Investigating implementation of school health policies through a health equity lens: A measures development study protocol

Abstract

BackgroundSchool-based policies that ensure provision of nutrition, physical activity, and other health-promoting resources and opportunities are essential in mitigating health disparities among underserved populations. Measuring the implementation of such policies is imperative to bridge the gap between policy and practice. Unfortunately, limited practical, psychometrically strong measures of school policy implementation exist. Few available explicitly focus on the issues of equity and social justice as a key component of implementation, which may result in underassessment of the equity implications of policy implementation. The purpose of this study is to develop equity-focused measures in collaboration with practitioners, researchers, and other key implementation partners that will facilitate evaluation of policy implementation determinants (i.e., barriers and facilitators), processes, and outcomes.MethodsWe will actively seek engagement from practitioners, researchers, and advocacy partners (i.e., stakeholders) who have expertise in school health policy throughout each phase of this project. We propose a multi-phase, 1-year project comprising the following steps: (1) selection of relevant constructs from guiding frameworks related to health equity and implementation science; (2) initial measure development, including expert feedback on draft items; (3) pilot cognitive testing with representatives from key target populations (i.e., school administrators, teachers, food service staff, and students and parents/guardians); and (4) measure refinement based on testing and assessment of pragmatic properties. These steps will allow us to establish initial face and content validity of a set of instruments that can undergo psychometric testing in future studies to assess their reliability and validity.DiscussionCompletion of this project will result in several school policy implementation measurement tools which can be readily used by practitioners and researchers to evaluate policy implementation through a health equity lens. This will provide opportunities for better assessment and accountability of policies that aim to advance health equity among school-aged children and their families.Trial registrationOpen Science Framework Registration doi: 10.17605/OSF.IO/736ZU.

Applying hybrid effectiveness-implementation studies in equity-centered policy implementation science

“…Lastly, policy IS studies can contribute best to health equity by elucidating which policies have the maximum impact on structural support and social determinants of health ( 5 ). To this end, instrument development for policy specific implementation outcomes is needed, currently there are some tools for school settings ( 41 , 42 ) and more broadly ( 31 ); however development and testing—including for qualitative data—remains nascent. In addition, examples of policy-specific implementation strategies are organized by target organizational level (e.g., educational trainings) vs. policy authority level (e.g., appointment of state leaders to garner resources) ( 17 ).…”

“…In addition, once implementation strategies are identified, a partner- engaged readiness assessment is recommended to understand whether the target partners have the capacity and motivations to implement (39). Many of the processes used in designing for dissemination (e.g., stakeholder engagement, participatory codesign, context analysis) will facilitate partner-focused implementation (40).…”

Mending the gap: Measurement needs to address policy implementation through a health equity lens

“…However, gaps remain such as meaningfully integrating health equity and social justice frameworks with implementation science [ 45 ]. One example of such integration is a measurement development study which seeks to iteratively develop measurement tools for school policy implementation [ 13 ]. This is a two-part study in which the first aim is to collaboratively select constructs from health equity and implementation science frameworks, ranked by school-based practitioners, researchers, and others involved with school policy implementation.…”

“…to develop policy implementation measurement tools through qualitative research (i.e. cognitive interviewing) to establish face and content validity [ 13 ]. For the field of implementation science to also prioritize these perspectives, a paradigm shift is essential, in addition to a larger focus on qualitative research to ensure that the voices of those in marginalized populations are truly heard.…”

“…Implementation science can fill an important gap between policy and practice [ 7 , 13 , 14 ], by illuminating the gray area between policy and impact through clear, rigorous methodology. However, although the notion of policy implementation has been studied for over 30 years [ 15 ], the lack of attention paid toward measuring implementation presents a clear gap in the field, and limits our understanding of how and why certain policies might be effective or ineffective, and where the gaps remain [ 7 , 13 ]. Furthermore, there is a clear need for more attention to measurement of policy implementation to understand content, determinants, processes, and outcomes of policies that promote health [ 12 , 16–18 ].…”