Implementation evaluation of an Irish secondary-level whole school programme: a qualitative inquiry

Abstract

Summary Whole-of-school programmes (WSPs) are recommended to promote physical activity for adolescents. The Active School Flag (ASF) programme for secondary-level schools is one such WSP. Due to the difficulties of incorporating WSPs into the complex school system, there is a risk of poor implementation. The monitoring of unanticipated influences can help to understand key implementation processes prior to scale-up. The aims of this study were to identify perceived facilitators and barriers to implementing the ASF and recommend evidence-based implementation strategies. Focus groups and interviews (N = 50) were conducted in three schools with stakeholders involved in programme implementation, i.e. school management (n = 5), ASF coordinator (n = 4), student-leaders (aged 15–16 years) (n = 64) and staff committee (n = 25). Transcripts were analysed using codebook thematic analysis and were guided by the Consolidated Framework for Implementation Research. Implementation strategies were identified and were selected systematically to address contextual needs. Three themes surrounding the facilitators and barriers to implementation were generated: intervention design factors (e.g. capacity building and knowledge of implementers; and interest and buy-in for the programme), organizational factors (e.g. optimization of people and the busy school environment) and interpersonal factors (e.g. communication and collaboration). The examination of facilitators and barriers to implementation of the ASF has assisted with the identification of implementation strategies including (not limited to) a shared leadership programme for student leaders and a more flexible timeline for completion. These facilitative implementation strategies may assist in the effective implementation of the ASF.

Rethinking children’s physical activity interventions at school: A new context-specific approach

“…Understanding rather than ignoring the context is important because some schools will be in affluent, well-resourced areas with financial and in-kind support from parents, local authorities, and third-sector groups, while other schools will be in more economically challenged or rural areas and may have very limited budgets, space or other challenges. These contextual factors have the potential to impact implementation within schools ( 37 ) and will shape what kind of physical activity intervention would be appropriate and successful. Schools may already have an initiative that mimics or is identical to an intervention program being offered, and so a “new” program may not be optimized for maximal impact.…”

“…While the importance and role of context has been discussed in the implementation of broader public health interventions ( 6 ), context is rarely considered at the earlier stage in designing a physical activity intervention ( 37 ). Any new initiative needs to work within existing infrastructure, school policy, staff capacity, pupil needs, and other aspects of the curriculum ( 39 ).…”

“…This would involve a level of engagement and collaboration with school staff that is consistent with the Creating Active Schools approach ( 55 ). Identification of intervention components could be informed by the Consolidated Framework for Implementation Research which encourages researchers to think about: (a) innovation characteristics, such as the adaptability of the “intervention” being implemented; (b) outer setting, such as external polices; (c) inner setting, such as school-specific resources; (d) characteristics of participants, such as pupil demographics and activity levels; and (e) the implementation process, that is, how the program is implemented in each school ( 10 , 37 , 56 , 57 ). This approach was used to inform the design of the Burn 2 Learn study highlighted above ( 58 ) as well as the iPLAY intervention ( 59 , 60 ).…”