Poor implementation? Process evaluations to explain implementation and effectiveness of school physical activity programmes using mixed-methods

Symposium A3

Abstract

Purpose: Schools are considered a key setting for physical activity promotion. However, meta-analyses suggest that many school-based physical activity interventions are not effective, with poor implementation given as a primary reason for the lack of effectiveness. This symposium provides an in-depth exploration of implementation outcomes via three school-based mixed-methods process evaluations to explain implementation effectiveness.

Description: We present three mixed-methods process evaluations of efficacious school-based physical activity interventions in two countries, across primary and secondary schools. In order to realise their public health benefits, these interventions have been scaled-up. To explain implementation effectiveness, we will explore where and if they are implemented (adoption), how much support was offered and obtained for this implementation (fidelity and reach) and if they are liked (acceptable), practically deliverable by schools (feasible) and perceived to work (appropriateness).

Chair: Patti-Jean Naylor

Presenter 1: Cassandra Lane. Title: Mixed-methods process evaluation of Physically Active Children in Education (PACE): an effective school-based physical activity policy implementation strategy Short description: PACE is an effective, multi-strategy intervention that was found to significantly increase schools’ implementation of a mandatory physical activity policy. In order to optimise such implementation interventions, the underlying mechanisms surrounding the intervention effect and relative contribution of each strategy are needed. This presentation will report on the findings of a mixed-methods process evaluation undertaken to explore the various implementation measures of PACE and the relative importance of each implementation strategy.

Presenter 2: Gabriella M. McLoughlin. Title: Mixed-methods process evaluation of the School Wellness Integration Targeting Child Health (SWITCH®) Dissemination Trial. Short description: The SWITCH® program has been shown as an effective program at enhancing children’s physical activity and nutrition behaviours, and is now in the dissemination phase across the state of Iowa. This presentation will report on the mixed- methods process evaluation findings, grounded in the Consolidated Framework for Implementation Research (CFIR). In particular, we will report on the implementation strategies adopted by schools according to socioeconomic status of population, baseline organizational readiness/capacity, and composite implementation score, as a means to identify adaptation techniques which can further promote and enhance implementation.

Presenter 3: Matthew Mclaughlin. Title: Mixed-methods process evaluation of the scale-up of ‘Physical Activity 4 Everyone’ (PA4E1): A Hybrid Type III Randomised Controlled Trial. Short description: The PA4E1 program is an efficacious secondary school physical activity program targeting students in low-socioeconomic areas, which increased students’ moderate-to-vigorous physical activity by 49 minutes per week. The program has now been scaled-up. This presentation will report the process evaluation findings of the scaled-up trial. The process outcomes are fidelity and reach of the implementation strategies, and the acceptability, appropriateness and reach of the program, inclusive of both the physical activity practices (the intervention) and the implementation support strategies. Specific sub-groups will be explored, including high Indigenous enrolment schools. Findings will help explain the scaled-up trial implementation outcomes.

Results: Quantitative and qualitative data collected from school end-users and implementers will be mixed and discussed in relation to the implementation effectiveness of each school-based program.

Conclusions: Detailed process evaluations may be used to optimise the effectiveness, cost-effectiveness and potential for scale of the current and future interventions in schools.