BackgroundNumerous studies have tested school-based interventions promoting healthy behaviors in youth, but few have integrated dissemination and implementation (D&I) frameworks. Using D&I frameworks can inform if and how an evidence-based intervention is implemented and maintained and provide strategies to address contextual barriers. Such application is necessary to understand how and why interventions are sustained over time. We evaluated a school wellness initiative called SWITCH® (School Wellness Integration Targeting Child Health) to (1) assess implementation outcomes of adoption, fidelity, and penetration, (2) discern implementation determinants through the Consolidated Framework for Implementation Research (CFIR), and (3) examine differences among inexperienced and experienced schools and influential factors to sustainment.MethodsA total of 52 schools from Iowa, United States enrolled in the 2019–2020 iteration of SWITCH (22 inexperienced; 30 experienced). The CFIR guided the adaptation of mixed methods data collection and analysis protocols for school settings. Specific attention was focused on (1) fidelity to core elements; (2) adoption of best practices; and (3) penetration of behavior change practices. Determinants were investigated through in-depth qualitative interviews and readiness surveys with implementation leaders. A systematic process was used to score CFIR domains (between −2 and +2) indicating positive or negative influence. Independent t-tests were conducted to capture differences between samples, followed by a cross-case analysis to compare determinants data. Inductive coding yielded themes related to sustainment of SWITCH beyond formal implementation support.ResultsExperienced schools had higher scores on fidelity/compliance (t = −1.86 p = 0.07) and adoption (t = −2.03 p = 0.04). CFIR determinants of innovation source, culture, relative priority, and leadership engagement were positive implementation determinants, whereas tension for change and networks and communications were negative determinants. Distinguishing factors between experienced and inexperienced schools were Readiness for Implementation and Self-efficacy (experienced significantly higher; p < 0.05). Strategies to enhance sustainability were increasing student awareness/advocacy, keeping it simple, and integrating into school culture.ConclusionsFindings provide specific insights related to SWITCH implementation and sustainability but more generalized insights about the type of support needed to help schools implement and sustain school wellness programming. Tailoring implementation support to both inexperienced and experienced settings will ultimately enhance dissemination and sustainability of evidence-based interventions.

BackgroundThe need for sustainable and scalable comprehensive school wellness interventions is evident, and the lack of attention toward capacity-building models warrants investigation. Furthermore, there is a dearth of understanding regarding implementation determinants grounded in dissemination and implementation (D&I) frameworks. This study sought to address: 1) implementation determinants of adoption, fidelity, and penetration for school-wide wellness programming; and 2) nuanced determinants between schools with prior experience and those new to the program, to enhance tailored implementation support and sustainability.MethodsThe School Wellness Integration Targeting Child Health (SWITCH®) capacity-building intervention was adopted in 52 elementary and middle (22 new; 30 experienced) schools across Iowa, United States in the 2019–2020 academic year. Mixed methods data collection and analysis procedures followed the Consolidated Framework for Implementation Research (CFIR) protocols, adapted to school settings. Implementation outcomes included: 1) fidelity/compliance to established quality elements; 2) adoption of best practices in multiple settings; and 3) penetration of behavior change practices across classrooms and grade levels. Assessed determinants comprised organizational readiness/capacity and CFIR constructs via interviews and surveys. Interview data were scored using a systematic process; each CFIR domain was assigned a score (ranging between -2 and +2) to denote either a positive or negative influence on implementation. Independent t-tests were conducted to capture potential differences between new and experienced schools, followed by Pearson bivariate correlation analyses to determine relationships between CFIR determinants and implementation outcomes. ResultsExperienced schools reported insignificantly higher fidelity (t=-1.86 p=.07) and higher rates of adoption (t=-2.03 p=.04) compared to new schools. Correlation analyses revealed positive relationships between implementation outcomes and CFIR determinants including innovation source, culture and relative priority, and leadership engagement. Negative relationships were observed in tension for change and networks and communications. Specific negative relationships for new schools between determinants and outcomes included relative advantage, engaging key stakeholders, and reflecting/evaluating, among others. ConclusionsFindings highlight the specific relationships between implementation outcomes and determinants; nuanced challenges for new schools highlight the need for a more tailored approach to implementation support and offer insights for sustainability. Adapted CFIR protocols provide opportunities for replication in other school-and community-based projects.

BackgroundAlthough comprehensive approaches to student health promotion through wellness policy implementation show potential for scale-up, scant empirical research has been conducted to meaningfully integrate dissemination and implementation (D&I) in evaluation procedures. Such application is necessary to understand how and why interventions are sustained over time. The aims of this study were to investigate: 1) implementation determinants of adoption, fidelity, and penetration for school-wide wellness programming; and 2) nuanced determinants between schools with prior experience and those new to the program, to enhance tailored implementation support and sustainability.MethodsThe School Wellness Integration Targeting Child Health (SWITCH®) capacity-building intervention was adopted in 52 elementary and middle (22 new; 30 experienced) schools across Iowa, United States in the 2019–2020 academic year. The Consolidated Framework for Implementation Research (CFIR) guided development of mixed methods data collection and analysis protocols, adapted to school settings. Determinants from CFIR were linked to three key implementation outcomes: 1) fidelity/compliance to established quality elements; 2) adoption of best practices in multiple settings; and 3) penetration of behavior change practices across classrooms and grade levels. Organizational readiness/capacity was also assessed at baseline. Interview data were scored using a systematic process; each CFIR domain was assigned a score (ranging between -2 and +2) to denote either a positive or negative influence on implementation. Independent t-tests were conducted to capture potential differences between new and experienced schools, followed by Pearson bivariate correlation analyses to determine relationships between CFIR determinants and implementation outcomes. ResultsIn experienced schools, fidelity/compliance (t=-1.86 p=.07) and adoption (t=-2.03 p=.04) were slightly higher than new schools. The CFIR determinants of innovation source, culture and relative priority, and leadership engagement were positively related to implementation outcomes, whereas tension for change and networks and communications were observed negative determinants. Unique negative determinants for new schools comprised relative advantage, engaging key stakeholders, and reflecting/evaluating, among others. ConclusionsFindings provide specific areas of need where implementation support may be most valuable, especially for new schools undertaking a comprehensive program such as SWITCH. Tailoring implementation support to both new and existing settings will ultimately enhance dissemination and sustainability of evidence-based interventions.