Project Description: Dissemination and Implementation (D&I) science enables the translation of evidence to action, and measurement of implementation is essential to moving the needle on physical activity and health promotion. Unfortunately, those most at risk for physical inactivity live in low-income households and identify as part of a minoritised racial/ethnic population, and existing measurement tools do not adequately measure equitable implementation. From 2021-2023, we conducted a measurement development project funded by the Urban School Food Alliance (US) to understand how policies, such as those targeting nutrition and physical activity behaviors, are implemented at the school level. This study is the first to meaningfully integrate both implementation science and health equity frameworks and we sought to achieve content and face validity through seeking primarily end-user (i.e., student, parent) and implementer (teacher, staff administration) feedback with additional input from those working in policy and higher education sectors.

Impact: The result of this project is a series of survey tools that hold face and content validity to measure determinants (i.e., facilitators, barriers), processes (i.e., the action components), and outcomes (i.e., indicators of success) of policy implementation. These tools were then administered among a diverse, urban population in the United States to gather psychometric properties and enhance internal validity. We have also developed an adaptation guide, funded by the US National Cancer Institute (NCI), to allow researchers and practitioners to adapt and tailor these surveys to other populations and target behaviors.

Learning: Attendees will leave with a concrete understanding of how to assess whole-school physical activity policy approaches grounded in implementation science and health equity, reducing the need to “reinvent the wheel” for their evaluation. This will ultimately enhance the gap between policy and practice and ensure that those most at risk for inactivity are a central part of the implementation evaluation process.

Background: Global guidance is driving systems-thinking to the forefront of research, policy, and practice. To achieve this, we need to consider ‘how things work’ to ensure successful implementation. Use of the implementation research logic model (IRLM) as a contemporary tool to aid the planning, reporting, synthesising, executing and evaluation of the novel Creating Active Schools (CAS) programme is illustrated. Methods: A five-step iterative process, underpinned by the IRLM was undertaken to hypothesise and identify conceptual pathways between the CAS; (1) programme determinants, (2) programme components and actions, (3) implementation strategies, (4) mechanisms of action and, (5) outcomes. Throughout development, school-based and CAS stakeholders engaged in reviewing appropriate implementation theories, models and frameworks, terminology, and content. An in-depth CAS logic model was created to detail the CAS programme and underpinning mechanisms. Conclusions: This presentation will provide novel insights into how contemporary implementation tools can be applied and adapted to enhance the planning, reporting, synthesising, executing and evaluation of complex interventions and strategies. The CAS logic model provides a blueprint for future school-based interventions to develop evidence-based logic models and to increase the likelihood of acceptance, feasibility, and sustainability.

We used Implementation Mapping (IM) to develop an implementation strategy for physically active learning in elementary schools. IM is a systematic process that leverages partner input, theory, and empirical evidence to develop implementation strategies. The objectives of this presentation are to: 1) share how IM can enhance implementation planning efforts in schools, and 2) share lessons learned from working with two elementary schools in Houston, Texas, USA. We assembled a planning group consisting of researchers and educators to help guide our effort. We then carried out the IM steps: 1) specifying implementation roles, 2) identifying implementation outcomes, behaviors, and determinants; 3) choosing theoretical change methods, and 4) developing implementation strategy materials. Based on this process, we created a multifaceted implementation strategy that centered on training sessions and facilitation. The training and facilitation sessions leveraged multiple change methods (e.g., active learning, persuasive communication, modeling, and guided practice) to address determinants (e.g., knowledge, attitudes, skills/self-efficacy). We then created an IM-Logic Model to specify the mechanisms of action for reporting and evaluation. There were multiple lessons learned. First, we benefited from a strong planning group and learned about effective ways to engage our collaborators throughout the process. Second, we learned about the importance of addressing implementation roles and behaviors of school leaders and support staff. Specifically, we focused on helping school leaders and staff model physically active learning, identify champions, and reinforce teacher’s implementation success. Third, we learned the importance of tracking process-based outcomes, sharing results and obtaining feedback throughout the effort, and documenting the implementation strategy. Overall, IM provides a structured approach for developing implementation strategies. This approach leverages core processes for planning and provides a structured way for specifying and evaluating mechanisms of action. This is highly impactful for future efforts to scale-up physically active learning in elementary schools.

During my two decades as a teacher and leader of PE, schools worldwide have attempted to integrate strategies to enhance PA. However, in recent years a critical gap has emerged in understanding the complexity of PA within the school system. My doctoral research will address this gap in a Scottish context. Whilst attempts have been made to mobilise a whole school physical activity (WSPA) approach, I would argue that the rapid expansion has not yet been met with the rigour required when applying ‘system thinking’ methodology and tools. In turn this has meant that current ‘systems thinking’ approaches have failed to support researchers, policy makers and practitioners in increasing and sustaining PA levels at a population level. In response to this, my intended research programme advocates for, but also crucially critiques, the adoption of a ‘systems thinking’ approach to WSPA, where ‘systems thinking’ tools will be utilised to help in unravelling the complexity in school settings. I will adopt and develop system methodology and tools from recent successful system approaches in increasing PA in other contexts, for example, Early Learning Centres (ELC) in Scotland. Initial tools identified which may help in answering my research questions include participatory system mapping and the development of causal loop diagrams. The advantage of adopting such soft system tools is that they will allow for a shared understanding of the complexity of PA and school settings. Moreover, the study will develop, and test tools to ensure that they are tailored for educational practitioners, policymakers, and researchers to use in real world situations. In conclusion by developing and employing a rigorous system thinking lens, this research will contribute to a deeper understanding of the intricate relationships between stakeholders, resources, and environmental factors shaping the landscape of whole school physical activity.

Evaluating the implementation and scale-up of programmes in complex systems, with quality and consistency, requires the use of a comprehensive approach capable of assessing the concepts and constructs. This presentation aims to describe the use of two frameworks to assess the implementation of The Creating Active Schools (CAS) Programme. Methods: The Implementation Evaluation Roadmap and The Consolidated Framework for Implementation Research (CFIR) were used to evaluate the nine and 24-month implementation of CAS programme. Data was obtained through focus groups with school staff (n = 26) from 22 schools, CAS Champions (n = 5) and CAS Facilitators (n = 2), guided by CFIR. The analysis integrated both a data-driven, inductive approach employing codebook thematic analysis and a deductive approach informed by a priori themes derived from McKay et al.'s implementation evaluation roadmap. Thus, we aligned the key findings, across the five domains of CFIR: intervention characteristic, outer setting, inner setting, characteristics of individuals, and process. Results: We found the use of both frameworks complementary in terms of identifying concepts, constructs, and conditions of the implementation process. The use of the Implementation Evaluation Roadmap highlighted the characteristics of the progress of the implementation, such as acceptability, compatibility, dose satisfaction and sustainability. The use of CFIR indicated the exposures that influenced implementation. Impacts: The use of both frameworks provides a comprehensive approach to assess the implementation of a whole-school physical activity programme. The frameworks provide a common language in the physical activity area, which allows us to understand the implementation in a way that hasn’t been applied to whole-school physical activity before. This is particularly pertinent when working with complex systems.

This study uses the R=MC^2 organizational readiness framework by Scaccia et al., 2015 to understand how to successfully onboard CAS in northern England primary schools. The framework describes readiness ‘r’ as constituted of motivation, capacity, innovation-specific capacity, and their respective subcategories. To understand the CAS onboarding process within the context of this framework, school leaders were interviewed and asked to complete a card activity. The majority of the leaders were head teachers, but the data also includes two focus groups comprised of National CAS Champions, that is CAS leaders. For the activity, 18 cards were divided into three colors, based on motivation, capacity, and innovation-specific capacity, and labeled with their subcategory titles and definitions. Interviews were recorded by dictaphone, transcribed, and analyzed thematically by multiple coders. As of March 2024, analysis is still underway. It is hypothesized that physical and financial resources are important, but not paramount to onboarding CAS in schools. Successful onboarding with the eventual goal of long-term sustainability requires school leadership and staff to understand the primary purpose of CAS beyond traditional PE approaches. CAS is intended to provide children in deprived areas with opportunities for a better future.

The physical inactivity levels of adolescents are a complex worldwide problem. Whole-school programmes (WSP) are recommended to improve physical activity in school settings. The second-level Active School Flag (SLASF) programme in Ireland is a Department of Education initiative. Co-designed with adolescents, this WSP aims to make “more schools, more active, more often”. SLASF is implemented by a coordinator (staff member) and an ASF class (transition year students) and has three implementation stages. The aim of this study was to understand the implementation process of the first stage. Semi-structured focus group interviews (N=11) were conducted online with SLASF implementers (transition year students and coordinators) in stage 1 schools (n = 10). Focus group script development was guided by the Consolidated Framework for Implementation Research (CFIR), to understand the implementation process of stage 1. Once transcribed, the data were thematically analysed with student and coordinator data separately and combined under the five CFIR domains. Impact and learning: A total of 31 students and seven SLASF coordinators participated. In the student data, six themes and 33 subthemes were identified, seven themes and 28 subthemes were generated from the coordinator data. Findings describe i) factors influencing successful implementation of SLASF stage 1, themes were identified as barriers, facilitators and strategies for successful implementation and were mapped to one of the 5 domains of CFIR; ii) opportunities to improve supports for schools implementing SLASF stage 1 as suggested by implementers and; iii) the perceived impact of engagement for the school and programme implementers.

Purpose: To share findings from the ACTIVE SCHOOL pilot project in a Danish real-life schools context. The intervention Move & Learn, was grounded in embodied learning theories. This presentation addresses understanding, acceptability, and feasibility of the intervention among teachers through qualitative exploration. Methods: Four shools, 13 teachers and 119 students from 3rd grade, took part in the 8-week pilot study. The intervention consisted of a minimum of 30 minutes of daily embodied learning integrated into Danish or Math lessons, supported by implementation strategies (education, inspirational teaching materials and principles). A part of the exploration was conducted in close collaboration between researchers and intervention educators (from teacher/pedagogue education), to tailor the strategies as close to the school personnel as possible. Observations of teaching (n=6), group interviews with teachers (n=4), and evaluation meetings (n=2) with intervention educators were conducted. The analysis of observations was based on "Taxonomies of embodiment in education" (1). Interviews underwent thematic reflexive analysis (2), and meeting minutes served as foundation for adjustments of strategies (3). Results: Three core themes in the interviews were identified: Instant perception, Translation of intervention, and Context matters. These were linked to implementation determinants of Acceptability, Understanding, and Feasibility. Subthemes included a range of sense making issues for school personnel, revealing that both personal mindset, class composition, and approach to physically active learning are decisive when operationalizing embodied learning. Observations showed a broad comprehension of embodied learning quality in math and Danish. Meetings with intervention educators emphasized a shift towards practical application over theoretical understanding in courses. Impact: This study's outcomes informed the refinement of implementation strategies for the ACTIVE SCHOOL RCT study. The project set-up with a close collaboration between researchers and intervention educators fostered new insights to be disseminated in initial teacher training and in the RCT teacher courses.