Pathways leading to success and non-success: a process evaluation of a cluster randomized physical activity health promotion program applying fuzzy-set qualitative comparative analysis

Int J Behav Nutr Phys Act

et al. 2020

Background School wellness programming is important for promoting healthy lifestyles and academic achievement in youth; however, research is needed on methods that can help schools implement and sustain such programs on their own. The purpose of this study was to investigate factors within and outside the school environment that influenced school capacity for implementation and potential sustainability of wellness programming. Methods As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N = 30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, and lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). Results Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA results revealed non-significant associations between implementation group and gains in school capacity (F [2, 24] = 1.63; p = .21), class capacity (F [2, 24]=0.20 p = .82), lunchroom capacity (F [2, 24]=0.29; p = .78), and physical education (F [2, 24]=1.45; p = .25). Qualitative data demonstrated that factors within the outer setting (i.e., engaging community partners) facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) influenced implementation. Implementation process themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors affecting sustainability, such as school culture and knowledge of school wellness policy. Conclusions The results from this implementation study document the importance of allowing schools to adapt programming to meet their local needs, and highlight the strengths of measuring multiple implementation outcomes. Increased support is needed for schools regarding the formation and improvement of wellness policies as a means to enhance sustainability over time.

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluating the implementation of the SWITCH® school wellness intervention and capacity-building process through multiple methods

Int J Behav Nutr Phys Act

et al. 2020

“…School-based wellness programming provides an important opportunity to promote children's physical activity and nutrition behavior (1,2). However, factors within and outside the school environment have been found to hinder adoption, implementation, and sustainability of comprehensive interventions (3)(4)(5)(6). To advance research on school wellness programming, it is important to test approaches aimed at building capacity for more effective school wellness programming.…”

Section: Introductionmentioning

confidence: 99%

Evaluating The Implementation of The SWITCH® School Wellness Intervention Through Mixed Methods

et al. 2020

Preprint

Abstract Background: School wellness programming is important for promoting academic achievement and healthy lifestyles in youth; however, research is needed on methods that can help schools implement and sustain programs on their own. The purpose of this study was to investigate factors within and outside the school environment that impacted school capacity for implementation and potential sustainability of wellness programming. Methods: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N=30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). Results: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA analyses revealed positive, non-significant variances between implementation group and gains in school capacity (F[2,24]=1.63; p=.21), class capacity (F[2,24]=0.20 p=.82), lunchroom capacity (F[2,24]=0.29; p=.78), and physical education (F[2,24]=1.45; p=.25). Qualitative data demonstrated factors within the outer setting (i.e., engaging community partners) that facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) significantly affected implementation. Implementation process construct themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors impacting sustainability, such school culture and knowledge of school wellness policy. Conclusions: Findings suggest a modest but important impact of implementation on capacity change which is the primary goal of SWITCH. The results document the importance of allowing schools to adapt programming to meet their local needs.

“…Background School-based wellness programming provides an important opportunity to promote children's physical activity and nutrition behavior (1,2). However, factors within and outside the school environment have been found to hinder adoption, implementation, and sustainability of comprehensive interventions (3)(4)(5)(6).…”

Section: Trial Registration: Nct04045288mentioning

confidence: 99%

“…The dissemination and implementation (D&I) literature offers many approaches and tools for understanding implementation with the Consolidated Framework for Implementation Research (CFIR) being one of the most comprehensive and widely used frameworks (13,14). The CFIR has predominantly been used in clinical research (15), but recent applications to school-based health interventions have shown value for evaluating implementation of programming (3,16). Although CFIR has been used to frame studies testing the implementation and potential success of evidence-based programs in schools (15-17), limited research has been conducted to understand the factors that affect school wellness implementation.…”

Section: Trial Registration: Nct04045288mentioning

confidence: 99%

Evaluating the Implementation of the SWITCH® School Wellness Intervention Through Mixed Methods

et al. 2020

Preprint

Background: School wellness programming is important for promoting academic achievement and healthy lifestyles in youth; however, research is needed on methods that can help schools implement and sustain programs on their own. The purpose of this study was to investigate factors within and outside the school environment that impacted school capacity for implementation and potential sustainability of wellness programming. Methods: As part of the School Wellness Integration Targeting Child Health (SWITCH®) intervention, elementary school wellness teams (N=30) were guided through a capacity-building process focused on promoting the adoption of healthy lifestyle behaviors in students. Data on implementation were collected through three standardized surveys and interviews (pre-mid-post) and a post-implementation interview. Indicators of organizational capacity were assessed using the School Wellness Readiness Assessment (SWRA). Paired t-tests were run to assess changes in implementation (classroom, physical education, lunchroom settings), capacity, and stakeholder engagement over time. One-way analysis of variance (ANOVA) tests were run to examine how implementation of best practices (low, moderate, high) explained differences in capacity gains. Qualitative data were analyzed through inductive and deductive analysis, following the Consolidated Framework for Implementation Research (CFIR). Results: Paired t-tests showed non-significant increases in school and setting-specific capacity and implementation of SWITCH best practices over time, in addition to a consistent level of engagement from key stakeholders. ANOVA analyses revealed positive, non-significant variances between implementation group and gains in school capacity (F[2,24]=1.63; p=.21), class capacity (F[2,24]=0.20 p=.82), lunchroom capacity (F[2,24]=0.29; p=.78), and physical education (F[2,24]=1.45; p=.25). Qualitative data demonstrated factors within the outer setting (i.e., engaging community partners) that facilitated programming. Inner-setting factors (i.e., relationships with administration and staff) significantly affected implementation. Implementation process construct themes (e.g., planning, adaptation of resources to meet school capacity/needs, and engaging students as leaders) were cited as key facilitators. Schools discussed factors impacting sustainability, such school culture and knowledge of school wellness policy. Conclusions: Findings suggest a modest but important impact of implementation on capacity change which is the primary goal of SWITCH. The results document the importance of allowing schools to adapt programming to meet their local needs.Trial Registration: NCT04045288