement. The aim of this study is therefore to explore local school heads' ability to implement the stated requirement of 45 min of daily PA within their local organizational capacity for change. Eleven semi-structured interviews were conducted across 11 schools. Respondents were school staff with management responsibilities (leading teachers with school management responsibilities, deputy heads and school heads). Results indicate that local school heads are central agents in converting the Danish school requirement of 45 min of daily PA into local action. This includes their ability to advance broad aims into concrete goals, secure supportive structures and organize the implementation strategy. Heads also need to support the staff in building sufficient knowledge capacity on how to arrange and incorporate PA into their daily practice, support the widespread dissemination of this knowledge across the school and reserve work hours for such activities. Assigning local PA ambassadors was particularly highlighted as important implementation support, as they can help build and disseminate knowledge while also broadcasting the school head's strategy and focus on integrating and upholding students' PA levels.

Pre-Service Teachers' Perceptions of and Experiences with Classroom Physical Activity

Physical inactivity is one of the most modifiable factors linked to childhood obesity. Several Canadian provinces adopted daily physical activity (DPA) policies to promote physical activity during the school day. In Ontario, only 23% of in-service teachers meet DPA mandates. Promoting DPA implementation must occur at the pre-service level to foster self-efficacy and create long-term teaching habits. This study surveyed 155 pre-service teachers from an Ontario university to determine key perceptions and practices that should be targeted during their educational training to improve DPA fidelity. Findings revealed that over 96% of pre-service teachers viewed physical activity as beneficial for their own and their students mental and physical health, and as much as 33% received no education or training related to DPA. Pre-service teachers valued DPA more if they had opportunities to learn about and observe DPA during school placements. Pre-service teachers were more confident implementing DPA if they were more physically active, viewed themselves as more athletic, and had more positive physical education experiences. This work brings to the forefront important factors that could contribute to DPA implementation among in-service teachers and highlights target areas at the pre-service level for improved fidelity.

Conceptual replication of an evidence-based peer learning programme to enhance career preparation — a cluster randomized controlled trial (RCT)

Previous randomized-controlled trials have shown that a peer learning group intervention for career preparation can have positive effects on adolescent career management and the transition to post-comprehensive education in secondary schools. However, this earlier evidence of efficacy has been found by intervention studies that have implemented the method intensively. Earlier studies suggest that tailoring implementation strategies to fit organizational processes may offer opportunities to improve the sustainability and scalability of evidence-based practices. In this study, the implementation of the career preparation intervention was integrated into the school curriculum as a part of regular career counselling, lengthening the delivery timeframe of the intervention programme and using the schools’ own guidance counsellors as intervention providers. We conducted a conceptual replication study to investigate how effectively the adapted intervention programme enhanced perceived career preparation skills by carrying out a new cluster randomized-controlled trial among 1068 pupils. Linear mixed models showed that the effect of peer learning sessions on career choice preparedness was positive in comparison to that in the control group. The result suggests that the adapted intervention programme preserved its identifiable positive effects, although dismissing intensive delivery features somewhat reduced the effect size. These study results have implications for school-based career counselling interventions as schools seek to identify evidence-based methods that are cost-efficient and may be integrated into regular school routines.

Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework

Objectives

Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and may impede diabetes self-management. Yet, OA is often underdiagnosed and undertreated due to competing health care demands. We sought to determine healthcare providers' (HCPs') perceptions of the barriers and enablers to assessing and treating knee OA in persons with T2DM.

Design

We conducted 18 semi-structured telephone interviews with HCPs who manage persons with T2DM (family physicians, endocrinologists, diabetes educators). Interviews were analyzed deductively using Theoretical Domains Framework (TDF), a framework developed to comprehensively identify behavioural determinants. Within relevant domains, data were thematically analyzed to generate belief statements, and these were compared across the different HCP disciplines.

Results

Six TDF domains influenced HCPs behaviour to assess and treat knee OA in persons with T2DM. For all HCPs, important barriers included not seeing assessment/treatment of joint pain as a priority for their patients (intention), and insufficient access to required resources such as physiotherapy to treat OA (environmental context and resources). Endocrinologists and diabetes educators perceived having insufficient knowledge and skills to identify and manage OA (knowledge, skills), did not consider it within their professional role to do so (professional role and identity), and perceived other physicians would not want to receive a referral for OA care (social influences).

Conclusions

We identified barriers and enablers encountered by diabetes HCPs to assessing and treating knee OA in persons with T2DM involving multiple domains of the TDF. These will help inform development of a complex intervention to improve health outcomes.

Exploring the acceptability and feasibility of a whole school approach to physical activity in UK primary schools: a qualitative approach

Background

UK Children generally fail to meet physical activity (PA) recommendations. Whole school approaches (WSA) have the potential to impact large numbers of children due to their ubiquitous nature for school wide implementation, however there is limited knowledge regarding primary school PA WSA implementation in the UK. This study aimed to investigate the acceptability and feasibility of a PA WSA in the UK. 

Methods

Semi structured interviews explored research aims with participants. A qualitative description approach was adopted and data were analysed using thematic analysis to draw codes and themes from the data.

Results

Thirteen primary school senior leadership team (SLT) and Physical Education (PE) leads were interviewed. A PA WSA was found acceptable by all participants. Implementation, however, was questioned when other significant mechanisms were not in place. A PA WSA aided prioritisation and planning of PA provision, providing a holistic overview of all key areas of PE, school-sport and PA (PESSPA). Due to the high acceptability but dependent feasibility of a PA WSA, it is recommended that PA WSAs align with whole-school health policy and improvement plans to advance implementation. Future research, however, is needed to explore how this method is best implemented as additional interventions may also be required to promote the prioritisation of the PA agenda due to the importance of SLT backing for implementation being paramount, as results highlight.

Conclusions

PA WSAs aid awareness, understanding and planning of school wide PESSPA provision, however their implementation in complex. Having SLT support and an appropriately resourced PE lead maximised the impact and utility of a PA WSA.

Shifting school health priorities pre-post cannabis legalization in Canada: Ontario secondary school rankings of student substance use as a health-related issue

This study examined how schools prioritize ten key health concerns among their student populations over time and whether schools' prioritization of alcohol and other drug use (AODU) corresponds to students' substance use behaviours and cannabis legalization as a major policy change. Data were collected from a sample of secondary schools in Ontario, Canada across four years (2015/16-2018/19 [N2015/16 = 65, N2016/17 = 68, N2017/18 = 61 and N2018/19 = 60]) as a part of the COMPASS study. School-level prevalence of cannabis and alcohol use between schools that did and did not prioritize student AODU as a health concern was examined. Ordinal mixed models examined whether student cannabis and alcohol use were associated with school prioritization of AODU. Chi-square tests examined changing health priorities among schools pre-post cannabis legalization. School priority ranking for AODU was mostly stable over time. While AODU was identified as an important health concern, most schools identified mental health as their first priority across the four years of the study. No significant changes to school AODU priorities were observed pre-post cannabis legalization nor was school prioritization of AODU associated with student cannabis and alcohol use behaviours. This study suggests that schools may benefit from guidance in identifying and addressing priority health concerns among their student population.

Barriers and enablers to physical activity behaviour in older adults during hospital stay: a qualitative study guided by the theoretical domains framework

Background

Older adults admitted with an acute medical illness spent little time active during hospitalisation and this has been associated with negative health outcomes. Understanding which barriers and enablers influence the physical activity behaviour of hospitalised older adults is a first step towards identifying potentially modifiable factors and developing, evaluating and implementing targeted interventions aimed at increasing their physical activity behaviour. Using a theoretical framework has been found to be more successful in changing behaviour than using a non-theory driven approach. This study aimed to explore barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness, as perceived by patients and healthcare professionals, and to categorise them using the Theoretical Domains Framework (TDF).

Methods

A qualitative study was conducted at a combined university and regional hospital in the Netherlands between January 2019 and February 2020. Older adults (≥70 years) admitted with an acute medical illness, and healthcare professionals (nurses, physicians, physiotherapists) were recruited using purposive sampling. Semi-structured interviews were audiotaped, transcribed and analysed using directed qualitative content analysis. Barriers and enablers to physical activity behaviour during hospitalisation were identified and coded using the TDF.

Results

Meaning saturation was determined after interviews with 12 patients and 16 healthcare professionals. A large number of barriers and enablers were identified and each categorised to 11 of the 14 domains of the TDF. The ‘Environmental Context and Resources’ domain in particular yielded many examples, and revealed that the hospital environment exerts an inactivating influence on patients.

Conclusions

The large number of identified barriers and enablers highlights the complexity of influencing older adults’ physical activity behaviour during hospitalisation. This overview of barriers and enablers to physical activity behaviour in older adults admitted to a hospital with an acute medical illness represents an initial step towards developing, evaluating and implementing theory-informed behaviour change interventions to improve hospitalised older adults’ physical activity levels. It can assist clinicians and researchers in selecting modifiable factors that can be targeted in future interventions.

Barriers and facilitators to the implementation of healthy eating, physical activity and obesity prevention policies, practices or programs in family day care: A mixed method systematic review

Family day care (FDC) services provide care to young children typically within the carer's own home and represents a unique setting to deliver public health programs to improve child health. To support the implementation of programs targeting healthy eating, physical activity and obesity prevention in the FDC setting, an understanding of the factors influencing their implementation is required. This mixed methods systematic review aimed to describe the barriers and facilitators to the implementation of healthy eating, physical activity or obesity prevention policies, practices and programs (hereafter referred to as programs) in the FDC setting, and synthesise these according to the Theoretical Domains Framework (TDF). Electronic searches were conducted in 7 databases up to July 2020 to identify studies reporting the barriers and/or facilitators to program implementation in the FDC setting. Methodological quality assessments of included studies were conducted using the Mixed Methods Appraisal Tool (MMAT). Twenty studies met the review inclusion criteria (12 qualitative, 6 quantitative, 2 mixed methods). Of the 20 included studies, 16 reported barriers and facilitators mapped to the 'environmental contexts and resources' TDF domain; 10 reported barriers mapped to the 'social influences' TDF domain. Ten of the 12 qualitative studies and none of the quantitative or mixed method studies met all relevant MMAT criteria. This review comprehensively describes barriers and facilitators that need to be addressed to improve the implementation of healthy eating, physical activity and obesity prevention programs in FDC to ensure the expected health benefits of such programs reach children attending FDC.

Identifying Cardiovascular Risk Profiles Clusters among Mediterranean Adolescents across Seven Countries

Cardiovascular diseases (CVDs) are the number one cause of death globally and are partially due to the inability to control modifiable lifestyle risk factors. The aim of this study was to analyze the profiles of adolescents from seven Mediterranean countries (Greece, Israel, Italy, Macedonia, Malta, Portugal, Spain) according to their modifiable lifestyle risk factors for CVD (overweight/obesity, physical activity, smoking, alcohol consumption). The sample consisted of 26,110 adolescents (52.3% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 across the seven countries. Sociodemographic characteristics (sex, age, country of residence, socioeconomic status) and CVD modifiable lifestyle risk factors (overweight/obesity, physical activity, smoking, alcohol consumption) were recorded. A two-step cluster analysis, one-way analysis of variance, and chi-square test were performed. Four different cluster groups were identified: two low-risk groups (64.46%), with risk among those with low physical activity levels; moderate-risk group (14.83%), with two risk factors (unhealthy weight and low physical activity level); and a high-risk group (20.7%), which presented risk in all modifiable lifestyle risk factors. Older adolescents reported a higher likelihood of being in the high-risk group. Given that the adolescence period constitutes an important time for interventions aimed at CVD prevention, identifying profiles of moderate- and high-risk adolescents is crucial.

Barriers and Facilitators to Implementation of a Preschool Outcome Measure: An Interview Study with Speech-Language Pathologists

INTRODUCTION

The Preschool Speech and Language Program in Ontario, Canada implemented the Focus on the Outcomes of Communication Under Six (FOCUS), an outcome measure, in 2012. This study aimed to investigate commonly experienced facilitators of and barriers to implementing the FOCUS in clinical practice from the perspectives of speech-language pathologists (SLPs).

METHODS

Thirty-seven SLPs participated in semi-structured interviews to share their experiences adopting the FOCUS in clinical practice. A deductive content analysis of interview transcripts was conducted using the Theoretical Domains Framework (TDF), followed by an inductive analysis to identify sub-themes within each domain.

RESULTS

SLPs frequently encountered barriers within three TDF domains: Environmental Context and Resources (e.g., difficulties integrating the FOCUS into assessment sessions and intervention schedules), Beliefs about Consequences (e.g., beliefs that data collected using the FOCUS lack relevance to clinical practice), and Social Influences (e.g., administration of the FOCUS harmed rapport with families). Commonly reported facilitators were found in the Behavioural Regulation (e.g., reminder system) and Environmental Context and Resources (e.g., availability of administrative personnel and technology support) domains.

CONCLUSIONS

SLPs identified barriers and facilitators to implementing an evidence-based outcome measure into practice. Insights drawn from SLPs' perspectives will support the design of new methods to improve the implementation of functional outcome measurement tools within programs.

Examining Engagement With Public Health in the Implementation of School-Based Health Initiatives: Findings From the COMPASS Study

BACKGROUND

Adolescence coincides with the adoption of health behaviors that schools are not necessarily equipped to properly address. Collaboration between schools and external health services such as public health could fill gaps in addressing student health.

METHODS

The current study uses student- and school-level survey data from 59 nonprivate secondary schools in Ontario, Canada in year 6 (2017-2018) of the COMPASS study to examine barriers to improving student health, and analyze the effect of public health engagement on student health behaviors.

RESULTS

The majority of schools have received resources from their local public health unit, however, less than one third of schools were developing/implementing programs jointly, and 12% of schools reported no engagement. Students had higher odds of better overall mental health, of meeting screen time guidelines, and were less likely to bully others if public health units solved issues together with schools regarding these health behaviors.

CONCLUSIONS

There is a notable lack of consistent public health engagement in schools participating in the COMPASS study despite a need for such services. Creating mechanisms to develop and strengthen effective partnerships between schools and external service providers such as public health might alleviate some barriers to implementing health interventions in Ontario secondary schools.

Barriers and Facilitators to Behavior Change for Individuals with Severe Mental Illness who Received the Transdiagnostic Intervention for Sleep and Circadian Dysfunction in a Community Mental Health Setting

The Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C) was implemented in a community mental health center (CMHC) setting. The goal of TranS-C is to improve sleep and circadian dysfunction among people with severe mental illness. The present study uses the Theoretical Domains Framework (TDF) to uncover barriers and facilitators to changing behaviors learned in TranS-C. Adults with severe mental illness who completed TranS-C (n = 14) were given a semi-structured interview based on the TDF. Interview transcripts were independently coded using inductive and deductive coding. The most commonly coded TDF domains were Behavior Regulation, Beliefs about Consequences, Knowledge and Beliefs about Capabilities. Action planning was the most discussed facilitator and compromising sleep health in favor of time spent with loved ones was the most discussed barrier. These findings suggest that TranS-C has promising strengths and raise important barriers that can be addressed in TranS-C to improve its fit within CMHCs.

Briggs A, Cottrell E, Doyle F, Dziedzic K, Finney A, Murphy P, Paskins Z, Sheridan E, Swaithes L, P. French H. Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol

Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a 'model of evidence-based, non-surgical OA care that has been implemented in a real-world setting'. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE-CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.

A systematic review of school health policy measurement tools: implementation determinants and outcomes

BACKGROUND

Governments in some countries or states/provinces mandate school-based policies intended to improve the health and well-being of primary and secondary students and in some cases the health of school staff. Examples include mandating a minimum time spent per week in programmed physical activity, mandating provision of healthy foods and limiting fat content of school meals, and banning tobacco products or use on school campuses. Although school health researchers have studied whether schools, districts, or states/provinces are meeting requirements, it is unclear to what extent implementation processes and determinants are assessed. The purposes of the present systematic review of quantitative measures of school policy implementation were to (1) identify quantitative school health policy measurement tools developed to measure implementation at the school, district, or state/provincial levels; (2) describe the policy implementation outcomes and determinants assessed and identify the trends in measurement; and (3) assess pragmatic and psychometric properties of identified implementation measures to understand their quality and suitability for broader application.

METHODS

Peer-reviewed journal articles published 1995-2020 were included if they (1) had multiple-item quantitative measures of school policy implementation and (2) addressed overall wellness, tobacco, physical activity, nutrition, obesity prevention, or mental health/bullying/social-emotional learning. The final sample comprised 86 measurement tools from 67 peer-review articles. We extracted study characteristics, such as psychometric and pragmatic measure properties, from included articles based on three frameworks: (1) Implementation Outcomes Framework, (2) Consolidated Framework for Implementation Research, and (3) Policy Implementation Determinants Framework.

RESULTS

Most implementation tools were developed to measure overall wellness policies which combined multiple policy topics (n = 35, 40%) and were in survey form (n = 75, 87%). Fidelity was the most frequently prevalent implementation outcome (n = 70, 81%), followed by adoption (n = 32, 81%). The implementation determinants most assessed were readiness for implementation, including resources (n = 43, 50%), leadership (n = 42, 49%), and policy communication (n = 41, 48%). Overall, measures were low-cost and had easy readability. However, lengthy tools and lack of reported validity/reliability data indicate low transferability.

CONCLUSIONS

Implementation science can contribute to more complete and rigorous assessment of school health policy implementation processes, which can improve implementation strategies and ultimately the intended health benefits. Several high-quality measures of implementation determinants and implementation outcomes can be applied to school health policy implementation assessment. Dissemination and implementation science researchers can also benefit from measurement experiences of school health researchers.

Dissemination and implementation of a policy on school health in public schools: A systematic review

BACKGROUND

The need to achieve school health and promote well-being that would transcend children's school life has been highlighted in several studies. Promotion of health and well-being of children has not been achieved despite the prescripts of the World Health Organization and national mandates.

OBJECTIVES

The purpose of this systematic review was to explore and describe the current evidence on the dissemination and implementation of a policy on school health in public schools.

METHODS

Five steps of a systematic review were used to achieve the purpose of the study. The steps include framing a clear review question, developing a search approach through gathering and classifying evidence, conducting a critical appraisal, evidence summary as well as the results. Ebscohost, SAE publications, Web of Science and JSTOR databases were used to identify articles written between 2013 and 2018 and to enable access to current studies on the promotion of school health. Keywords included the following: dissemination; implementation; school health policy; and public schools. The search yielded n = 1995 articles. From this figure, 1976 articles were ineligible and only 19 articles met the inclusion criteria.

RESULTS

Seven themes emerged from the findings of this systematic review as follows: shared information, training and development of key role-players, programme development and research, commitment from key role-players, monitoring activities, executive support and collaborative partnerships.

CONCLUSION

The findings show that it is possible for a policy on school health to be disseminated and implemented effectively in public schools.

Traumatic dental injuries in the Eastern Region of Saudi Arabia: Factors influencing teachers' management practices

BACKGROUND/AIMS

Traumatic dental injuries (TDIs) in children frequently occur in schools where teachers can play an important role in their management. Therefore, the aim of this study was to assess schoolteachers' knowledge and the factors that determine their management of TDIs.

MATERIALS AND METHODS

This cross-sectional study was conducted in the Eastern Province of Saudi Arabia from January to June 2018. Data were collected through an online pre-tested questionnaire. The questionnaire collected demographic data and included questions that assessed participants' knowledge and management practices for TDI. Chi-square test and multivariate logistic regression analysis were performed.

RESULTS

A total of 443 teachers were included in the study, and 72.5% of the participants were females. The prevalence of TDIs was 49% yet only 7.2% of the participants reported managing dental trauma. Fights (22.8%) and falls (21.7%) were the most common causes of dental injuries. Mean TDI knowledge score was 2.75 ± 2.05, but only 47.2% were willing to receive training about TDI management. Regarding supportive environments, 75.8% of teachers reported having safety playgrounds, however 10.6% reported having a nurse in schools. After controlling for other variables, male respondents were 3.85 times more likely to manage TDIs than female respondents (P = .001). Similarly, previous knowledge of dental trauma management (OR = 4.32, P < .001) and having less than 50 students in class (OR = 2.61, P = .021) were significantly associated with TDI management.

CONCLUSION

The teachers demonstrated inadequate knowledge about TDIs which were highly prevalent in primary schools. Male gender, having knowledge of TDI management and teaching less students were associated with increased likelihood of TDI management. There is a crucial need for the reinforcement of policies that support school safety and a supportive environment.

A Pragmatic Feasibility Trial Examining the Effect of Job Embedded Professional Development on Teachers' Capacity to Provide Physical Literacy Enriched Physical Education in Elementary Schools

A gap in physical literacy (PL) oriented professional development (PD) for generalist teachers exists and thus their capacity to develop PL and maximize student health is potentially limited. We explored the feasibility of a novel job-embedded professional development (JEPD) program (10 weeks) and its impact on teachers’ capacity to deliver PL-enriched physical education (PE) and student PL. A pragmatic feasibility trial with mixed methods included quantitative measurements of teacher PL, knowledge and confidence (pre), and knowledge, confidence, satisfaction and intention (post), as well as self-reported change, to evaluate the impact on teacher capacity and practices. A pre–post comparison of student PL outcomes (motor skills using PLAYbasic, Sport for Life, Victoria, BC, Canada) during the JEPD and teacher implementation phase explored the impact on student PL. In total, 15/44 teachers participated in surveys and 11/44 completed interviews (87% female, mean age bracket = 25–44 years). Confidence to deliver PL enhancing PE increased significantly after JEPD (p < 0.0001). Teachers were highly satisfied with the JEPD (X = 4.67/5) and intended to change their practices (X = 4.09/5). At three months, teachers reported changes including enhanced lesson planning, increased activity variety (often from the JEPD), intentional skill development, student-focused discussions, introductory, transition, and closing activities, and more equipment adaptations. During JEPD, with the exception of throwing (p < 0.0001), children’s (47% female, mean age = 7.9 (1.7)) change in running, jumping, kicking and balance walking backwards did not differ from usual practice (UP). During teacher implementation, motor skill competence regressed; confounding factors could not be ruled out. JEPD appears feasible and effective for changing teacher capacity to deliver PL and enhancing PE; however, post-JEPD teacher implementation and outcomes need further exploration.

Determinants of Sedentary Behaviour in Individuals with COPD: A Qualitative Exploration Guided by the Theoretical Domains Framework

In people with chronic obstructive pulmonary disease (COPD), there is increasing recognition that the prolonged accumulation of sedentary time (ST) is associated with adverse cardio-metabolic health outcomes. Nevertheless, changing this lifestyle, which has evolved over several decades, is likely to be challenging. This study reports the determinants, perceived by individuals with COPD, as being important for reducing ST. An in-depth understanding of this information is essential when planning an intervention to reduce ST. Fourteen individuals with COPD completed semi-structured one-on-one interviews, which were audio recorded and transcribed verbatim. Both the interview schedule and mapping of data items extracted from the interview transcripts were informed by the Theoretical Domains Framework (TDF). A total of 867 quotes were mapped to the 14 TDF domains. Seven of the fourteen domains were identified as being important determinants for reducing ST: knowledge, beliefs about consequences, beliefs about capabilities, environmental context and resources, social influences, social/professional role and identity, and behavioural regulation. There was a lack of knowledge regarding the meaning of sedentary behaviour. Participants' desire to be educated by knowledgeable health professionals in a formal programme was a dominant theme across multiple domains. The most frequently reported barriers to reducing ST related to the domains of social/professional role and identity and environmental context and resources, while the most frequently reported enablers were related to the domains pertaining to beliefs about consequences and social influences. Potential strategies to reduce ST among people with COPD include education and other determinants identified in this research.

Dance Dance "Cultural" Revolution: Tailoring a Physical Activity Intervention for South Asian Children

In Canada, South Asian (SA) children are more likely to be overweight and physically inactive than non-SAs. This study uses a mixed-methods embedded design to investigate factors associated with physical activity (PA) among SAs, and develops a culturally-relevant exercise intervention for SA children ages 8-11. Twenty-eight (28) participants including children, parents, principals, teachers, and Bhangra instructors across four elementary schools in Surrey, BC participated in semi-structured interviews and a self-report survey. Using the immersion/crystallization approach, four major themes were identified: (1) awareness of the importance and benefits of PA, (2) discrepancy between expectations and actual opportunities for PA in the school-setting, (3) sub-optimal conditions for PA at school and home, and (4) intervention characteristics conducive for promoting exercise in SA children. Competing demands and lack of opportunities posed as prominent obstacles. To address these barriers, a culturally-appealing exercise intervention may offer a viable approach to motivate SA children to exercise.

Exploring the effectiveness of a school-based physical activity policy in British Columbia, Canada: a mixed-methods observational study

The Daily Physical Activity (DPA) policy in British Columbia requires elementary schools to help students achieve 30 min of physical activity during instructional and noninstructional time on school days. The purpose of this study was to determine how elementary teachers implement the DPA policy, and examine differences in children's light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) at school, based on how the teacher implemented the DPA policy during the school day (provision of DPA during instructional time or only noninstructional time). In this observational mixed-methods study, 12 teachers were interviewed on their implementation approaches. Teachers provided DPA opportunities during instructional time (i.e., prescriptive implementers, n = 9) or relied on students to be active during noninstructional times (i.e., nonprescriptive, n = 3). Next, 10 students from each interviewed teacher's classroom were randomly selected to wear accelerometers for one school week. Hierarchical linear modeling was used to examine the contribution of teacher's implementation strategy on student's activity levels. t-Tests examined differences in students' activity levels between implementation groups. Teacher's DPA implementation strategy accounted for a significant proportion of variance in student's activity throughout the school day (p's < .05). The prescriptive group (n = 88) was more active (LPA and MVPA) and spent a greater proportion of their school days in MVPA during instructional time than the nonprescriptive group (n = 23). Heterogeneity in policy implementation creates variations in policy effectiveness. Students provided with opportunities to be active during instructional time may accumulate more MVPA compared with those who are not given these opportunities. Registration: Not applicable.

Acceptability and Feasibility of Single-Component Primary School Physical Activity Interventions to Inform the AS:Sk Project

Multi-component school-based interventions provide physical activity (PA) opportunities for children but are often difficult for schools to execute and may not be implemented as intended. The primary aim of this study was to explore the acceptability and feasibility of three brief single-component primary school PA interventions targeting 9–10-year-old children. The secondary aim was to examine the effectiveness of the interventions on increasing PA levels and reducing sedentary time. The single-component interventions included active classroom breaks (AB; 3 schools; n = 119 children) Born to Move (BTM) exercise videos (2 schools; n = 50 children), and playground supervisory staff training (2 schools; n = 56 children). Qualitative data from participating children (n = 211), class teachers (n = 6), and playground supervisory staff (n = 8) explored the experiences, acceptability, and feasibility of each intervention component. Accelerometers were worn by 225 children during the last week of implementation. Teachers reported that they were able to implement ABs daily, but BTM videos were more difficult to implement daily because of accessing sufficient space. Playground staff reported difficulties in implementing activities due to children’s age and competing responsibilities on the staffs’ time. Children reported that the ABs and BTM videos were enjoyable. During half hour time windows, including the ABs and BTM videos, children engaged in 4.8 min and 8.6 min of moderate to vigorous PA (MVPA) on average, respectively. ABs and BTM videos positively affected MVPA. ABs were feasible to implement; however, teachers faced some barriers in implementing the BTM videos. Feasibility of playground interventions may be dependent on staff responsibilities and age of the children.

Associations between teacher training and measures of physical literacy among Canadian 8- to 12-year-old students

BACKGROUND

Quality physical education (PE) contributes to the development of physical literacy among children, yet little is known about how teacher training relates to this development. We assessed the association between teacher training, and the likelihood that children met recommended achievement levels for components of physical literacy as defined by the Canadian Assessment of Physical Literacy (CAPL).

METHODS

Canadian children (n = 4189; M = 10.72 years, SD = 1.19) from six provinces completed the CAPL. Logistic regression was used to examine the relationship between teacher training (generalist/PE specialist), adjusting for children's age and gender, and physical competence protocols (sit and reach, handgrip, plank, Progressive Aerobic Cardiovascular Endurance Run [PACER], body mass index [BMI], waist circumference, Canadian Agility and Movement Skill Assessment [CAMSA]), the four CAPL domain scores, and the total CAPL score.

RESULTS

Teacher training, in addition to children's age and gender, explained only a very small proportion of variance in each model (all R2 < 0.03). Children taught by a generalist were less likely to reach recommended levels of motivation and confidence (OR = 0.83, 95% CI, 0.72-0.95) or CAMSA scores (OR = 0.77, 95% CI, 0.67-0.90), even when accounting for a significant increase in CAMSA score with age (OR = 1.18, 95% CI, 1.12-1.26). All other associations between measures of components of physical literacy and teacher training were not significant.

CONCLUSIONS

While teacher training is hypothesized to contribute to the development of physical literacy among elementary school students, the observed effects in this study were either small or null. Children taught by PE specialists were more likely than those taught by generalists to demonstrate recommended levels of motivation and confidence, and to have better movement skills, which are hypothesized to be critical prerequisites for the development of a healthy lifestyle. Further research with more robust designs is merited to understand the impact of teachers' training on the various components of physical literacy development.