Partnerships for Active Children in Elementary Schools (PACES): First year process evaluation

Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

BACKGROUND

A range of school-based interventions are effective in improving student diet and physical activity (e.g. school food policy interventions and classroom physical activity interventions), and reducing obesity, tobacco use and/or alcohol use (e.g. tobacco control programmes and alcohol education programmes). However, schools are frequently unsuccessful in implementing such evidence-based interventions.

OBJECTIVES

The primary review objective is to evaluate the effectiveness of strategies aiming to improve school implementation of interventions to address students' (aged 5 to 18 years) diet, physical activity, obesity, tobacco use and/or alcohol use. The secondary objectives are to: 1. determine whether the effects are different based on the characteristics of the intervention including school type and the health behaviour or risk factor targeted by the intervention; 2. describe any unintended consequences and adverse effects of strategies on schools, school staff or students; and 3. describe the cost or cost-effectiveness of strategies.

SEARCH METHODS

We searched CENTRAL, MEDLINE (Ovid), Embase (Ovid), five additional databases, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and the US National Institutes of Health registry (clinicaltrials.gov). The latest search was between 1 May 2021 and 30 June 2023 to identify any relevant trials published since the last published review.

SELECTION CRITERIA

We defined 'implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any randomised controlled trial (RCT) or cluster-RCT conducted on any scale, in a school setting, with a parallel control group that compared a strategy to improve the implementation of policies or practices to address diet, physical activity, obesity, tobacco use and/or alcohol use by students (aged 5 to 18 years) to no active implementation strategy (i.e. no intervention, inclusive of usual practice, minimal support) or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary outcome using a decision hierarchy (i.e. continuous over dichotomous, most valid, total score over subscore). Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model. Where we could not combine data in meta-analysis, we followed recommended Cochrane methods and reported results in accordance with 'Synthesis without meta-analysis' (SWiM) guidelines. We conducted assessments of risk of bias and evaluated the certainty of evidence (GRADE approach) using Cochrane procedures.

MAIN RESULTS

We included an additional 14 trials in this update, bringing the total number of included trials in the review to 39 trials with 83 trial arms and 6489 participants. Of these, the majority were conducted in Australia and the USA (n = 15 each). Nine were RCTs and 30 were cluster-RCTs. Twelve trials tested strategies to implement healthy eating practices; 17 physical activity, two tobacco, one alcohol, and seven a combination of risk factors. All trials used multiple implementation strategies, the most common being educational materials, educational meetings, and education outreach visits, or academic detailing. Of the 39 included trials, we judged 26 as having high risks of bias, 11 as having some concerns, and two as having low risk of bias across all domains. Pooled analyses found, relative to a control (no active implementation strategy), the use of implementation strategies probably results in a large increase in the implementation of interventions in schools (SMD 0.95, 95% CI 0.71, 1.19; I2 = 78%; 30 trials, 4912 participants; moderate-certainty evidence). This is equivalent to a 0.76 increase in the implementation of seven physical activity intervention components when the SMD is re-expressed using an implementation measure from a selected included trial. Subgroup analyses by school type and targeted health behaviour or risk factor did not identify any differential effects, and only one study was included that was implemented at scale. Compared to a control (no active implementation strategy), no unintended consequences or adverse effects of interventions were identified in the 11 trials that reported assessing them (1595 participants; moderate-certainty evidence). Nine trials compared costs between groups with and without an implementation strategy and the results of these comparisons were mixed (2136 participants; low-certainty evidence). A lack of consistent terminology describing implementation strategies was an important limitation of the review.

AUTHORS' CONCLUSIONS

We found the use of implementation strategies probably results in large increases in implementation of interventions targeting healthy eating, physical activity, tobacco and/or alcohol use. While the effectiveness of individual implementation strategies could not be determined, such examination will likely be possible in future updates as data from new trials can be synthesised. Such research will further guide efforts to facilitate the translation of evidence into practice in this setting. The review will be maintained as a living systematic review.

Exploring teachers' perspectives on movement integration using a job-embedded professional development intervention

PURPOSE

The purpose of this study was to gain teachers' insight and evaluate a teacher training intervention on movement integration (MI).

METHODS

An embedded mixed methods study was used to combine post-intervention qualitative and quantitative data from 12 teachers.

RESULTS

Four themes were generated: employable strategies, increased student engagement, value of additional support, and space, time, and behaviour management. These themes illustrate the intrapersonal, institutional, and public policy barriers that impact MI implementation.

CONCLUSION

An evidence-based teacher MI implementation intervention that utilizes best practices can address intrapersonal barriers to MI use but does not alleviate institutional and public policy barriers.

International students’ study-related burnout: Associations with perceptions of the teaching-learning environment and approaches to learning

International students study in new, unfamiliar teaching-learning environments (TLEs) and may thus experience study-related burnout. However, little research exists on the relationship between perceptions of the TLE and such burnout, especially among international students. Nevertheless, one key factor is thought to be students’ approaches to learning. This study investigated the relationship between international students’ perceptions of the TLE, approaches to learning and study-related burnout and how these approaches mediate the relationship between perceptions of the TLE and burnout. The data were collected among international students (n = 162) in a research-intensive Scandinavian university and analyzed using confirmatory factor analyses and structural equation modelling. The results indicated that international students’ study-related burnout correlated negatively with perceptions of the TLE (alignment, interest and relevance, constructive feedback and peer support). Their study-related burnout was positively related to the unreflective approach to learning and negatively related to the deep approach to learning and organized studying. The study proved that approaches to learning acted as mediators between perceptions of the TLE and study-related burnout. The findings indicated that how the dimensions of study-related burnout were affected by different constructs of perceptions of the TLE and approaches to learning among international students. Based on these findings, the study provides implications for improving teaching. Future research should focus on the relationship between the deep approach to learning and exhaustion and how peer support affects study-related burnout.

Association of Physical Educators' Socialization Experiences and Confidence with Respect to Comprehensive School Physical Activity Program Implementation

Comprehensive school physical activity programs (CSPAPs) are recommended to support physical education (PE) and increase the amount of physical activity (PA) youth receive each day. However, adoption of CSPAPs in the United States is low. PE teachers are well positioned to lead the implementation of CSPAPs, but research is needed to better understand (a) PE teachers' confidence to assume the multiple roles involved with CSPAP implementation and (b) the factors that are associated with such confidence. This study examined PE teachers' role breadth self-efficacy (RBSE) as a measure of PE teachers' CSPAP-related confidence and its association with seminal life experiences as framed within teacher socialization theory. A survey was emailed to a stratified-random sample of 2976 PE teachers and distributed on social media, garnering a total of 259 responses. Exploratory structural equation modeling supported a three-factor solution for teacher socialization variables (acculturation, professional socialization and organizational socialization), in line with the theoretical framework, and a single factor solution for RBSE. Professional socialization and organizational socialization were significant predictors of RBSE, and qualitative data from open-ended survey questions supported these relationships. The results highlight the importance of preservice teacher education and current employment contexts in PE teachers' CSPAP-related confidence.

Strategies for enhancing the implementation of school-based policies or practices targeting diet, physical activity, obesity, tobacco or alcohol use

BACKGROUND

Several school-based interventions are effective in improving child diet and physical activity, and preventing excessive weight gain, and tobacco or harmful alcohol use. However, schools are frequently unsuccessful in implementing such evidence-based interventions.

OBJECTIVES

1. To evaluate the benefits and harms of strategies aiming to improve school implementation of interventions to address student diet, physical activity, tobacco or alcohol use, and obesity. 2. To evaluate the benefits and harms of strategies to improve intervention implementation on measures of student diet, physical activity, obesity, tobacco use or alcohol use; describe their cost or cost-effectiveness; and any harms of strategies on schools, school staff or students.

SEARCH METHODS

We used standard, extensive Cochrane search methods. The latest search was between 1 September 2016 and 30 April 2021 to identify any relevant trials published since the last published review.

SELECTION CRITERIA

We defined 'Implementation' as the use of strategies to adopt and integrate evidence-based health interventions and to change practice patterns within specific settings. We included any trial (randomised controlled trial (RCT) or non-randomised controlled trial (non-RCT)) conducted at any scale, with a parallel control group that compared a strategy to implement policies or practices to address diet, physical activity, overweight or obesity, tobacco or alcohol use by students to 'no intervention', 'usual' practice or a different implementation strategy.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Given the large number of outcomes reported, we selected and included the effects of a single outcome measure for each trial for the primary (implementation) and secondary (student health behaviour and obesity) outcomes using a decision hierarchy. Where possible, we calculated standardised mean differences (SMDs) to account for variable outcome measures with 95% confidence intervals (CI). For RCTs, we conducted meta-analyses of primary and secondary outcomes using a random-effects model, or in instances where there were between two and five studies, a fixed-effect model. The synthesis of the effects for non-randomised studies followed the 'Synthesis without meta-analysis' (SWiM) guidelines.

MAIN RESULTS

We included an additional 11 trials in this update bringing the total number of included studies in the review to 38. Of these, 22 were conducted in the USA. Twenty-six studies used RCT designs. Seventeen trials tested strategies to implement healthy eating, 12 physical activity and six a combination of risk factors. Just one trial sought to increase the implementation of interventions to delay initiation or reduce the consumption of alcohol. All trials used multiple implementation strategies, the most common being educational materials, educational outreach and educational meetings. The overall certainty of evidence was low and ranged from very low to moderate for secondary review outcomes. Pooled analyses of RCTs found, relative to a control, the use of implementation strategies may result in a large increase in the implementation of interventions in schools (SMD 1.04, 95% CI 0.74 to 1.34; 22 RCTs, 1917 participants; low-certainty evidence). For secondary outcomes we found, relative to control, the use of implementation strategies to support intervention implementation may result in a slight improvement on measures of student diet (SMD 0.08, 95% CI 0.02 to 0.15; 11 RCTs, 16,649 participants; low-certainty evidence) and physical activity (SMD 0.09, 95% CI -0.02 to 0.19; 9 RCTs, 16,389 participants; low-certainty evidence). The effects on obesity probably suggest little to no difference (SMD -0.02, 95% CI -0.05 to 0.02; 8 RCTs, 18,618 participants; moderate-certainty evidence). The effects on tobacco use are very uncertain (SMD -0.03, 95% CIs -0.23 to 0.18; 3 RCTs, 3635 participants; very low-certainty evidence). One RCT assessed measures of student alcohol use and found strategies to support implementation may result in a slight increase in use (odds ratio 1.10, 95% CI 0.77 to 1.56; P = 0.60; 2105 participants). Few trials reported the economic evaluations of implementation strategies, the methods of which were heterogeneous and evidence graded as very uncertain. A lack of consistent terminology describing implementation strategies was an important limitation of the review.

AUTHORS' CONCLUSIONS

The use of implementation strategies may result in large increases in implementation of interventions, and slight improvements in measures of student diet, and physical activity. Further research is required to assess the impact of implementation strategies on such behavioural- and obesity-related outcomes, including on measures of alcohol use, where the findings of one trial suggest it may slightly increase student risk. Given the low certainty of the available evidence for most measures further research is required to guide efforts to facilitate the translation of evidence into practice in this setting.

Health and Academic Performance With Happy Children: A Controlled Longitudinal Study Based on the HOPP Project

Background

Overweight/obesity in children and adolescents, largely arising due to increased food intake and reduced physical activity, is a major health concern. Physical activity (PA) integrated into learning has been shown to not only lead to improved health outcomes and wellbeing but also positively affect academic performance. The Health and Academic Performance with Happy Children (HAPHC) project aims at enhancing health and academic performance in elementary school children via implementation of a daily unit of Physical Activity Across the Curriculum (PAAC), which is carried out within the school setting. In this project, PA as an integrated part of learning will be evaluated and the learning material adapted for a large scale implementation across several European countries.

Methods

In three European countries (Austria, Slovenia, and Belgium), 12 primary schools in total will be recruited to act as either intervention or control school in a large intervention study, which applies the PAAC pedagogy during lectures. It is estimated that, at least 3,000+ children across the three countries will be recruited in this study. All teachers of intervention schools will receive training and materials/teaching equipment that will allow them to integrate a daily PA unit of 45 min over 3 years across the curriculum. In response to the daily PA intervention, the following primary outcomes will be assessed: changes in health related physiological factors, academic achievement, psycho-social aspects and wellbeing.

Impact of Project

The HAPHC project aims at promoting public health by increasing PA at an early age within the school setting and therewith preventing the increasing risk of non-communicable diseases across Europe. HAPHC project aims to develop knowledge and materials, which will ensure that the PAAC can be scalable to other European countries.

Trial Registration Number

ClinicalTrials.gov, identifier: NCT04956003.

Two-Year Effectiveness of a Controlled Trial With Physically Active Lessons on Behavioral Indicators of School Children

Purpose: In this study, we evaluated the effectiveness of two years of an intervention with physically active lessons on indicators of sedentary behavior and physical activity measured objectively in elementary school children. Methods: A controlled clinical trial with cluster sampling was carried out in 2018 and 2019, with four classes of children in the 2nd year of elementary school. The intervention group classes received dynamic activities linked to the pedagogical content (n = 34) for 2 years. The indicators of sedentary behavior and physical activities were evaluated using ActivPal and ActiGraph GT3X accelerometers during the school shift. Crude and adjusted models of Generalized Estimation Equations with Bonferroni's post hoc were used to identify the differences between the groups (three evaluations in 2018 and two evaluations in 2019). Results: There was a reduction in stationary behavior (p = .01) and an increase in light physical activity (p = .044) during the two years. In the first year there were reductions in standing time (p = .044) and number of transitions (p ≤ .001), and an increase in walking time (p = .017). However, in the second year, the mean differences in percentage points were smaller than in the first year. No differences were found for sitting time as well as for moderate and vigorous physical activity. We observed a large effect size for all variables. Conclusions: The introduction of physically active lessons in the classroom reduced time in stationary behavior and increased time in light physical activity. However, the effects on behavior observed in the first year were not maintained in the second year of intervention.

Are Physically Active Breaks in School-Aged Children Performed Outdoors? A Systematic Review

(1) Background: Children spend an ever-increasing amount of time performing sedentary behaviors, and an important part of their daily life is at school. Learning in an outdoor environment improves children’s physical activity levels, and their cognitive and social spheres. Furthermore, physically active breaks are a solution to reduce sedentary behaviors and improve well-being and academic performance. The study evaluated the published literature on physically active breaks during school hours and explored (a) if the interventions were proposed in an outdoor context and (b) the outcomes of these interventions. (2) Methods: This review collected 31,559 articles from different electronic databases. After the screening, the results were analyzed narratively. (3) Results: 41 studies have been included in the analysis. As reported by the results, most of the interventions took place in the classroom, and only three studies were performed outside. A common aspect of all studies is the feasibility of active breaks, assessing positive outcomes. (4) Conclusions: Physically active outdoor breaks are poorly adopted, highlighting the necessity for deeper study on this topic. Although the protocols considered present differences, generally breaks increase physical activity levels, present positive learning outcomes, and improve social well-being. Furthermore, they are sustainable in terms of time, cost, and effort of the teacher.

Does Learning Through Movement Improve Academic Performance in Primary Schoolchildren? A Systematic Review

Physically active children have greater motor competence and a faster maturation compared with their sedentary peers. Recent research also suggests that physical activity during childhood may also promote cognitive development and therefore improve academic performance. The aim of this study was to understand if physically active academic lessons may improve academic achievement in primary schoolchildren. A systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. The search was performed on the following database: PubMed, Web of Science, Scopus, Education Resources Information Center (ERIC), and PsycINFO (APA). Studies evaluating schoolchildren aged between 3 and 11 years taking part in educational contexts that include physical activity and natural environments evaluating physical fitness and/or educational outcomes were included. A total of 54 studies (for a total sample of 29,460 schoolchildren) were considered eligible and included in the qualitative synthesis. The Effective Public Health Practice Project risk-of-bias assessment revealed a moderate quality of the included studies with only two considered weeks. Despite differences in the retrieved protocols, physically active academic lessons improve the total time engaged in physical activity, motor skills, and/or academic performance. The results of this review suggest that learning through movement is an effective, low-cost, and enjoyable strategy for elementary schoolchildren.

Behaviours that prompt primary school teachers to adopt and implement physically active learning: a meta synthesis of qualitative evidence

BACKGROUND

Physically active learning (PAL) - integration of movement within delivery of academic content - is a core component of many whole-of-school physical activity approaches. Yet, PAL intervention methods and strategies vary and frequently are not sustained beyond formal programmes. To improve PAL training, a more comprehensive understanding of the behavioural and psychological processes that influence teachers' adoption and implementation of PAL is required. To address this, we conducted a meta-synthesis to synthesise key stakeholders' knowledge of facilitators and barriers to teachers' implementing PAL in schools to improve teacher-focussed PAL interventions in primary (elementary) schools.

METHODOLOGY

We conducted a meta-synthesis using a five-stage thematic synthesis approach to; develop a research purpose and aim, identify relevant articles, appraise studies for quality, develop descriptive themes and interpret and synthesise the literature. In the final stage, 14 domains from the Theoretical Domain Framework (TDF) were then aligned to the final analytical themes and subthemes.

RESULTS

We identified seven themes and 31 sub-themes from 25 eligible papers. Four themes summarised teacher-level factors: PAL benefits, teachers' beliefs about own capabilities, PAL teacher training, PAL delivery. One theme encompassed teacher and school-level factors: resources. Two themes reflected school and external factors that influence teachers' PAL behaviour: whole-school approach, external factors. Ten (of 14) TDF domains aligned with main themes and sub-themes: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, Beliefs about Consequences, Reinforcement, Goals, Environmental Context and Resources, Social influences and Emotion.

CONCLUSIONS

Our synthesis illustrates the inherent complexity required to change and sustain teachers' PAL behaviours. Initially, teachers must receive the training, resources and support to develop the capability to implement and adapt PAL. The PAL training programme should progress as teachers' build their experience and capability; content should be 'refreshed' and become more challenging over time. Subsequently, it is imperative to engage all levels of the school community for PAL to be fully integrated into a broader school system. Adequate resources, strong leadership and governance, an engaged activated community and political will are necessary to achieve this, and may not currently exist in most schools.

Self-Regulations for Educators Questionnaire (SREQ) for implementation programming

The adoption and dissemination of evidence-based programs is predicated on multiple factors, including the degree to which key stakeholders are motivated to implement program best practices. The present study focuses on the development of indicators that capture motivations of teachers to adopt school wellness programming since personal motivations are central to achieving sustainable impacts in these settings. The study specifically describes the measurement development and validation of the Self-Regulations for Educators Questionnaire (SREQ), designed to measure educators’ autonomous and controlled motivation for adopting evidence-based programming in their schools. A naturalistic design to study motivation to adopt aspects of NFL PLAY60 programming through the NFL PLAY60 FitnessGram Partnership Project was used. A total of 1,106 teachers completed the SREQ online. Internal validity was assessed through exploratory and confirmatory factor analysis, and predictive validity using structural equation modeling (SEM). The results supported the two-factor solution with separate items capturing aspects of autonomous and controlled motivation. Both factors had good internal reliability and the item-total correlation coefficients were above 0.40 for both factors. The results also supported the predictive validity as autonomous motivation positively predicted the level of overall engagement, teaching effectiveness, fitness testing reports sent home, and completion of fitness testing with students (p < .05). Controlled motivation positively predicted whether the teachers conducted fitness testing and the engagement of Play 60 Challenge (p < .05). Findings suggest that the SREQ displays a number of psychometric characteristics that make the instrument useful for examining motivation of providers to implement evidence-based best practices.

Improving implementation of school-based healthy eating and physical activity policies, practices, and programs: a systematic review

Although best practice recommendations exist regarding school-based healthy eating and physical activity policies, practices, and programs, research indicates that implementation is poor. As the field of implementation science is rapidly evolving, an update of the recent review of strategies to improve the implementation of healthy eating and physical activity interventions in schools published in the Cochrane Library in 2017 was required. The primary aim of this review was to examine the effectiveness of strategies that aim to improve the implementation of school-based policies, practices, or programs to address child diet, physical activity, or obesity. A systematic review of articles published between August 31, 2016 and April 10, 2019 utilizing Cochrane methodology was conducted. In addition to the 22 studies included in the original review, eight further studies were identified as eligible. The 30 studies sought to improve the implementation of healthy eating (n = 16), physical activity (n = 11), or both healthy eating and physical activity (n = 3). The narrative synthesis indicated that effect sizes of strategies to improve implementation were highly variable across studies. For example, among 10 studies reporting the proportion of schools implementing a targeted policy, practice, or program versus a minimal or usual practice control, the median unadjusted effect size was 16.2%, ranging from -0.2% to 66.6%. Findings provide some evidence to support the effectiveness of strategies in enhancing the nutritional quality of foods served at schools, the implementation of canteen policies, and the time scheduled for physical education.

Facilitators and Barriers to Movement Integration in Elementary Classrooms: A Systematic Review

PURPOSE

A systematic review was conducted to identify facilitators and barriers to movement integration (MI) in elementary school classrooms.

METHOD

Online databases (Educational Resources Information Center, Google Scholar, PsycINFO, and PubMed) served as data sources for the study. Following the PRISMA guidelines, relevant published research on MI was identified and screened for inclusion in a qualitative synthesis. Content analysis of the included articles (N = 28) was used to identify themes of MI facilitators and barriers. Facilitators and barriers were then categorized using a social-ecological framework.

RESULTS

A total of 12 themes of MI facilitators and barriers were identified and categorized into two social-ecological levels: institutional factors (e.g., administrative support, resources) and intrapersonal factors (e.g., teacher confidence, ease of implementation).

CONCLUSION

This review can inform research and practice aimed at supporting the implementation of MI in elementary classrooms.

Systematically Observed Movement Integration in a Low Socioeconomic School District: A Cross-Sectional, Observational Study

PURPOSE

To describe teacher's integration of activity into general education classroom time (ie, movement integration-MI).

DESIGN

Cross-sectional, observational.

SETTING

Eight elementary schools in a rural, low-income school district.

PARTICIPANTS

Elementary classroom teachers (N = 48).

MEASURE

Classroom teachers were observed using the System for Observing Student Movement in Academic Routines and Transitions (SOSMART) on random, unannounced days during the 2015-16 academic year.

ANALYSIS

Descriptive statistics were calculated for the frequency and types of MI being used.

RESULTS

Of the 9398 SOSMART scans completed, students engaged in movement in 41.3% of the scans. Student movement was observed to be teacher directed in 14.4% and nonteacher directed in 26.9% of scans. Nonteacher-directed movement consisted mostly of transitions ( M = 99.5%) in which movement occurred as a result of preestablished classroom rules, protocols, and organization.

CONCLUSION

This is one of the first studies to provide objective information about MI. These descriptive data lay the groundwork for future correlational and experimental research that can lead to the development of effective intervention design to increase MI use in schools.

Understanding the Multidimensional Nature of Student Engagement During the First Year of Higher Education

In the description of the complex relationship between individual students and their education context, as well as understanding of questions related to progression, retention or dropouts in higher education, student engagement is considered the primary construct. In particular, the significance of the first year of higher education in terms of engagement is decisive. We aim at developing a multidimensional conceptualization of engagement and utilized network analysis. Data were collected as part of the annual Student Barometer survey in Finland during the 2012-2013 academic year, and we gathered a nationally representative sample (n = 2422) of first-year students in different disciplines at 13 Finnish universities. Network analysis confirmed the multidimensional process model of engagement and its six dimensions. The central dimensions of engagement are identity and sense of belonging, which develop in the interplay between individual and collective dimensions as a long-term process. Additional network analyses with covariates identified positive and negative factors that affect engagement. The study adds new perspectives to existing knowledge of engagement. It is important to understand the process-like nature of engagement and make visible factors affecting the process. Based on these findings, we provide novel practical recommendations for interventions for university students who struggle with engagement during their first year.

Case study of a health optimizing physical education-based comprehensive school physical activity program

In this article, we report a qualitative case study, in which we examined enablers and barriers related to the development, implementation, and sustainability of a comprehensive school physical activity program (CSPAP) aligned with the Health Optimizing Physical Education (HOPE) curriculum model at a middle school. Literature on program-diffusion and school-university partnerships guided data collection and analysis. Data sources included semi-structured interviews with the program implementation team (n = 9) and the school's health and physical education teachers (n = 7); a focus group interview with students; documents (e.g., lesson plans), and observations. Constant comparison techniques were used to code and draw out themes from the data. Findings revealed the extensive effort needed for program implementation and highlighted the importance of strong external support mechanisms, conducting needs assessments, and training teachers to market physical activity programming. Partnerships may provide critical support for schools in their efforts to generate and sustain CSPAPs.